Spectacle design preferences among school children in Enugu State, Nigeria

Background

Uncorrected refractive error has profound effects on children's educational and social development and spectacles are cost-effective in correcting this. However, the cosmetic appearance of spectacles may affect compliance to prescribed spectacles.

Aims

This study explored spectacle design preferences of school children in Enugu State, Nigeria and any associated sociodemographic factors. A cross-sectional study among children aged 5-15 years from schools in Enugu state, Nigeria.

Patients and Methods

The children independently selected from sets of spectacle frames, indicating their preferences on the basis of spectacle frame color, material, shape and size of the lens portion, design of the earpiece portions. Simple descriptive analysis was performed. Frequency tables were generated. Pearson's Chi-square test was used to test associations between categorical variables. Odds ratios were used to measure the strength of the associations where P < 0.05. Tests of significance were set at the 95% level.

Results

A total of 1,167 children (45.6% male and 54.4% female) were seen. Majority of the children preferred red colored spectacle frames 467 (40%), plastic frames 723 (62%), rectangular shaped lens-pieces (55.2%), and frames with a straight earpiece 987 (84.6%). There is a strong association between gender and choice of spectacle colour (P < 0.01), gender and lens size preference (P < 0.05), and between school location and shapes of spectacle earpiece (P < 0.01).

Conclusions

Spectacle preferences exist among the study population and some demographic factors are associated with these preferences which should be considered in any childhood refractive error services.

Prevalence of refractive errors and visual impairment in school children in Enugu South-East Nigeria

Aims

To determine the prevalence of refractive errors and causes of visual impairment in school children in Enugu State, South-eastern Nigeria.

Methods

A descriptive cross-sectional, school-based survey in children aged 5-15 years from selected primary and junior secondary schools (public and private) in both urban and rural communities of Enugu State was carried out. Ocular examinations were performed on them according to the Refractive Error in School-age Children (RESC) protocol.

Results

A total of 1167 children were examined. The mean age (standard deviation) was 10.58 ± 3.0 years. Females were 653 (54.4%) of the study population. The uncorrected, presenting and best-corrected visual acuity of ≤20/40 (6/12) in the better eye of the children in this study were 3.6%. 3.5% and 0.4%. Among the children that had visual impairment, refractive error accounted for 33.3% of reduced vision while the overall prevalence of refractive error was 2.1%. Prevalence of myopia was 1.9% and hyperopia, 0.1%. The most prevalent astigmatism was ≤0.75 dioptre cylinder.

Conclusion

The prevalence of refractive error in this study is low, with myopia being more common. Despite the low prevalence of refractive error, school vision screening is still important for African children as it serves as an opportunity to identify other ocular morbidities among the children.

Conjunctival bacterial flora and their antibiotic sensitivity among patients scheduled for cataract surgery in a tertiary hospital in south-east Nigeria

PURPOSE

To determine the pre-operative conjunctival bacteria flora and their antibiotic susceptibility among patients scheduled for cataract surgery.

METHODS

A descriptive, cross-sectional, hospital-based study design was adopted. It involved 104 consecutive, consented patients scheduled for cataract surgery at the University of Nigeria Teaching Hospital Enugu, from June to September 2017. The participants' socio-demographic characteristics, medical, and social history were obtained through interviewer-administered questionnaire. Conjunctival swab was obtained from the inferior fornix of the eye scheduled for cataract surgery using sterile swab stick and transported to medical laboratory for analysis. Susceptibility tests were carried out on the representatives of different groups of available antibiotics. Data was analyzed using the SPSS version 23.

RESULT

The participants were mainly females (64.4%), married, and farmers, with at least primary school education and a mean age of 64 ± 2SD years. The conjunctival swab bacteria isolation rate was 36.5%. Gram-positive bacteria accounted for 73.7% of the total isolates. Coagulase-negative Staphylococcus (34.2%) was the most frequently isolated bacteria. Gentamicin, ofloxacin, and polymycin B (76%) were the most efficacious antibiotics followed by moxifloxacin and tobramycin (68%) on all the isolates. Ofloxacin (82%) was the most sensitive to Gram positive while gentamicin (90%) was for Gram-negative bacteria.

