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Pattern of eye diseases in a university health service clinic in northern Nigeria

Authors:
  • University of Ilorin Ilorin Kwara State Nigeria

Abstract

Eye diseases constitute one of the common health problems presenting to the general practice clinic and could have significant socioeconomic consequences. To determine the pattern of eye diseases presenting to the eye clinic of Ahmadu Bello University Sick Bay, Samaru, Zaria. A prospective study of both new and old consecutive patients presenting to the eye clinic of Ahmadu Bello University Sick Bay between March 2009 and May 2010 was conducted. A screening format designed by the authors was used to extract information on biodata, presenting complaint, visual acuity, anterior and posterior segment examination, investigations and diagnosis. The data was analysed using Analyse-it V2.22(2010) statistical software. There were 1448 patients comprising 856 males and 592 females who were aged 24.3 years +/- 11.7SD with an age range of 0 to 60 years. The majority (63.5%) were students. The common eye diseases seen were infective conjunctivitis (40.3%), allergic conjunctivitis (32.7%), refractive errors (17.3%), glaucoma (1.9%) and cataract (1.8%). Eye diseases were found to be common within the community of Ahmadu Bello University which is made up of students predominantly. This implies that avoidable (preventable and treatable) ocular disorders are still common among Nigerian students. Early detection (through periodic eye screening) and prompt treatment will significantly reduce visual impairment and needless blindness from these avoidable causes.
Eye diseases constitute one of the commonest problems
presenting to the general practice clinic (10-21%) and
2, 3
could have significant socioeconomic consequences . A
study of the pattern of eye diseases in an environment
where students are predominant is critical because while
some eye conditions are just causes of ocular morbidity,
others invariably lead to blindness. Again, while some
conditions such as refractive errors and cataract are
treatable others like measles and vitamin A deficiency are
4
largely preventable.
In addition, the population under study is mainly a young
population. Therefore Disability Adjusted Life Years
4
(DALYS) becomes relevant. It is a measure of the time
lived with a disability and the economic loss incurred
during the years. The younger the individual the more the
economic loss because of the number of blind years.
The study is also designed to benefit students with eye
diseases who were not fortunate to be screened earlier
(primary and secondary level of education). Other age-
groups within the university community are also likely to
benefit from the exercise. Students with poor vision from
treatable eye diseases will no longer be considered by
5
their teachers to be poor students.
In Nigeria, hospital based and school surveys on the
pattern of eye diseases carried out in parts of the country
have indicated that refractive errors, conjunctivitis,
corneal scarring and injuries were some of the most
6,7
common eye conditions affecting Nigerian students.
Even though refractive errors appear to be the
commonest eye disorder in Nigeria, very few children
8
wear glasses. This is because of the commonly held (but
mistaken ) view that wearing eyeglasses causes children's
9
vision to deteriorate faster. Many studies on eye diseases
in children within the United Kingdom, Canada, and the
United States of America have shown that the common
ocular disorders in these countries were congenital or
10
hereditary.
A clear knowledge of the pattern of eye diseases will form
a frame work which stake holders will utilize to
effectively prevent (health education etc.) or treat
blinding diseases .This will reduce needless blindness
and visual impairment in students, and ultimately, it will
help students to attain their full potential in life with
corresponding economic benefit to Nigeria.
MATERIALS AND METHOD
A prospective study of 1448 patients was conducted at
the Ahmadu Bello University Sick Bay, Samaru, between
ABSTRACT
BACKGROUND: Eye diseases constitute one of the
common health problems presenting to the general
practice clinic and could have significant socioeconomic
consequences.
OBJECTIVES: To determine the pattern of eye diseases
presenting to the eye clinic of Ahmadu Bello University
Sick Bay, Samaru, Zaria.
METHODS: A prospective study of both new and old
consecutive patients presenting to the eye clinic of
Ahmadu Bello University Sick Bay between March 2009
and May 2010 was conducted. A screening format
designed by the authors was used to extract information
on biodata,presenting complaint,visual acuity,anterior
and posterior segment examination,investigations and
diagnosis.The data was analysed using Analyse-it
V2.22(2010) statistical soft ware.
