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A study of ocular morbidity of patients attending ophthalmic outreach services in rural Ethiopia

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To determine the prevalence of eye diseases and visual impairment among patients presenting outreach site in rural Ethiopia. A cross-sectional survey for ocular morbidity among self selected patients during ophthalmic outreach campaign in Kersa town, Ethiopia, in June 2012 was conducted. A total of 214 patients underwent detailed eye examinations including visual acuity test, intra-ocular pressure measurements, anterior and posterior segment evaluation and refraction. A total of 214 patients were examined, where males comprised of 50.5%. Ocular diseases were quite prevalent among the study group. Conjunctivitis was the primary ocular morbidity accounting for 29%, followed by cataract (16.3%), presbyopia (15.4%), refractive errors (7.9%), Blepharitis 7.5%. Twenty four patients (11.2%) had uncorrected visual acuity of less than 6/60 in the better eye. The prevalence of visual impairment (VA less than 6/18) was 19.1% (41/214) in the study subjects. Eye diseases are common amongst rural Ethiopian community. Therefore, screening for eye diseases is important in identifying those patients at risk of getting blind and providing the right treatment to them and also give a chance to be treated for those who have logistic problems. The majority of the causes for ocular morbidity, visual impairments as well as blindness in the study were either preventable or treatable. Key words: Ocular morbidity, Ethiopia, visual impairment, presbyopia, outreach campaign.
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International Journal of Medicine and Medical Sciences ISSN: 2167-0404 Vol. 3 (4), pp. 450-454, June,
2013. Available online at www.internationalscholarsjournals.org © International Scholars Journals
Full Length Research Paper
A study of ocular morbidity of patients attending
ophthalmic outreach services in rural Ethiopia
Zelalem Addisu Mehari
Nigist Eleni Mohammed Memorial Hospital, Eye unit, P.O. Box 22, Hossana, Ethiopia. E-mail: zadissu@yahoo.com.
Accepted 29 February, 2013
To determine the prevalence of eye diseases and visual impairment among patients presenting outreach site in
rural Ethiopia. A cross-sectional survey for ocular morbidity among self selected patients during ophthalmic
outreach campaign in Kersa town, Ethiopia, in June 2012 was conducted. A total of 214 patients underwent
detailed eye examinations including visual acuity test, intra-ocular pressure measurements, anterior and
posterior segment evaluation and refraction. A total of 214 patients were examined, where males comprised of
50.5%. Ocular diseases were quite prevalent among the study group. Conjunctivitis was the primary ocular
morbidity accounting for 29%, followed by cataract (16.3%), presbyopia (15.4%), refractive errors (7.9%),
Blepharitis 7.5%. Twenty four patients (11.2%) had uncorrected visual acuity of less than 6/60 in the better eye.
The prevalence of visual impairment (VA less than 6/18) was 19.1% (41/214) in the study subjects. Eye diseases
are common amongst rural Ethiopian community. Therefore, screening for eye diseases is important in identifying
those patients at risk of getting blind and providing the right treatment to them and also give a chance to be treated
for those who have logistic problems. The majority of the causes for ocular morbidity, visual impairments as well as
blindness in the study were either preventable or treatable.
Key words: Ocular morbidity, Ethiopia, visual impairment, presbyopia, outreach campaign.
INTRODUCTION
Ethiopia has one of the highest blindness prevalence
rates in the world, with 1.2 million blind people and an
estimated 5 million people suffering from visual
impairment. Although over 80% of blindness and visual
impairment in the region is preventable, tens of
thousands of people continue to lose their sight simply
because they do not have access to the basic eye care
that is so readily available in the developed world.
Various non-governmental organizations have been
working in Ethiopia to reduce the burden of avoidable
blindness and visual impairment. In the rural area of
Ethiopia where eye care facilities are primitive or non-
existent, ocular morbidities are common. Eye diseases
causing preventable blindness are often the result of a
combination of factors such as poverty, lack of education
and inadequate health-care services. The challenge that
Vision 2020 has set itself in Africa is enormous. The
social and financial hardships created by blindness that
occur as result of not having on time treatment seriously
affect individuals and families, in particular, and the
nation at large.
Eye diseases constitute one of the commonest problems
presenting to the health facilities in Ethiopia. A study of
the pattern of ocular diseases is very important because
while some eye conditions are just causes of ocular
morbidity, others invariably lead to blindness. Also while
some conditions like refractive errors and cataract are
treatable, others like trachoma and vitamin A deficiency
are largely preventable.
This study was therefore designed to supply information
about the pattern of ocular diseases in rural community of
central Ethiopia. Information obtained from the study will
assist government and NGOs in planning and facilitate
the incorporation of primary eye care into the existing
primary health care structure of the region.
