Screening for refractive error among primary school children in Bayelsa State, Nigeria

Visual impairments amongst preschool and school attendees: A scoping review of vision school screening in Nigeria and Kenya

Background: The United Nations Convention on the Rights of the Child emphasises the importance of quality education and good health. Vision problems affect the academic performance of schoolchildren in developing and under-resourced countries. The most prevalent vision problem amongst children is uncorrected refractive errors (URE).Aim: To gain knowledge about vision problems and visual impairments (VI) through school vision screening amongst children in Kenya and Nigeria.Method: A scoping review of online databases (Web of Science and PubMed) and one African registry (African Journals Online) for articles from January 2011 until April 2021 was conducted. The authors included 26 articles of the 439 screened.Results: The literature revealed inconsistencies in how VI was defined. The main cause of vision problems is URE. Furthermore, there is a lack of systematic school vision screening tools and programmes.Conclusion: Efficient eye care services to schoolchildren aged 3–18 years in Kenya and Nigeria must involve multiple disciplinary interventions and governmental responsibility. Collaboration models between public and private health sectors, nongovernmental organisations and families are necessary to prevent VI amongst children. Better vision enhances school performance.

Demographic characteristics and ocular needs of children attending child eye clinics in Cross River State, Nigeria: a retrospective analysis of clinical records

OBJECTIVES

To describe the demographic characteristics and ocular needs of children attending four child eye clinics in Cross River State, Nigeria, to inform the development of a sustainable spectacle cross-subsidisation scheme.

DESIGN

Retrospective analysis of clinic records.

SETTING

Four child eye clinics in Calabar, Ogoja, Ikom and Ugep, Cross River State, Nigeria, from 1 May 2017 to 30 June 2019.

PARTICIPANTS

Children who failed the vision screening in schools and visited assigned child eye clinics, and self-referred children from the community.

MAIN OUTCOME MEASURES

Children's age, sex, residence, diagnosis, disease management, presenting and corrected visual acuity, history of spectacle wear and magnitude of refractive errors in spherical equivalent in the worse eye.

RESULTS

Of all the 3799 records reviewed, data were available for 3774 children (mean age 10.6±4.35 years; 61.6% girls; 69.1% from urban settings); 30.8% (n=1162) of them had vision impairment. Of those children, 71.2% (n=827) were diagnosed with refractive error. For management, 48.6% (n=1833) were prescribed spectacles and 40.5% (n=1527) were prescribed ocular medications. Children prescribed spectacles were significantly more likely to be girls (68.0%, p<0.001), and older than 13 years of age (53.6%, p<0.001). The most common range of spherical equivalent (in the worse eye) was <-0.50 DS to +1.75 DS (51.6%, n=945), followed by >-0.25 DS to -3.00DS (39.7%, n=727). Non-refractive eye conditions such as cataract (33.3%) and corneal disorders (14.1%) contributed to almost half of the total blindness.

CONCLUSION

The findings show that spectacles provisions and ocular medications are the primary and secondary needs for children who attended child eye clinics seeking eye care services. Further research is needed to understand parents' willingness to pay for spectacles to set strategic multitier pricing for a sustainable cross-subsidisation scheme.

A cross-sectional analysis of refractive error prevalence and associated factors among elementary school children in Hawassa, Ethiopia

Objective

This study assessed the prevalence of refractive error (RE) and its associated factors among elementary school children in Hawassa, Ethiopia.

Methods

In this school-based cross-sectional study, a random selection technique with proportional allocation was used to ensure a representative sample of students. Survey questionnaires were used to collect sociodemographic, environmental, and family history data. Clinical examinations were performed to assess RE and ocular health. Associations between dependent and independent variables were computed using adjusted odds ratios (AORs) and 95% confidence intervals (CIs).