RESULTS: There were 1448 patients comprising 856
males and 592 females who were aged 24.3 years
±11.7SD with an age range of 0 to 60years.The
majority(63.5%) were students. The common eye
diseases seen were infective conjunctivitis (40.3%),
allergic conjunctivitis, (32.7%), refractive errors
(17.3%), glaucoma (1.9%) and cataract (1.8%).
CONCLUSION: Eye diseases were found to be
common within the community of Ahmadu Bello
University which is made up of students predominantly.
This implies that avoidable (preventable and treatable)
ocular disorders are still common among Nigerian
students. Early detection (through periodic eye
screening) and prompt treatment will significantly
reduce visual impairment and needless blindness from
these avoidable causes.
KEY WORDS: eye disease, pattern, university
community, Nigeria
Date Accepted for Publication: 8th February, 2012
NigerJMed 2012:334-337
Copyright Ó2012. Nigerian Journal of Medicine
INTRODUCTION
The university community is an academic environment
with a high percentage of the inhabitants engaged in
reading and writing. The importance of good eye health
cannot be over emphasized in such setting. Most patients
with eye diseases first present to the general practitioner
who may have limited knowledge of ophthalmic
practice. Some disease conditions are treated correctly,
while others are either misdiagnosed or wrongly treated
with unwanted complications. Less than 50% of such
1
patients get timely referral to an eye specialist.
Pattern of Eye Diseases in a University Health Service Clinic in Northern Nigeria
1 1 1 2
OLADIGBOLU KK, ABAH ER, CHINDA D, ANYEBE EE.
1
Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Shika-Zaria
2
Research and Training Unit, School of Nursing, Ahmadu Bello University Teaching Hospital, Shika-Zaria.
Corresponding: Oladigbolu KK, Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Shika-Zaria (oladigbolukehinde@yahoo.com
334
Nigerian Journal of Medicine, Vol. 21 No. 3, July - September, 2012, ISSN 1115 - 2613
Original Article
disorders seen 583 (40.3%), followed by allergic
conjunctivitis 474 (32.7%), refractive errors 251
(17.3%), glaucoma 27 (1.9%) and cataract 26 (1.8%).
Pterygium was seen in 20 (1.4%) adults; chalazion, stye
and episcleritis/scleritis in 12 (0.8%) persons each.
Blepharitis was seen in 9 (0.6%) individuals. Only 5
(0.4%) children had ocular trauma with 4 boys (80%) and
1 girl (20%), all being closed globe injuries (Table 2).
The incidence of allergic conjunctivitis was higher in the
age group 0-13 years, 261 (55%). No gender difference
was observed. Infective conjunctivitis was commoner in
children 332 (57%).
Out of the 1448 patients seen within the study period, 251
(17.3%) had uncorrected refractive error. Refractive
error is defined as an error of 0.5 diopter or more in either
eye, while presbyopia is difficulty seeing near in those
aged 35 years or older and correctable with convex lenses
of 1.0 diopter or more. One hundred and thirty eight
(55.0%) of them were males and 113 (45.0%) were
females. Simple myopia was the commonest error found
70 (28.0%), followed by simple hyperopia 43 (17.0%).
Others include compound myopic astigmatism 30
(12.0%), simple hyperopic astigmatism 10 (4.0%),
compound hyperopic astigmatism 4 (1.6%) and simple
myopic astigmatism2 (0.8%). Presbyopia was found in
92 patients (36.6%) and students were 42 (46%).
March 2009 and May 2010. Ethical approval was
obtained from the university authority and informed
consent from each patient. The Sick Bay provides health
care for students, academic and non-academic staff of the
university and their relations. Consecutive new and old
patients who visited the eye clinic were first seen by one
of the two ophthalmic nurses who completed part of a
screening format (section on bio-data and visual acuity)
designed by the authors to extract information on biodata,
presenting complaints, visual acuity for distance and
near, anterior and posterior segment examinations,
diagnosis and treatment offered. Visual acuity (VA) was
tested for both distance and near using the Snellen's chart
and Jaegers chart respectively. Patients with VA less than
6/6 in one or both eyes had their VA tested with the use of
pinhole.