METHODS
We conducted a cross-sectional survey for ocular
morbidity among self selected patients from June 23-25
2012 during ophthalmic outreach campaign in Kersa
town. It is located 230 kilometres south-eastern of Addis
Ababa, the Ethiopian capital city. All patients who
attended the ophthalmic campaign at Kersa health center
were enlisted for this study. All the subjects had their
Mehari 450
Table 1. Distribution of screened patients by age and sex at Kersa town, Ethiopia, June 2012
(n=214).
Age (yrs)
Sex
Total
Male
Female
No (%)
< 10
16
10
26 (12.1)
11 20
15
20
35 (16.4)
21 30
7
11
18 (8.4)
31 40
16
16
32 (15.0)
41 50
15
16
31 (14.5)
51 60
14
14
28 (13.1)
> 61
25
19
44 (20.5)
Total
108
106
214 (100)
Table 2. Visual acuity as per WHO categorization among the study population at Kersa town, Ethiopia
June 2012, (n=214).
vision tested on the Snellen’s E chart and those who
failed to identify the largest test type (6/60) were asked to
count fingers at less than six meters. If they failed again,
eyes were tested for perception of pointed flashlight.
Those with poor vision (less than the 6/18 line) were
tested with pinhole, and then refracted with non-
cycloplegic/cycloplegic objective (retinoscopy) and
subjective refractions by the optometrist. Fundus
examination through dilated pupil was made whenever
necessary and the media was clear. A total of 214
patients attended the services, which constituted the
sample size of the study. Personal observation form was
used to collect the data, which comprised of detail history
and evaluation of the patients. Intraocular pressure (IOP)
was taken using the schiotz indentation tonometer in
each eye.
Anterior segment was examined with torchlight and
magnifying loupe if and where necessary. The fundus
was examined with the direct ophthalmoscope. A fundus
evaluation under mydriasis was done in relevant cases.
Difficult cases which required examination under the slit
lamp were referred to nearby secondary eye units for
further evaluation and management. Such cases were
not included in the study.
We used the World Health Organization (WHO)
recommended categories of visual impairment. Visual
impairment denotes VA of less than the 6/18 line.
Cataract, regardless of visual acuity, was that cataract in
which the cortex is very opaque or that caused low vision
or blindness with significant change in the lens.
Glaucoma was defined as IOP greater than 20 mm of
Mercury (Hg) with glaucomatous cupping of the optic
disc; or high intraocular pressure over 35 mm Hg with
fixed and dilated pupil. Patients with no optic disc
abnormality but IOP between 20 and 35 mm of Hg
mercury were considered as having ocular hypertension
(4). The diagnosis of the rest of the problems was made
based on conventional history and clinical presentations.
Age, sex, VA and the type of ocular morbidity were
recorded.
Statistical analysis was performed with Statistical
Package for the Social Sciences (SPSS) version 12. A P
Visual impairment category
Left Eye
No (%)
No visual impairment
(6/6-6/18)
149 (69.6)
Visual impairment
(<6/18-6/60)
22 (10.3)
Severe visual impairment
(<6/60-3/60)
6 (2.8)
Blindness (<3/60)
30 (14.0)
Undetermined
7 (3.3)
Total
214 (100)
451 Int. J. Med.Med.Sci.
Table 3. Pattern of ocular diseases at Kersa town, Ethiopia, June 2012.
Eye Disease No of patients (%) Eye Disease No of patients (%)
Eye Lid Retina
Trichiasis 4(1.9) Diabetic retinopathy 2(0.9)
chalazion 2(0.9) AMD 6(2.8)
Ptosis 3(1.4) Macular Scar 1(0.5)
Dermoid Cyst 1(0.5) Retinal Detachment 1(0.5)
Blepharitis 16(7.5)
Lacrimal system Optic Nerve
Dry eyes 8(3.7) Optic atrophy 1(0.5)
Nasolacrimal duct obstruction 4(1.9) Optic Neuritis 2(0.9)
Conjunctivia Papilloedema 1(0.5)
VKC 22(10.3)
Allergic conjunctivitis (others) 26(12.1) Refractive Errors
Bacterial Conjunctivitis 14(6.5) Myopia 7(3.3)
Pterygium/Pinguecula 4(1.9) Hyperopia 5(2.3)
Cornea Astigmatism 5(2.3)
Keratitis 3(1.4) Presbyopia 33(15.4)
Corneal Ulcer 2(0.9)
Bullous keratopathy 1(0.5) Glaucoma
Corneal Opacity 6(2.8) Glaucoma Suspect 2(0.9)
Uveal Advanced Glaucoma 7(3.3)
Uveitis 3(1.4) Squint
Lens Convergent squint 3(1.4)
Cataract 35(16.4) Divergent squint 1(0.5)
Pseudophakia 4(1.9) Trauma
Subluxated Lens 2(0.9) Superficial FB 2(0.9)
Deep Lacerations 2(0.9)
value of <0.05 was accepted as indicative of statistical
significance.