Results

Overall, 529 children participated in this study, with a response rate of 95.5% (529/554). Most participants were aged ≥12 years (337 [63.7%]), in grade levels 5 to 8 (307 [58%]), and attended public schools (366 [69.2%]). RE prevalence was 12.9% (95% CI: 10.0–16.1). Higher grade level (AOR=3.18, 95% CI: 1.68–5.97), positive family history of RE (AOR=3.69, 95% CI: 1.57–8.67), lack of paternal formal education (AOR=3.25, 95% CI: 1.20–8.77), and public school attendance (AOR=3.33, 95% CI: 1.52–7.27) were factors significantly associated with RE.

Conclusions

RE prevalence among elementary school children in Hawassa was higher than in previous reports. Grade level, family history, paternal education level, and school type significantly influenced RE status.

Ocular Disorders among Preschool Children in Southwest Nigeria

PURPOSE

The aim of the study was to determine the prevalence and causes of ocular disorders among preschool children.

METHODS

A multi-stage random sampling technique was used to select 560 children from a total of 9944 children aged 3-5 years attending nursery schools in the study area. Demographic and other relevant data were collected from the children. They underwent full ophthalmic evaluation including anterior and posterior segment examination as well as cycloplegic autorefraction.

RESULTS

Out of the 560 children screened, 170 (30.3%) were 3 years old, 183 (32.7%) were 4 years old, while the remaining 207 (37.0%) were 5 years old. Male-to-female ratio was 1:1.1. Visual acuity was testable using Lea symbol chart in 90% of the children. Ocular disorders were found in 61 eyes of 35 children giving a prevalence of 6.3%. The most common ocular disorder among participants was refractive error (3.9%), followed by allergic conjunctivitis (1.3%). Other identified ocular disorders were strabismus (0.9%), congenital cataract (0.4%), congenital ptosis (0.4%), optic atrophy (0.4%), ectopia lentis (0.2%), and phthisis bulbi (0.2%). There was no statistically significant difference in the distribution of ocular disorders by age or gender.

CONCLUSION

Screening is useful in early detection and treatment of ocular disorders in preschool children. Uncorrected refractive error which was identified as the major ocular disorder in these children is treatable. Periodic preschool vision screening would reduce the burden of uncorrected refractive error and other ocular disorders which can interfere with the learning skills of young children entering school.

Prevalence and causes of visual impairment among hearing impaired students in Lagos, Nigeria

OBJECTIVES

To determine the prevalence and causes of visual impairment in hearing-impaired students in Lagos, Nigeria and to assess their level of ophthalmic care utilization.

METHODS

Descriptive cross sectional study carried out in a primary school for hearing impaired students in Lagos, Nigeria. Socio-demographic characteristics, medical and ocular history were obtained. Ocular examination comprised of distance and near visual acuity assessment; cover tests; anterior segment examination and direct fundoscopy. Visually impaired students had cycloplegic refraction, dilated fundoscopy and subjective refraction. In-depth interviews were carried out for parents of students requiring referral for further eye care.

RESULTS

One hundred and nine students participated in the study. The prevalence of visual impairment was 19%. The causes of visual impairment were refractive error (11%), amblyopia (6%), cataract (1%) and macular scarring (1%). A lower mean age (p = 0.020) and ocular misalignment (p = 0.037) were associated with visual impairment on multivariate analysis. The spectacle correction coverage was 11% and only 8% of the students had prior ophthalmic care utilization. Ignorance of ocular morbidity and perceived inaccessibility of eye care were cited by parents/guardians as reasons for poor utilization of eye-care services.

CONCLUSION

A high prevalence of visual impairment was found among the hearing impaired students; uncorrected refractive error and refractive amblyopia were the most prevalent causes. The level of prior ophthalmic service utilization was found to be low. It was recommended that ophthalmic services especially refractive services should be made available in schools for the hearing impaired.

Visual impairment and associated factors among primary school children in Gurage Zone, Southern Ethiopia

Background

Visual impairment is one of the major public health problems worldwide, especially in developing countries.