The anterior and posterior segments of the eyes were
examined by one of the two consultant ophthalmologists
who visited the clinic twice a week. Retinoscopy was
done manually by the ophthalmologists who also
completed the other portions of the screening format.
Patients with treatable eye diseases were treated and
those that require further evaluations and management
were referred to the nearby Ahmadu Bello University
Teaching Hospital, Shika-Zaria. The data was analyzed
using Analyze-it V2.22 (2010), statistical soft ware.
RESULTS
A total of 1448 patients were seen in the clinic during the
study period. There were more males 856 (59.1%) than
females 592 (40.9%), with M: F=1.4:1.0. Their age range
was 1-60 years with a mean age of 24.3 years (SD ±11.7).
Figure 1 shows age and sex distribution of the patients
with a preponderance of the age groups 21-30 years 607
(41.9%) and 11-20 years 326 (22.5%). Majority were
students 920 (63.5%), out of which undergraduates
constitute 857 (93.1%). The staff seen were 160 (11.1%)
with 124 (77.5%) non-academic and 36 (22.5%)
academic staff. The staff relations and dependants
constituted 368 (25.4%) of the study population (Table
1). Infective conjunctivitis was the most common
Figure 1: Age and Sex Distribution
Age Range (years)
ÿ
ƒ
Table 1: Spectrum of Occupation
Occupations Frequency Percent
Student
920 63.5
Undergraduate
857
93.1
Post -graduate
21
2.3
Primary and Secondary
42
4.6
Staff
160
11.1
Academic
36
22.5
Non -academic
124 77.5
Staff relations/
368 25.4
Dependants
Total
1448
100.0
Table 2 : Ocular Abnormalities
Types of Abnormality Frequency Percent
Infective conjunctivitis 583 40.3
Allergic conjunctivitis 474 32.7
Refractive error 251 17.3
Glaucoma (POAG) 27 1.9
Cataract 26 1.8
Pterygium 20 1.4
Chalazion 12 0.8
Stye 12 0.8
Episcleritis/scleritis 12 0.8
Blepharitis 9 0.6
Retinopathy 9 0.6
Trauma 5 0.4
Granuloma 4 0.3
Chemical conjunctivitis 4 0.3
TOTAL 1448 100
335
Nigerian Journal of Medicine, Vol. 21 No. 3, July - September, 2012, ISSN 1115 - 2613
6, 11, 12
similar to that of other studies (1.3%-1.9%) in
Nigeria. It is however, lower than what is obtained in the
26-28
general population (2.7%-10%). This is probably
because majority of the patients in this study were
students, less than 40years of age. The commonest form
of glaucoma in Nigerians is primary open angle (POAG)
29
type found in individuals =40 years of age.
Also, only 1.8% had cataract. Studies in South-Western
2,
and Eastern Nigeria recorded prevalence of 0.2%-1.3%.
11, 15
Diseases of ocular adnexia were low with 1.4%
Pterygium, chalazion and stye 0.8% each and 0.6%
blepharitis. No squint or corneal opacity seen. Other
6, 12
studies reported 0.2%-0.7%. Ocular trauma was seen
in only 5(0.4%) patients (staff relations/dependants)
within the age of 3-7years. The male sex has been
25
identified as a risk factor for ocular injuries, this is
reflected in this study with 4(80%) boys affected. Works
done by many authors, show that school children and
students of post primary institutions were particularly
vulnerable to trauma with subsequent visual impairment
6,25
or blindness especially while at play.
CONCLUSION /RECOMMENDATION
This study has shown that the predominant eye diseases
affecting students, staff and relations in Ahmadu Bello
university community are infective and allergic
conjunctivitis and uncorrected refractive errors with
student forming the bulk of the population. This implies
that avoidable (preventable and treatable) ocular
disorders are still common among Nigerian students.
Health education, early detection (through periodic eye
screening) and prompt treatment will significantly
reduce visual impairment and needless blindness from
these avoidable causes.