RESULTS
A total of 214 patients were examined, and nearly equal
proportions of males and females were examined at the
outreach site by the survey team, 50.5% (108/214) and
49.5% (106/214), respectively. Patients examined were
from all age groups; the mean age (SD) were 39.4
(+22.3) years, ranging from 9 month to 80 years. Eye
diseases were more frequent in aged 60 and above years
followed by 11-15 years group accounting 20.5% and
16.4%, respectively. The number of female patients was
more than males in 11-20 and 21-30 age groups (Table-
1).
When data on patients’ visual acuity was considered, the
uncorrected visual acuity of 6/18 or better in at least one
eye was found in 150(70%) cases. Twenty four patients
(11.2%) had uncorrected visual acuity of less than 6/60 in
the better eye. The prevalence of visual impairment (VA
less than 6/18) was 19.1% (41/214) in the study subjects.
Vision couldn’t be tested in 7 cases (they are children)
(Table 2). Visual acuity difference was not statistically
significant between genders (P=0.94, 95% CI, 1.31-1.66).
The prevalence of various ocular diseases is shown in
Table 3. Some patients suffered more than one eye
disease. For that reason, the total number of diseases in
the table is more than the total number of patients in the
study. Blepharitis was the most common eyelid disease
(7.5%, 16/214), followed by trachomatous trichiasis.
Conjunctivitis was seen in 66 patients (30.8%), of these
VKC accounted the largest part (33.3%) of the
conjunctiva diseases. Corneal opacity (of any cause) was
seen in 6 out of 12 (50%) corneal diseases. Cataract was
also the commonest eye disease seen in 16.5 % (35/214)
cases.
Three cases of uveitis were detected, in all cases it was
burnout. Glaucoma was seen in 9 cases. There was
enlargement of optic cup in two patients who were
diagnosed as glaucoma suspects and investigated using
intraocular pressure and direct ophthalmoscope and
referred for visual fields testing.
A percentage of 70 cases had VA 6/18 or better, while
9.8 %( 21/214) of the cases examined had visual
impairment due to cataract, in 3.3 %( 7/214) due to RE,
and the remaining 5.6% (12/214) of the subjects had
visual impairment due to corneal opacity, glaucoma,
amblyopia and optic atrophy. Reason for visual
impairment (visual acuity less than 6/18 in the better eye)
has shown in table 4.
Mehari 452
Table 4. Causes of visual impairments among 214 patients in Kersa town, Ethiopia,
June 2012. (n=45).
Eye Disease
Visual impairment*
No %
Cataract
21
51.2
RE
8
19.5
CO
5
12.2
Glaucoma
4
9.7
Amblyopia
2
4.9
Optic atrophy
1
2.4
Total
41
100
*Presenting visual acuity of less than 6/18 in the better seeing eye was considered as
visual impairment.
DISCUSSION
The limitations of such conventional surveys based on
self-selected participants are well recognized. The
coverage of this survey was low because only those who
thought to have some sort of eye problem subjected
themselves for the screening those who lived at far
distance suffering from eye problems that did/ not cause
them pain or redness in the eyes or visual impairment
may not seek medical attention due to logistical
difficulties. Therefore, results from such mobile eye
clinics do not provide exact information on the prevalence
of eye diseases in the community under study. They are
subject to a number of biases. However, the data
obtained is of great importance in the planning of eye
services in these areas. Screening for eye diseases is
important in identifying those patients at risk of getting
blind and providing the right treatment to them. The
majority of the causes for ocular morbidity, visual
impairments as well as blindness were either preventable
or treatable.
In the present study the attendance of men and women
was in equal ratio. This is in contrast with the general
observation that fewer females are seen in medical
clinics than males in the developing countries ( KC RM et
al., 1998). As the study was took place at the rural areas
thereby enabling the females for easy access to eye care
services equally to males. Cataract was one of the
commonest causes of ocular morbidity in this study that
accounted for 16.4% and the main cause (>50%) of
bilateral blindness and low vision in this survey similar to
the national survey and it also is elsewhere in the world (
Yemane Berhane et al., 2007; Resnikoff et al., 2002).
This finding is similar to population based studies
conducted in two different parts of rural Ethiopia, and
slum of Addis Ababa (In self selected patients) that
showed 50%, 66.7%and 48% of the blindness were due
to cataract ( Meles M et al., 2003; Alemayehu Woldeyes
and Yilkal Adamu, 2011; Aga 2001). But larger than
findings of a study conducted in mobile outreach clinic,
Adjumani settlement camps for Sudanese refugees in
Uganda (44%) ( M. Kawuma M, 2000). Bilateral
congenital cataract is the most common cause of
treatable childhood blindness, and this was seen in two
infants. Attempts made to produce drugs for the
prevention of cataract have not been successful yet, and
the only treatment for cataract remains to be surgical
removal of the opaque lens. The cataract backlog in
Ethiopia is one of the highest and reversely the cataract
surgical rate is very low ( Alemayehu W and Chernent A,
1993). Refractive error is one of the most common
causes of visual impairment around the world and the
second leading cause of treatable blindness ( Taylor HR,
2000). Also similar prevalence of refractive errors has
been observed in the above studies. Nearly sixteen
percent of the patients examined had difficulty in reading
which was age related. All of them were refracted and
then glasses were prescribed.