CONCLUSION

In Enugu, the most common pre-operative conjunctival bacteria isolated were Coagulase-negative Staphylococcus with varied antibiotic sensitivity. Routine prophylaxis with gentamicin and ofloxacin is therefore advised to forestall the dreaded post-operative endophthalmitis.

Relationship between corneal biomechanical properties among pregnant women in a tertiary hospital in Nigeria

Objective

In Nigeria, many pregnant women as well as health-care providers are unaware of the effect of pregnancy on the eye. The present study investigated the changes in central corneal thickness (CCT), corneal sensitivity (CS), and intraocular pressure (IOP) among pregnant women in a tertiary hospital in Nigeria and the relationship between them.

Materials and Methods

A prospective longitudinal study was used. One hundred and thirty-four pregnant women attending the Obstetric Clinic of the University of Nigeria Teaching Hospital, Enugu, were consecutively recruited in their second trimester for the study. Changes in CCT, CS, and IOP were monitored at the second and third trimesters and 6-week postpartum. Data obtained were analyzed using Statistical Package for the Social Sciences version 20. The effect of duration of pregnancy on these variables was determined using simple linear regression and further analysis was done using Bonferroni's post hoc test.

Results

The women were aged 18-48 years, with a mean age of 30.81(±5.49) years and majority of them (61.2%) were multigravida. The duration of pregnancy varied inversely and significantly with CS (P < 0.05) and IOP (P < 0.000) with the least values recorded in the third trimester, while it varied directly and also significantly with CCT (P < 0.000) with the highest value obtained in the third trimester. A negative correlation that was significant only in third trimester was found between CCT and IOP (P < 0.02) and CS (P < 0.03).

Conclusion

There was a progressive increase in CCT with a corresponding decrease in CS and IOP across the trimesters of pregnancy, but these changes reversed 6-week postpartum.

Promoting Prepackaged Drugs for Prompt and Appropriate Treatment of Febrile Illnesses in Rural Nigerian Communities

Among the strategies being tested to improve prompt and appropriate treatment of febrile illness, especially malaria, in young children is the prepackaging of antimalarial drugs in easy to use daily dosages. A TDR-sponsored study in three rural communities in southern Nigeria tested a delivery system for prepackaged chloroquine and cotrimoxazole for children aged 6 months to 6 years. A variety of distributors were trained including village health workers (VHWs), patent medicine vendors (PMVs), and health clinic staff. These distributors also performed community health education. During a 12-month study period, 3954 units of project medicines were sold. While VHWs accounted for the majority of distributors and as a group sold the largest proportion of drugs overall, health staff sold the highest number on average. A follow-up survey found a 25 percent increase in the use of antimalarials over baseline, almost all of which could be attributed to sales of the project chloroquine. While there was also an increased use of cotrimoxazole over baseline, the contribution of project drugs was less. PMVs remained the most common source of treatment both before and after intervention, and there was a small but significant rise in the proportion who sought care from VHWs. While 93 percent of respondents sought care for their sick child within 24 hours, there was significantly more delay among those whose first choice was a government or private clinic. Factors that were positively associated with use of project drugs included reports that the child had a high temperature and seeking care from a VHW or PMV. The results indicate that it is possible to gain a significant market share for prepackaged drugs using locally available distribution channels. The value lies in using a variety of channels, both ones that are centrally located and others that are accessible to scattered, outlying communities that are poorly served by orthodox medicine.

Prevalence and profile of ophthalmic disorders in oculocutaneous albinism: a field report from South-Eastern Nigeria

To assess the burden and spectrum of refractive and non-refractive ophthalmic disorders in south-eastern Nigerians with oculocutaneous albinism. In a population-based survey in Enugu state, between August, 2011 and January, 2012, albinos were identified using the database of the Enugu state's Albino Foundation, and mass media-based mobilisation. The participants were enrolled at the Eye Clinics of the University of Nigeria Teaching Hospital and Enugu State University of Science and Technology Teaching Hospital using a defined protocol. Relevant socio-demographic and clinical data were obtained from each participant. Descriptive and comparative statistics were performed. Statistical significance was indicated by p < 0.05. The participants (n = 153; males, 70) were aged 23.5 + 10.4 SD years (range 6-60 years). Both refractive and non-refractive disorders were present in all participants. Non-refractive disorders comprised nystagmus, foveal hypoplasia, hypopigmented fundi and prominent choroidal vessels in 100.0% participants; and strabismus in 16.3% participants. Refractive disorders comprised astigmatism -73.2% eyes, myopia -23.9% and hypermetropia 2.9%. Spherical refractive errors ranged from -14.00 DS to +8.00 DS while astigmatic errors ranged from -6.00 DC to +6 DC. Mixed refractive and non-refractive disorder i.e. presenting visual impairment was present in 100.0% participants. Overall, refractive error was associated with non-possession of tertiary education (OR 0.61; 95% CI 0.38-0.96; p = 0.0374). There is high prevalence of refractive, non-refractive and mixed ophthalmic disorders among albinos in south-eastern Nigeria. This underscores the need for tailored provision of resources to address their eye care needs, and creation of needs awareness amongst them.