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24
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Nigerian Journal of Medicine, Vol. 21 No. 3, July - September, 2012, ISSN 1115 - 2613
... Oladigbolu et al (2) in their study of pattern of eye diseases in a university health service clinic in northern Nigeria discovered that the common eye diseases seen were infective conjunctivitis (40.3%), allergic conjunctivitis (32.7%), refractive error (17.3%), glaucoma (1.9%) and cataract (1.8%). They therefore concluded that eye diseases were found to be common within the community of Ahmadu Bello University which is made up of students predominantly (2). ...
... Oladigbolu et al (2) in their study of pattern of eye diseases in a university health service clinic in northern Nigeria discovered that the common eye diseases seen were infective conjunctivitis (40.3%), allergic conjunctivitis (32.7%), refractive error (17.3%), glaucoma (1.9%) and cataract (1.8%). They therefore concluded that eye diseases were found to be common within the community of Ahmadu Bello University which is made up of students predominantly (2). This implies that common preventable and treatable ocular disorders are still common among Nigerian students within a University community. ...
... Geraldine et al (10) in Zimbabwe where 71% of the participants reported having a history of eye disease. This pattern also follows Oladigbolu et al findings where 21% of the eye conditions are preventable causes of blindness (refractive error, glaucoma and cataract) even though it is in a clinic based study within a University community as against the population based in this study (2). On the other hand, in the general community, cataract and glaucoma which are treatable causes of blindness and visual impairment were the leading eye disorders in some previously conducted studies in hospital and rural community (11,12) while literature has shown a lot of ignorant and poor attitude towards eye care and uptake of eye care services in developing countries, as concluded by Akaraiwe (13) et al in their study. ...
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Abstract Background – University, a subset of the general population, will expectedly have common ocular problems as prevalent in the population. Knowing these problems as done through screening and health education during WSD activities in 2017 thus raise awareness for their prevention. Objective - This study was aimed at determining the types of eye defects in a university community. Methodology – A descriptive cross-sectional survey utilizing purposive serial selection to examine inhabitants of a university community. Socio-demographic information and detailed ocular examinations were carried out. Data analysis using SPSS Version 20 and cross tabulations with statistical significance derived using paired sample t-test at p values < 0.05 were done. Results – With n=140, 79(56.4 %) were males. Mean age was 26.7 + 11.5years. Majority were staffs (77.1%) with 62.1% having tertiary education. Normal vision was reported in (92.9%), while 5.7% had visual impairment with 1.4% uniocular blindness. Common ocular findings were allergic conjunctivitis (12.9%), glaucoma suspects (10.0%), Pterygium (3.6%), glaucoma/corneal opacity (2.1% respectively), and optic atrophy (1.4%). Conclusion –Disorders seen were mostly avoidable. Incorporating eye health services into University Healthcare will control their occurrence allowing optimal job performance.
... In Africa, many cultural barriers to the uptake of ophthalmic services in orthodox hospital have been documented [3,4] and many patients are known to seek orthodox eye care only when traditional eye medications have failed [5][6][7]. The commonest causes of ocular morbidity in Nigerian hospitals have been Cataracts, Refractive errors, Glaucoma and Conjuctivitis [8][9][10][11].These mobidities were also similar to those documented in some African Countries like Ethopia [11] and Sudan [12] . Ocular mobidities have varing impact on the vision and quality of life of patients and its especially worse in those with severe VI and blindness [13,14]. ...
... In Africa, many cultural barriers to the uptake of ophthalmic services in orthodox hospital have been documented [3,4] and many patients are known to seek orthodox eye care only when traditional eye medications have failed [5][6][7]. The commonest causes of ocular morbidity in Nigerian hospitals have been Cataracts, Refractive errors, Glaucoma and Conjuctivitis [8][9][10][11].These mobidities were also similar to those documented in some African Countries like Ethopia [11] and Sudan [12] . Ocular mobidities have varing impact on the vision and quality of life of patients and its especially worse in those with severe VI and blindness [13,14]. ...
... The most prevalent ocular morbidities recorded in this study were refractive errors, conjunctivitis, cataracts and Glaucoma which was similar to previous studies in southern and northern Nigeria [8][9][10][11]. This was also similar to the findings in studies carried out in other African countries like Ethiopia [12], Sudan [13] and South Africa [16]. However, according to the global causes of ocular morbidities, conjunctivitis especially the allergic variant which seems to be common in Africa is not listed as a prevalent condition by the WHO [1]. ...