In general, Ocular diseases were quite prevalent among
the study group. Conjunctivitis was the primary ocular
morbidity accounting for 29%, of these vernal
keratoconjunctivitis (VKC) or spring catarrh is accounted
one-third. This is a self-limiting disorder; it often leads to
visual impairment due to secondary corneal
complications if not treated during active stage of the
illness. Apart from this, the illness is known to affect the
productivity and quality of life in school going children due
to absenteeism and limitations to outdoor activities. The
second common ocular morbidity among the study group
was cataract (16.3%), followed by presbyopia (15.4%),
refractive errors (7.9%) extra ocular diseases, like
Blepharitis 7.5%, Posterior segment diseases (6.5%),
which includes age related macular degenerations,
Diabetic retinopathy and optic Neuritis and others. A
clinic based survey of several rural eye clinics in
Cambodia showed that cataract, refractive error, anterior
segment diseases, glaucoma were the common diseases
seen in the community ( Thomson I, 1997). Conjunctivitis
32.9%, cataract 14.7%, ocular injuries 12.8% and
refractive errors 9.9% were some of the diseases
identified at an outpatient clinic in Ibadan, Nigeria ( Scott
SC and Ajaiyeoba AL, 2003). A study of eye diseases in
Gaza showed cataract, refractive errors, trachoma,
keratitis, ocular trauma as the common causes of ocular
morbidity ( Thomson IM and Chumbley LC, 1984).
Cataract (48.0%), glaucoma (21.1%), refractive errors
(12.4%) were some of the ocular problems seen among
rural dwellers in a study conducted in South-western
Nigeria ( Adegbehingbe BO and Majengbasan TO, 2007).
In a similar survey of ophthalmic conditions in rural
Lesotho, it was seen that conjunctivitis, refractive errors,
cataract and glaucoma were the common conditions
presenting in the community ( Yitzhak JG and Mokete M,
1980). But the findings of the present study were larger
than findings of rural Nigeria where the prevalence of
refractive errors was 41.2% and it was the most common
condition followed by allergic conjunctivitis and pterygium
each accounting for 8.2% ( Nwosu SN, 1998). The finding
of prevalence of visual impairment (19.1%) among the
study group was similar to the rural community (20%) in
Gurage Zone (Ethiopia), Malaysia (18.9%), and
comparable to the urban population (27%) in Addis
Ababa and Saudi Arabia (25.6%). This finding was larger
than findings of Abeshge and Kebena districts study
(14.4%), south of Addis Ababa ( Meles M et al., 2003;
Alemayehu Woldeyes and Yilkal Adamu, 2011; Aga,
2001; Reddy SC et al., 2004; al Faran MF and Ibechukwu
BI,1993). The reason for this variation could be the age
group, number of patients examined and the study
design. The prevalence of visual impairment and
blindness varies geographically due to socio-economic
factors, availability of health services and awareness of
eye diseases among the population. Globally,
uncorrected refractive errors were the main cause of
visual impairment; cataracts remained the leading cause
of blindness in middle- and low-income countries; the
number of people visually impaired from infectious
diseases had greatly reduced in the last 20 years; and
80% of all visual impairments could have been avoided or
cured ( World Health Organization, 2011). In the present
study, 88% of causes of visual impairment could have
been avoidable or cured.
In conclusion, the majority (88%) of causes of blindness
among the study group in this survey was avoidable,
cataract being the leading cause. Stable intervention
programs targeting cataract, refractive errors, glaucoma
and trachoma may significantly decrease the burden of
visual impairment in the area. Health educations that
raise awareness about preventable and curable eye
diseases and the benefits of personal and environmental
sanitation are mandatory.
ACKNOWLEDGEMENTS
I would like to acknowledge Harmee Education for
Development Association for its financial support for the
outreach campaign. I am also gratefully all the patients
and their relatives for their co-operation. Similarly; I would
453 Int. J. Med.Med.Sci.
like to acknowledge the entire team of the outreach
campaign for their tireless support.
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... Our study showed a small difference in the presentation of male (46.4%) and female (53.6%) patients to the outpatient department at Saint Joseph's Hospital. 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% ...
... Nevertheless, higher numbers were shown for other areas of sub-Saharan Africa like Nigeria (19.9%) and Uganda (20.0%) [1,22]. Unspecified conjunctivitis was described by Zalelem et al. [16] with 29.0%, by Khan et al. [20] with 26.0% and by Kimani et al. [9] with 31.0%. Concerning infectious conjunctivitis, Kamali et al. [22] found 8.0% in Uganda, compared to 3.2% in our study. ...