Prevalence of eye diseases among school children in a rural south-eastern Nigerian community

INTRODUCTION

Vision has an essential role in a child's development, and visual deficit is a risk factor not only for altered visio-sensory development, but also for overall socioeconomic status throughout life. Early detection provides the best opportunity for effective treatment of eye and vision problems in children. Therefore, timely screening is vital to avoid lifelong visual impairment. There is a paucity of data regarding the causes of eye disease among rural children in Nigeria. The aim of this study was to determine the prevalence and causes of eye disease among children residing in rural communities in Nigeria.

METHODS

A cross-sectional survey was conducted to determine the prevalence and common causes of ocular morbidities in primary school children in Abagana, a rural community in Njikoka Local Government Area of Anambra State, South-East Nigeria. Children aged 6-16 years in all 8 primary schools were registered, interviewed and their eyes examined. Data were analyzed according to age, sex, type of ocular disorder and causes of visual impairment. Frequency and percentages were calculated with univariate analysis and parametric method.

RESULTS

The census population consisted of 2092 children, 1081 (51.7%) males, with a male to female ratio of 1.07:1. Ocular disorders were found in 127 (6.1%) of the population. The most common ocular disorders in this community were vernal conjunctivitis 61 (2.9%) followed by refractive error 14 (0.7%). Amblyiopia, which is avoidable, was the most common cause of visual impairment.

CONCLUSION

Study findings indicated that early detection through early eye screening; health education and access to a quality eye care facility will reduce the burden of eye disease and blindness among rural Nigerian children.

Computerized motion sensitivity screening tests in a multicountry rural onchocercal community survey in Africa

Purpose:

To determine whether the Wu–Jones Motion Sensitivity Screening Test (MSST) accurately reflects the burden of optic nerve disease in several onchoendemic communities in Africa.

Materials and Methods:

The MSST was used to evaluate subjects in the communities of Raja in Sudan, Bushenyi in Uganda, Morogoro in Tanzania, and Ikon, Olomboro, and Gembu in Nigeria. Motion sensitivity was expressed as a percentage of motion detected in the individual eye, and this was averaged for the community. A perfectly normal eye would detect all motion and score 100%.

Results:

In this study, 3858 eyes of 2072 subjects were tested. The test was completed in 76% of respondents. Acceptability was high. Average test time was 120.4 s. The overall mean motion sensitivity of all eyes tested was 88.49%, ±17.49. Using a cutoff level of 50%, 6.4% of all subjects tested were subnormal. The highest proportion of subnormals recorded was in Morogoro at 12.7%. Severe defects in a community best correlated with optic nerve disease prevalence, while the proportion of the defect from a higher cutoff level best correlated with overall ocular morbidity. A repeat examination in the next 5 years following ivermectin treatment will show the influence, if any, on community-wide MSST performance.

Conclusion:

A wide range in community scores reflected disease diversity. The MSST appears to be a useful test in community-wide screening and diagnosis as it reflects the general level of ocular pathology and specifically, optic nerve disease.