Objective

To determine the prevalence of visual impairment and its associated factors among school children in Gurage Zone, Southern Ethiopia

Methods

A cross sectional study was conducted in eight primary schools of Gurage Zone. A total of 1064 pupils, of whom589 boys and 475 girls were selected using multistage sampling technique. Socio-demographic characteristics of the participants were collected using structured questionnaires and visual acuity was measured using Snellen's chart. Logistic regression analysis was used to determine the associated factors of visual impairment.

Results

The prevalence of visual impairment was 5.2%. Factors significantly associated with visual impairment were age group of 13–18 years (AOR = 9.44, 95% CI = 3.83 – 23.25), school grade level of 5- 8 (AOR = 2.97, 95% CI = 1.23 – 7.17), rural residents (AOR = 2.59, 95% CI = 1.22 – 5.54), family's monthly income of less than 2000 Ethiopian Birr (AOR = 2.87, 95% CI = 1.08 – 7.61) and visually impaired parents (AOR = 2.16, 95% CI = 1.06 – 4.39).

Conclusion

This study found that the prevalence of visual impairment was 5.2%.

Prevalence of vision impairment and refractive error in school learners in Calabar, Nigeria

Background: Uncorrected refractive error could negatively affect learning and academic performance, there is still inadequate information for planning school health.Aim: To determine the proportion of students with vision impairment because of uncorrected refractive error, and prevalent types among learners aged 10–18 years.Setting: The study site included two of 18 local government areas of the Cross River State in Nigeria, with 23 public and mission secondary schools.Methods: A two-stage cluster sampling method was used to enrol 4241 study participants from eight selected secondary schools.Results: The prevalence of vision impairment (presenting visual acuity worse than 6/12) was 7.9% (95% confidence interval [CI]: 7.17% – 8.6%). The prevalence of vision impairment because of refractive error was 7.2% (95% CI: 6.41% – 7.96%) in the better eye. Astigmatism was the predominant type of refractive error with a prevalence of 4.2% (95% CI: 3.6% – 4.8%), followed by myopia (1.72%; 95% CI: 1.3% – 2.1%) and hyperopia (1.3%; 95% CI: 0.9% – 1.6%). There were statistically significant differences in proportions of female participants who presented with myopic astigmatism (30.8%; p 0.012). Statistically significant difference in proportions was found in older (33.3%; p 0.0004) and male (29.6%; p 0.0003) participants who presented with hyperopic astigmatism compared to younger and female participants, respectively. Myopia accounted for 4.8% (95% CI: 4.2% – 5.5%) and was significantly higher in female participants (5.5%; p 0.033).Conclusion: Refractive error was the major cause of vision impairment and myopic astigmatism was the predominant type of refractive error among secondary school children in Calabar.

Comparison between focometer and autorefractor in the measurement of refractive error among students in underserved community of sub-Saharan Africa

PurposeTo compare focometer and autorefractor in the measurement of refractive errors among students in an underserved community of sub-Saharan Africa.MethodsThe study was a descriptive comparative cross-sectional study conducted in October/November 2014 among secondary school students of Ijaiye-Orile, Oyo State, Nigeria. Students were selected using systematic random sampling method. Ocular examination and measurement of refractive error was carried out on each student using a focometer and an autorefractor.ResultsA total of 230 students were studied. Mean age of the students was 15.1±1.9 years with a range of 13-21 years. Refractive error was detected in 95 (41.3%) of the students using autorefractor and in 81 (35.2%) with focometer. Among those found to have refractive error using autorefractor, 75 (78.9%) students had a difference of ≤±0.75 DS between the autorefractor and focometer readings. The sensitivity and specificity of the focometer relative to the autorefractor was 73.7% and 91.9%, respectively.ConclusionThe focometer is comparable to the autorefractor in the measurement of refractive error because of its high sensitivity and specificity. The high positive and negative predictive values makes the focometer an effective tool for both screening and diagnosis of refractive error in rural areas among secondary schools students. Its use would make refractive service available and affordable to individuals living in the resource poor rural communities thereby reducing the burden of refractive error in such areas. The focometer should also be a useful tool in school eye health programs.