... Three more studies performed in countries of sub-Saharan Africa revealed similar numbers. Those are the Ethiopia study by Zalelem et al. [16] with 16.3%, the Nigeria study of Ukponmwan [1] with 15.9% and the Uganda study of Kamali et al. [22] with 9.0%. Numbers lower than 5% were illustrated by Khan et al. [20] with 4.3% and by Khadse et al. [18] with 4.8%. ...
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... Ethiopia was one of the highest blindness prevalence rates in the world, with 1.6 million blind people and an estimated 3.7 million people suffering from visual impairment. Although over 90% of blindness and visual impairment in the region is preventable [7]. The most common eye diseases seen among patients attending ophthalmic outreach services in a rural area in Ethiopia were conjunctivitis (29%), cataract (16.3), presbyopia (15.4%), refractive errors (7.9%), and blepharitis (7.5%) [7]. ...
... Although over 90% of blindness and visual impairment in the region is preventable [7]. The most common eye diseases seen among patients attending ophthalmic outreach services in a rural area in Ethiopia were conjunctivitis (29%), cataract (16.3), presbyopia (15.4%), refractive errors (7.9%), and blepharitis (7.5%) [7]. In general, the pattern of ocular diseases varies in different parts of the world and is in luenced by racial, geographic, socioeconomic and cultural factors [6][7][8][9][10]. ...
... The most common eye diseases seen among patients attending ophthalmic outreach services in a rural area in Ethiopia were conjunctivitis (29%), cataract (16.3), presbyopia (15.4%), refractive errors (7.9%), and blepharitis (7.5%) [7]. In general, the pattern of ocular diseases varies in different parts of the world and is in luenced by racial, geographic, socioeconomic and cultural factors [6][7][8][9][10]. ...
... In a rural community in Ethiopia, four ocular morbidities were identified in order of severity included conjunctivitis (29%), cataract (16.3%), presbyopia (15.4%) and uncorrected refractive error (7.9%), [6]. In Imo State, Nigeria rural communities were screened, and the most common ocular morbidities found were refractive error (31.6%), glaucoma (23.5%), presbyopia (17%) and cataract (12%), which were suggestive of establishing well equipped primary eye care services [7]. ...
... The undetermined cases where vision that could not be tested in about nine cases of children that was not cooperating. The visual acuity findings in this survey is far much less compared to a study done in Ethiopia were uncorrected refractive error was found to be 7.9%, [6]. Table 1 shows distribution pattern of the various ocular diseases. ...
... Conjunctivitis occurred most commonly in 562 (73%) participants, followed by refractive errors 118 (15%) and 31 (4%) cataracts. These findings are similar to a study conducted in Ethiopia, the most common of which was conjunctivitis, but the percentage was much lower (29%), [6]. A similar study in West Nepal showed that refractive errors (26.8%) were the most common ocular morbidity followed by conjunctivitis (20.6%) [5]. ...
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Background: Majority of ocular morbidities found in developing countries are preventable and curable and vary from country to country and from community to community. Screening of ophthalmic conditions in communities with underserved ophthalmic services, can help detect and treat various spectra of ocular morbidity. Untreated ocular conditions may lead to vision impairments and blindness. Methods: A free walked-in ophthalmic screening outreach survey was conducted at a rural community in Rwanda and the total number of attendees was 762. Patients' demographics, detailed case history, and ophthalmic specific evaluation tests generated the survey data. Treatment offered was based on the diagnoses made. Patients who required special treatment or reviews were referred to the health care facilities for further investigations and subsequent management. The recorded data on observation forms were analyzed by Statistical Package for Social Sciences (SPSS) computer software using descriptive statistics. Results: Majority (91.5%) of the patients were from Mageragera community where the outreach was conducted. The number of females 71.7% (546) seen were more than males 28.3% (213) in the ratio of 2.5:1. Age group with the highest number of patients was (1-10) years, 139 (18.2%) while the least was ≥71 years, 34 (4.5%). Among ocular morbidities diagnosed, conjunctivitis ranked highest 562 (73.8%), followed by refractive errors 118 (15.5%) and cataract 31 (4.1%). Glaucoma was diagnosed in 4 (0.5%) clients. Medication given included steroidal, non-steroidal and antibiotics ophthalmic drugs. Conclusion: A total of 762 patients benefited from early diagnoses, treatment and referrals. The pattern of eye diseases observed was similar to other reports from other developing countries. Statistics from this survey provides baseline data which can be used for planning, management and prevention of ocular conditions in the studied community as well as in research.
... This may be attributed to the fact that this was a free outreach which was brought literally to the door steps of these women who ordinarily are kept busy with household chores and no extra funds for their health care. The age range ( Table 1) was similar to what was seen in other outreaches with a mean age of 48 years [16] [17]. ...