Prevalence and distribution of ocular onchocerciasis in three ecological zones in Nigeria

The African Programme for Onchocerciasis Control (APOC) sponsored a baseline study in Nigeria between 1998 and 1999 on the prevalence and distribution of Onchocerciasis. The randomly selected 1,064 subjects in the baseline study underwent detailed eye examination in Cross River (rain forest), Taraba (savanna) and Kogi (forest-savanna) States. This paper compares and contrasts the public health significance of ocular onchocerciasis in these ecological zones. A blindness prevalence of 2.4% was recorded in the study, onchocerciasis being responsible for 30.2% of the bilaterally blind subjects. Onchocerciasis-induced blindness prevalence was relatively high in the rain forest and forest savanna zones of Cross River and Kogi States, Cross River having the highest site-specific prevalence (50.0%), followed by Kogi (41.7%). Taraba recorded only 27.3%. Other conditions identified included glaucoma, optic nerve disease and cataract rates of which were also found to be high among the population (6.9%, 6.5 % and 8.9% respectively). Anterior segment onchocercal lesions, punctate and sclerosing keratitis were the predominant features of the infection in the savanna zone (14.1% and 6.3% respectively), while posterior segment lesions were much more common in the forest zone. The need to sustain the present efforts to control onchocerciasis through mass ivermectin treatment is recommended.

Utility and effectiveness of computerised motion sensitivity screening tests in rural onchocercal community survey

BACKGROUND

Non-invasive tool of community diagnosis for onchocercal endemicity needs to be identified and ascertained for their utility and effectivity in order to facilitate the control of onchocerciacis in sub-Saharan Africa

OBJECTIVE

To determine the utility and effectiveness of the Wu-Jones Motion Sensitivity Screening Test (MSST) in detecting optic nerve diseases in onchocercal-endemic rural Africa.

METHODS

MSST was applied to sampled subjects in the selected communities of Raja in Sudan; Bushenyi in Uganda; Morogoro in Tanzania; and of Ikom, Olamaboro and Gashaka in Nigeria. Basically, six points within the central field of vision were repeatedly tested at 1/3 meter from the screen of a laptop computer in a room darkened. Motion sensitivity was expressed as a percentage of motion detected in the individual eye and this was averaged for the community.

RESULTS

A total of 3,858 eyes of 2,072 patients were examined. Seventy-six percent of the subjects completed the test, at an average test time of 120.4 (66.7) seconds. The overall mean motion sensitivity of all eyes tested was 88.49 (17.49%). At a cut-off point of 50%, 6.4% of all subjects tested were subnormal, while at 70% cutoff, 13.3% were subnormal. The highest proportion of 50% cutoff sub-normality was recorded at Morogoro at 12.7%.

CONCLUSION

Motion Sensitivity Screening Test was widely accepted and easily administered to the rural and largely illiterate subjects studied. Our data suggest that the proportion of severe field defects by MSST in a community, with cutoff at 33%, best correlates with optic nerve disease prevalence, while proportion of defect from a higher cut-off level at about 50%, best correlates with overall ocular morbidity.

APOC impact assessment studies: baseline ophthalmological findings in Morogoro, Tanzania

The goal of the African Programme for Onchocerciasis Control (APOC) is to eliminate Onchocerciasis as a disease of public Health significance and an important constraint to socio-economic development in the 19 none OCP (Onchocerciasis Control Project) countries covered through Community-Directed Treatment with Ivermectin, CDTI. In 1998, impact assessment studies were carried out in Morogoro, Tanzania during which baseline ophthalmological parameters were established. The hypothesis being tested is that CDTI will prevent or delay progression of onchocercal eye lesions and blindness. A total of 425 subjects aged 10 years or more from 14 villages within Bwakira district ofMorogoro region in Tanzania were examined for Snellen visual acuity, ocular microfilaria, lens opacities, uveitis and posterior segment disease especially chorioretinitis and optic nerve disease. Motion Sensitivity Screening Test (MSST) was carried out as well. Microfilaria was present in the anterior chamber of nearly half (49.2%) of all subjects examined. Prevalence of blindness was extremely high at 15.2%. Onchocercal lesions were responsible for blindness in 41.5% of these, followed by cataracts (27.7%), glaucoma (10.8%) and trachoma (6.2%). The main pathway to onchocercal blindness in this population was anterior uveitis with or without secondary cataracts. There is an urgent need to get CDTI underway and institute other horizontal primary eye care measures, especially cataract backlog reduction, in order to reduce the excessive burden of avoidable blindness in this community.

Causes of childhood blindness: results from schools for the blind in south eastern Nigeria

AIM

This cross sectional study was undertaken to identify the major causes of childhood severe visual impairment/blindness (SVI/BL) among students in schools for the blind in south eastern Nigeria with a view to offering treatment to those with remediable blindness.