... Similar numbers in gender were also noted in ocular morbidity studies conducted in India [21,23] with 46.9% and 46.5% males, Ethiopia [16] with 49.5% males, Nigeria [25] with 51.3% males and in the study of Thomson and Chumbley [26] in 1984 where 55.4% of patients were women and 44.6% were men. In the study of Oladigbolu et al. [27], almost 20.0% more males presented with eye diseases. ...
... Glaucoma was diagnosed in 6.4% of patients, mainly in patients aged 50 and older. In a Northern Nigeria study of Oladigbolu et al. [27], the prevalence was found to be 1.9%, which was less than what was found in the African population of other regions like Cameroon (8.2%) [33] and Ghana (8.5%) [34] or elsewhere in Nigeria (11.9%) [1]. However, it can be explained by the fact that the majority of patients in the study were younger than 40 years. ...
... To improve and to manage health care service more effectively, different strategies were discussed by others, like integrating social workers into care systems [2], forming a framework which stakeholders will utilize to train personnel to prevent blindness [27] or restructuring and shifting parts of care away from expensive services to primary care levels [9]. 4. ...
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The aim of this study was to analyse outpatient services in an ophthalmic clinic of a church-run hospital providing secondary level care in an African megacity, paying special attention to the poorest users of the services. The range of examination was reviewed from 500 patient records of all ages consecutively chosen on random days attending the outpatient department for the first time in order to optimize workflow and to analyse the offered treatment modalities. Mean age was 41.9 ± 21.9 years, and 53.6% of the patients were female. Of the patients, 74.8% presented with visual impairment. The most frequent findings were refractive errors (35.8%), presbyopia (21.2%), allergic conjunctivitis (14.0%), cataract (13.2%) and glaucoma (6.4%). Patient management consisted of optical treatment (49.6%), surgery (11.4%) and medical treatment (39.0%). These results show the importance of the demand in refractive services and the need to train specific service providers. Knowing the frequencies of common conditions enables more appropriate diagnostic and treatment strategies, e.g., the importance of refractive errors, and should lead to improvements in training, staffing, therapeutics and patient outcomes. This approach can be applied to many other outpatient services and should be evaluated in light of the city’s impoverished health outreach and educational situation.
... Refractive error occurred in 77.9% of participants ( [4][5][6]. This may be due to culture, attitude or socioeconomic factors. ...
... This is in line with the greater health-seeking behavior of women in many parts of Nigeria primarily because they are economically disadvantaged compared to the men. In contrast studies in Northern Nigeria [4] and India report the reverse [7] probably due to cultural restrictions on women. There is a large body of evidence that women are 40% more affected by blindness and visual impairment than men [8]. ...
... Refractive error occurred in 77.9% of participants ( Figure 3) and [4][5][6]. This may be due to culture, attitude or socioeconomic factors. ...
... This is in line with the greater health-seeking behavior of women in many parts of Nigeria primarily because they are economically disadvantaged compared to the men. In contrast studies in Northern Nigeria [4] and India report the reverse [7] probably due to cultural restrictions on women. There is a large body of evidence that women are 40% more affected by blindness and visual impairment than men [8]. ...
... Red eye is one of the most common presentation to ophthalmology out-patient and emergency clinics. 1,2 It results from dilation and engorgement of ocular blood vessels caused by a wide variety of conditions. The spectrum of diseases range from conjunctivitis, keratitis, epicscleritis, scleritis, trauma, dry eye disease to vision threatening conditions like orbital cellulitis, angle closure glaucoma and endophthalmitis. ...
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... The disease pattern compares with that observed in other studies of tertiary eye care centers in Nigeria [27,28]. Result from this study can therefore reasonably be inferred to be valid for such other places. ...
... 14 It is also estimated that every minute a child goes blind in both eyes in a developing country. 15 In Nigeria, while about 75 million of the population belong to 0-15 years, about 75,000 of this group, are blind mostly from preventable ocular morbidity, 15,16,17 with about 60% of the blind children dying within a year of becoming blind. 15 ...
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