... The most common type of ocular disorder noted in this study ( [19]. Other studies however, reported cataract, [14] [16] and conjunctivitis [17] as the most common ocular disorders. Uncorrected Refractive error in the Nigerian National Blindness Survey was shown to be the commonest cause of mild (77.9%) and moderate (57.1%) [1] visual impairment and the leading cause of visual impairment at a prevalence of 43% [20]. ...
... Presbyopia at 17% ( Table 2) was the third most common ocular disorder similar in prevalence to the findings in Ethopia [17]. Larger figures were reported by Omoti (68.6%) and Akinsola (61%) in their studies [3] [11]. ...
... In most sub-Saharan African countries including Ethiopia visual impairment is a result of either preventable or treatable morbidities due to a combination of factors such as lack of education, poverty, inadequate health-care services and material resource [5,33,34]. ...
... In Ethiopia regardless of multipronged approaches and strategies to reduce the burden of visual impairment through promoting use of eye glasses, increasing public awareness, free mass campaign service on cataract and trichiasis surgery, blinding factors are still on the rise due to growing population and aging [34]. ...
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Background Globally, visual impairment affects about 285 million (4.25%) people, of those, 266.4 million were adults aged 18 years and above. Ethiopia is one of developing countries estimated to have high prevalence of visual impairment which have an enormous socio-economic impact. Also there is limited available information regarding with the magnitude of visual impairment among adults in our country at large and east Gojjam zone in specific. Therefore the aim of this study was to assess the magnitude of visual impairment and its associated factors among patients attending Debre Markos Referral Hospital ophthalmic clinics in east Gojjam zone, North West Ethiopia. Methods An institutional-based cross-sectional study was conducted at Debre Markos Referral Hospital which is the only hospital in east gojjam zone with ophthalmic care service from March 1 to 30, 2020 by using systematic random sampling technique to select study participants after informed consent was obtained. Data were collected by interview with 5% pretested, structured questionnaire and ocular examinations. Data were cleaned, coded and entered to Epi-data version-3.1, and analyzed using Statistical Package for Social Science software version 26. The descriptive statistics was presented in tables, text and graphs. Bivariable and multivariable logistic regression analysis to identify factors associated with visual impairment was conducted. Covariates with P-value < 0.05 were considered statistically significant. Results A study was conducted among 312 study participants with 96% response rate. The magnitude of visual impairment was 114 (36.5%) [95% CI, (33.8, 39.2%)]. Age > 50 years [AOR = 3.82; 95% CI (1.56, 9.35)], rural residency [AOR = 4.33 95% CI (1.30, 14.44)], inability to read and write [AOR = 3.21; 95% CI (1.18, 8.73)] and Cataract [AOR = 4.48; 95% CI (1.91, 10.52)] were factors significantly associated with visual impairment. Conclusions The overall magnitude of visual impairment was found to be high. Older age, rural residency, inability to read and write and cataract were associated with visual impairment. Increasing literacy, expanded cataract surgery, as well as community based visual acuity screening especially for elders and rural residents is crucial. Zonal police makers should give emphasis on prevention of visual impairment to decrease economic, social and political burden of visual disability.
... However, there are few reports of pattern of eye diseases seen in rural outreaches, [9][10][11][12][13] especially in Northern Nigeria. [14] The aim of this study is to ascertain the pattern of eye diseases seen at eye outreach program in a rural community of Kebbi State so as to have baseline information which will help in formulating and planning community-based eye care service for rural dwellers in the state. ...
... One out of every six persons (17.9%) seen in this outreach presented with one form of refractive errors or the other and is the third most common form of ocular morbidity seen. In Eastern Nigeria, [10] refractive error was the second most common eye problem seen while in a rural area of Ethiopia, [11] refractive errors including presbyopia was the most common ocular problem among the rural dwellers. ...
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Background: The lower socioeconomic status and long distance to eye care facility of the rural dwellers in many communities in developing countries accounts for the increase in the number of preventable and avoidable causes of blindness compare to developed countries of the world. It is widely believed that the best option to reduce blindness and visual impairment in these communities is to bring eye care services to their doorsteps in the form of outreach programs this has been practiced successfully in India and other Asian countries. Aims: To assess the pattern of eye diseases presenting at a free eye outreach in a rural community of Nigeria. Materials and Methods: A retrospective study was carried out on the findings of 3-day outreach programs at Zuru General Hospital, in Zuru Emirate of Kebbi State, Northwestern Nigeria. The following information was extracted from patient's folders: sociodemographics, diagnosis, treatment offered the patient, and distance of the patient house to the eye outreach center. The data were analyzed by SPSS version 18 (2006 Statistical Package for the Social Sciences, Chicago, Illinois, USA). Results: There were 458 patients seen at the outreach of which 197 (43%) were males and 261 (57%) were females. More than half of the patients 236 (52%) were 50 years and above, followed by age group of 34–50 years 99 (21.6%). The majority of the patients 128 (27.9%) were homemakers, followed by civil servants 125 (27.2%), and farmers 112 (24.5%). Most of the patients 188 (41%) covered a distance of 3–5 km before reaching the outreach center. The predominant ocular diseases seen were cataract 148 (32.3%), glaucoma 84 (18.3%), and refractive error 82 (17.9%). Conclusion: There were more females seen at our free eye outreach and majority of participants were 50 years and above. Cataract, glaucoma, and refractive error were the main reasons why patients presented at the outreach center. Efforts at improving the ocular health of this community should be focused on reducing the burden of cataract, glaucoma, and refractive error.