METHODS

142 students attending three schools for the blind in the study area were interviewed and examined using the World Health Organization programme for prevention of blindness (WHO/PBL) childhood blindness proforma.

RESULTS

By anatomical classification, the major causes of SVI/BL identified in the children (aged 15 years or less) were lesions of the lens (30.4%), corneal lesions (21.7%), whole globe lesions (mainly phthisis bulbi) (17.4%), and glaucoma/buphthalmos (10.9%). For the young adults (more than 15 years) these lesions accounted for 31.9%, 21.3%, 23.4%, and 8.5% of SVI/BL, respectively. For all the students, the commonest single diagnoses were cataract (23.5%) and corneal scarring (21.4%), of which 86.7% were caused by measles. By aetiological classification, childhood factors (38.6%) constituted the major cause of blindness: 37.0% in the children and 39.4% in the young adults. In 74.5% of all the students, blindness was considered avoidable.

CONCLUSIONS

A high proportion of childhood blindness in schools for the blind in south eastern Nigeria is avoidable. Development of paediatric ophthalmology in Nigeria to manage childhood cataract and glaucoma is advocated.

The prevalence of glaucoma in an onchoendemic community in South-Eastern Nigeria

METHODOLOGY

With the aim of examining all the adults aged 30 years and above a survey was conducted in Alum-Inyi, a mesoendemic Community in South-Eastern Nigeria. The people were subjected to basic ophthalmic tests for the diagnosis of glaucoma namely corrected and uncorrected visual acuity at 6 metres using an illiterate E-chart, with pinhole assessment if visual acuity < 6/18; direct ophthalmoscopy to assess the vertical cup-disc ratio through undilated pupils and Schiotz indentation tonometry. In addition, static visual field analysis using the MK 1 Friedman visual field analyser was carried out in any glaucoma suspect.

RESULTS

Of 664 eligible persons examined (out of the estimated total of 946), 14 definite cases of glaucoma were identified, giving a prevalence of 2.10% in the 30 years of age and older population. The mean vertical cup-disc ratio for the non-glaucoma cases were 0.30 (+0.004) and 0.31 (+/- 0.004) and 0.31 (+/- 0.09) in the right and left eyes respective. Among the glaucoma cases, the average vertical cup-disc ratio in the right and left eye were 0.63 (+/- 0.05) and 0.70 (+/- 0.06 respectively. No physiological cup of > or = 0.6 was recorded in our study. The mean iOP in the right and left eyes respectively were 18.54 (+/- 0.15) and 19.42 (+/- 0.14) in the nonglaucomatous cases and 26.39 (+/- 1.75) and 27.46 (+/- 2.59) in the glaucoma cases.

CONCLUSION

Despite its limitations, this study confirms that the prevalence of glaucoma varies from one African population or population of African origin to another. It agrees with other reports that the risk of glaucoma increases with age.

Eye health of industrial workers in Southeastern Nigeria

A cross-sectional ophthalmological survey to determine the ocular health in Nigerian industries was undertaken in four randomly selected industrial establishments in Enugu State of Nigeria. The industrial establishments studied were the cement factory, coal mine, saw mill and iron/steel works where motor spare parts are fabricated. Of the 646 workers, 184 (28.5%) had a history of industrial accidents, 81 (12.5%) of which affected the eye. Eye injury was most commonly caused by metal chips, cement dust, fragments of wood, pieces of coal stone and welders' arc rays all of which could be prevented by wearing appropriate protective eye coverings. Contusion injury was the most common type of injury reported. Eye accident rate varied from factory to factory as also did the wearing of protective eye devices. overall, the percentage of workers using protective eye cover was 16.7% but there was a significant difference between the factories in this respect, protective eye wear being more often used in factories with higher eye accident rates. A total of 646 technical workers had detailed ophthalmological examination. The types and frequencies ofvisual disorders seen as well as the nature and causes of eye injuries were determined. Five hundred and twenty-eight workers (81.7%) had eye disorders. Presbyopla was responsible for 203 (31.4%) of these disorders while 169 (26.2%) were refractive errors. Of the others, pterygium and pingueculum together numbered 179 (27.7%) while cataract was found in 79 (12.2%) subjects. The results showed a high frequency of eye injuries among industrial workers and a low level of use of protective eye cover while at work. It is recommended that legislation requiring the use of protective devices in high-risk industries should be vigorously enforced to improve the eye health of Nigerian industrial workers.