... [2][3][4] Studies indicate that Ethiopia is one of the world's highest rates of blindness populations especially in the elderly. 5,6 By the year 2020 depression was expected to be the major cause of disease burden for older populations. 7 As a result, the burden on both eye care and mental health care for people with a visual impairment (VI) is expected to increase. ...
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Background: Depression among older adults with visual impairment is the commonest psychiatric problem and causes a range of effects in on disability and progression of visual health outcomes that may even end in death. In Ethiopia, there are gaps in the detection of the comorbidity of mental health problems especially depressive symptoms among those older people. This study aimed to assess the prevalence of self-reported depressive symptoms and determinant factors among the elderly people with visual impairment attending the ophthalmologic outpatient clinic. Methods: A group of 423 elderly people with visual impairment invited by systematic random sampling technique to took part in the interview for this cross-sectional study at Menelik II referral hospital, Addis Ababa, Ethiopia from January to June 2019. Descriptive statistics like frequency, percentage, mean and standard deviation were used to summarize the distribution of the data. Binary logistic regression analysis was employed to examine the associated factors. An adjusted odds ratio with a 95% confidence interval was used for reporting the result, and a p-value of <0.05 was considered as statistically significant. Results: The prevalence of self-reported depressive symptoms among elderly people with visual impairment was 26.7% with a 95% confidence interval (22.6-30.8). Widowhood, single and/divorced [Adjusted Odds Ratio (AOR)= 3.17, 95% CI: 1.71, 5.91]; [AOR=2.70, 95% CI: 1.35, 5.38], respectively, poor social support [AOR=4.34, 95% CI: 1.84, 10.24], severe level [AOR=2.63, 95% CI: 1.73, 6.63] and longer duration (>5 years) of the illness [AOR=3.15, 95% CI: 1.60, 6.19] were the factors significantly associated with higher odds of depressive symptoms. Conclusion: The Prevalence of self-reported depressive symptoms among elderly people with visual impairment in Ethiopia was high. Public health interventions targeting risky individuals with high depressive symptoms are needed to reduce depressive symptoms and to prevent disability and poor medical illnesses outcomes related to depressive symptoms.
... The commonest ocular disorder seen was refractive error which presented in 77.9% of participants, followed by allergic conjunctivitis 17.3% A few studies done in our region have reported Cataract, uncorrected refractive error [5], Glaucoma, allergic conjunctivitis [13], Refractive error, cataract [16,17], cataract, refractive error [18]. It is noteworthy that refractive error appears in most of the studies as a common cause of ocular morbidity except in the study by Osuji (3) where glaucoma was the commonest ocular disorder followed by cataract and pterygium. ...
... The commonest ocular disorder seen was refractive error which presented in 77.9% of participants, followed by allergic conjunctivitis 17.3% A few studies done in our region have reported Cataract, uncorrected refractive error [5], Glaucoma, allergic conjunctivitis [13], Refractive error, cataract [16,17], cataract, refractive error [18]. It is noteworthy that refractive error appears in most of the studies as a common cause of ocular morbidity except in the study by Osuji (3) where glaucoma was the commonest ocular disorder followed by cataract and pterygium. ...