A blind parallel comparative study of the efficacy and safety of rovamycin versus augmentin in the treatment of acute otitis media

A single blind randontised controlled parallel clinical trial of Rovamycin was conducted in which (Rovamycin Rhone-Poulenc Rorer) was compared with Augmentin in patients with acute otitis media. Forty patients were randomised to treatment with either Rovamycin or Augmentin and the drugs were evaluated for efficacy and safety. The efficacy parameters used were fever clearance, symptom clearance and cure rate after 8 days of treatment Our study showed that fever regressed in 19 (95%) of the 20 patients in both groups; otalgia in 19 (95) patients for the Augmentin and 18 (90%) for Rovamycin after 8 days of application of the trial drugs in these parameters. There was also no significant difference between them in their safety and tolerability profiles. These results showed that Rovamycin is a useful addition to our armamentarium in the fight against bacterial otitis media. Operationally, Rovamycin has an advantage over Augmentin for the reason that is given only twice a day as against thrice-daily dosage f orAugmentin. Compliance and consequently effectiveness in practices should therefore be better for Rovamycin.

Treatment of childhood fevers and other illnesses in three rural Nigerian communities

The seeking of healthcare for childhood illnesses was studied in three rural Nigerian communities of approximately 10,000 population each. The aim was to provide a baseline understanding of illness behaviour on which to build a programme for the promotion of prepackaged chloroquine and cotrimoxazole for early and appropriate treatment of childhood fevers at the community level. A total of 3117 parents of children who had been ill during the 2 weeks prior to interview responded to questions about the nature of the illness and the actions taken. Local illness terms were elicited, and the most prevalent recent illness and the actions taken. Local illness terms were elicited, and the most prevalent recent illnesses were 'hot body' (43.9 per cent), malaria, known as iba (17.7 per cent), and cough (7.4 per cent). The most common form of first-line treatment was drugs from a patent medicine vendor or drug hawker (49.6 per cent). Only 3.6 per cent did nothing. Most who sought care (77.5 per cent) were satisfied with their first line of action, and did not seek further treatment. The average cost of an illness episode was less than US$2.00 with a median of US$1.00. Specifically, chloroquine tablets cost an average of US 29 cents per course. Analysis found a configuration of signs and symptoms associated with chloroquine use, to include perception of the child having malaria, high temperature and loss of appetite. The configuration positively associated with antibiotic use consisted of cough and difficult breathing. The ability of the child's care-givers, both parental and professional, to make these distinctions in medication use will provide the foundation for health education in the promotion of appropriate early treatment of childhood fevers in the three study sites.

The causes and profile of visual loss in an onchocerciasis-endemic forest-savanna zone in Nigeria

In an onchocerciasis-endemic forest-savanna mosaic zone of southeastern Nigeria, blindness was found in 5.4% of 1,217 people who voluntarily attended for examination from a population of 14,000. Apart from cataract, the most important causes of blindness in the area were eye diseases that are known to be associated with onchocerciasis. Refractive error, although a non-onchocerciasis-related eye defect, was the number one cause of visual loss found in the study. The causes of blindness in our examined population are similar to what is found in onchocerciasis-endemic areas of the savanna zone and dissimilar from those found in the forest zone. In this forest-savanna mosaic zone, the prevalence of onchocerciasis was higher in the respondents with poor vision than in those with adequate vision. Similarly, low vision was found to be more common in people with high microfilarial loads, but people with high loads also tended to be older than those with moderate or low microfilarial loads, which might suggest that low vision was only a function of age. Nonetheless, analysis of our data shows evidence of an association between low vision and microfilarial load in adults aged 60 years and above. It is concluded that onchocerciasis in the forest-savanna mosaic zone of Nigeria has the features until recently associated only with savanna onchocerciasis, and that this should be taken into consideration in planning and executing onchocerciasis control programs in the area.

Herpes zoster ophthalmicus and HIV infection in Nigeria

Eight patients, 3 men and 5 women, aged between 24 and 40 years who had herpes zoster ophthalmicus (HZO) were seen in the Eye Department of the University of Nigeria Teaching Hospital, Enugu between 1994 and 1997. One of the patients was already on treatment for active pulmonary tuberculosis at the time he was first seen. All had skin eruptions at different stages of development in the area of distribution of the first trigeminal nerve on the affected side of the face and head. Ocular examination revealed impaired vision in the affected eye (between 6/12 and hand movement) in all the patients. All had lid oedema while 5 had ptosis (3 partial and 2 complete). Various degrees of conjunctival injection were observed in all patients while 6 of them had corneal anaesthesia and keratitis. Uveal inflammation, present in all the patients varied from mild iritis in 4 individuals to severe iridocyclitis in the remaining 4. Pupils reacted to light sluggishly in 2 patients while they were dilated and fixed in 3 others. None had any associated abnormalities in the posterior segment. Six of the patients consented and were screened for human immunodeficiency virus (HIV) infection. Of these, 4, including the patient with pulmonary tuberculosis, tested seropositive while 2 were seronegative. All 8 were treated with topical acyclovir. This was combined with oral acyclovir in one of the patients. Follow-up period was between 2 and 52 weeks. During this period skin eruptions and anterior segment signs improved in 5 patients while remaining stable in 3 others; post-herpetic neuralgia persisted on the affected side in 4 patients. Patients who were HIV seropositive did not recover as quickly or to the same extent as the seronegative ones. It is concluded that HZO infection may indicate underlying HIV infection in young Africans as has been found in whites.

Clinical pharmacokinetics of suramin in patients with onchocerciasis

OBJECTIVE

Ten male patients with onchocerciasis received six weekly infusions of suramin according to the WHO-recommended regimen.

RESULTS

In no case did the plasma concentration of suramin exceed 300 mg x l(-1), and serious toxicity was not observed. The apparent volume of distribution (median 20.6 l) was comparable to that reported for patients with prostatic carcinoma. Elimination from patients with onchocerciasis was relatively slow (median plasma clearance 6.2 ml x h(-1), median terminal elimination half-life 91.8 days).

CONCLUSION

Microfilariae were eliminated in eight out of ten patients. Spontaneous nodule regression was noted in four patients.

Causes and visual outcome of childhood eye injuries in Nigeria

Two hundred and twenty-eight children of both sexes (152 males and 76 females) aged between 1 and 15 years treated for eye injuries at the University of Nigeria Teaching Hospital, Enugu, Nigeria were studied. The injuries were commonly sustained during domestic activities (29.8%), at play or sports (23.7%), in the schoolroom (16.7%) and during farm work (10.1%). Causative agents were mostly sticks, followed by stone missiles and other flying objects. There was a general delay in reporting to hospital in all types and degrees of severity of injuries, with only 28.5% reporting in the first 24 hours and as many as 10.5% after 1 month. How quickly the patient came to hospital was determined more by social and economic factors than by sex, age and type of injury. Visual outcome was best in patients with mild non-penetrating injuries and worst in those with severe penetrating injuries. Amongst the latter the outcome was worse when the posterior segment was involved than when the injury involved only the anterior segment. Our study showed that there has been a change in the causation of childhood eye injuries in the country compared with reports of 25 years ago. The visual outcome in our patients was worse than in reports from developed countries. This was due mainly to delay in seeking specialist treatment and lack of sophistication of the treatment, especially in severe cases.

Eye disease in an onchocerciasis-endemic area of the forest-savanna mosaic region of Nigeria

In a forest-saving mosaic zone of south-eastern Nigeria endemic for onchocerciasis, we identified eye disorders in 65.5% of a randomly selected population sample. Onchocerciasis-related eye disease was present in 13.7% of the study sample and constituted 21% of the total number of eye disorders. A total of 78 (33.2%) of 235 subjects with visual impairment had onchocerciasis-related eye lesions, and of 35 who were blind in both eyes, onchocerciasis-induced eye disease was the cause in 28 (80%). The prevalence of bilateral blindness from all causes in the study area was 4.1%, while that from onchocerciasis-related causes was 3.3%. The commonest onchocerciasis-induced lesions that were responsible for visual impairment and blindness were choroidoretinitis and optic nerve disease. Sclerosing keratitis, an important causative lesion in onchocerciasis-endemic savanna regions, was encountered only one. Eye disease is therefore an important feature of onchocerciasis in the forest-savanna mosaic areas of Nigeria and should be borne in mind when planning and executing control programmes.