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Abstract Background: A large and growing body of evidence shows that socio-demographic factors – age, race, ethnicity and language as well as socioeconomic status (SES), such as income and education, can influence health seeking behaviours and thus health outcomes. Worldwide, the pattern of ocular diseases varies from one location to another. However, cataract, glaucoma, conjunctivitis, refractive errors, pterygium are considered the common ocular disorders. This study is aimed at finding the sociodemographic characteristics and ocular status of participants at a screening programme. Methods: A cross sectional population-based study conducted among individuals who voluntarily sought to be screened for glaucoma and ocular conditions during the 2020 World Glaucoma Week. Prevalidated self/interviewer administered questionnaire was used for socio-demographic information while clinical data was obtained from eye examination. Data so obtained was analyzed using SPSS version 25. Results: There were 139 (60.2%) female participants and 92 (39.8%) male participants in the ratio 1.5:1. Age group 31-40 years was the highest. Participants with post-secondary education only was 80 (34.6%) while 64 (27.7%) had primary education only, civil/public service was the highest occupation 72 (32.9%).The commonest diagnosis were presbyopia ±refractive error 56 (20.1%) and cataract 52 (18.6%). One hundred and sixty three (70.5%) had a VA of 6/18 or better while 39 (16.9%) had a VA of ≤3/60(CF) in the RE. Twenty one (10.4%) participants had a VCDR.>0.7 RE. Conclusion: Uncorrected refractive errors/ presbyopia remains the predominant cause of visual impairment. Cataract and glaucoma are still the commonest causes of preventable and avoidable blindness respectively. Key word: socio-demographic factors, visual impairment, screening
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Background: The magnitude and causes of eye diseases in Ethiopia has been derived from small scale studies. This information became no longer useful in tracking the success of intensified efforts in preventing and controlling avoidable causes of blindness and eye diseases in line with the goals of Vision 2020: The Right to Sight. Objective: The national household survey was conducted primarily to provide national and regional state level estimates of low vision, blindness and trachoma. The secondary aims include describing the major causes of low vision and blindness. Methods: The national survey utilized cross sectional epidemiological study design with multistage sampling strategy. All nine regional states and two city administrations of the country were involved in the survey. Sample size and sampling strategies were developed taking into account population size of the regional states. Visual acuity was tested using the LogMar chart and trachoma grading was done following the WHO grading system. The cause of low vision and blindness were determined by ophthalmologists. Results: A total of 174 clusters, 6056 households and 30022 individuals were involved in the survey. Of the total 30022 individuals 25650 (85.4%) were present and examined by the survey team. Implementing quality control supervision in the very remote clusters was a major challenge. About 55% of the survey clusters were within 10 Km of health facility that stock tetracycline; 18.3% within 10 Km of health facility that provides Trachomatous Trichiasis (TT) surgery and 18.6% were within 10Km of health facility that provides cataract surgery. Only 29.4% of the survey clusters were fully accessible by car. The majority of survey household head were farmers (70.8%) and illiterate (64.5%). About 48% of the households obtain their water from either a protected well/spring or piped distribution. Only 40.4% of the households reported that no animal is kept around the living quarter. Most households dispose garbage in open field (84.6%) and have no latrine (60.3%). Conclusion: The survey was conducted on a representative sample and provides reliable estimates at the national and regional levels. However, careful interpretations of results from remote and inaccessible areas are warranted. Access to eye care facilities are limited and need expansion in order to reduce the blindness and low vision load. Sanitation conditions favoring fly breeding are rampant and trachoma control program need to emphasize a more integrated approach.Ethiopian Journal of Health Development Vol. 21 (3) 2007: pp. 185-203
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To determine the magnitude and causes of low vision and blindness in the Gurage zone, central Ethiopia. A cross sectional study using a multistage cluster sampling technique was used to identify the study subjects. Visual acuity was recorded for all adults 40 years and older. Subjects who had a visual acuity of <6/18 were examined by an ophthalmologist to determine the cause of low vision or blindness. From the enumerated population, 2693 (90.8%) were examined. The prevalence of blindness (<3/60 better eye presenting vision) was 7.9% (95% CI 6.9 to 8.9) and of low vision (6/24-3/60 better eye presenting vision) was 12.1% (95% CI 10.9 to 13.3). Monocular blindness was recorded in 16.3% of the population. Blindness and low vision increased with age. The odds of low vision and blindness in women were 1.8 times that of the men. The leading causes of blindness were cataract (46.1%), trachoma (22.9%), and glaucoma (7.6%). While the prevalence of vision reducing cataract increased with age, the prevalence of trachoma related vision loss did not increase with age, suggesting that trichiasis related vision loss in this population might not be cumulative. The magnitude of low vision and blindness is high in this zone and requires urgent intervention, particularly for women. Further investigation of the pattern of vision loss, particularly as a result of trachomatous trichiasis, is warranted.
Article
Background: Over three-quarter of all blindness worldwide are preventable and usually caused by cataract and trachoma. Objective: To assess the prevalence of cataract blindness in rural Ethiopia in order to facilitate further health care planning. Methods: A Cross-sectional, community-based study of inhabitants over 40 years of age from villages in the Abeshge and Kebena Districts, south of Addis Ababa. A total of 1100 eligible participants were identified in the study. Visual acuity (VA) was measured using a Snellen's E chart at 6 metres and eye examinations were performed using torch light, 2.5 X magnifying glasses and an ophthalmoscope. Cataract was defined as lens opacity identified as the cause of blindness and low vision after ruling out other causes. Unfortunately, there was no access to a refraction set and slit lamp to conduct thorough examinations. Results: The adjusted prevalence of bilateral cataract blindness (VA<3/60) was 2.4%, 95% confidence interval [CI], 1.8%-3.0%. Cataract is the major cause of bilateral blindness (66.7%) among the participants. The cataract surgical coverage was 28.9% for men and 18.1% for women. The adjusted prevalence of bilateral cataract and VA<6/60 was 3.6% (95% CI, 1.4%-5.8%). In this last group, the surgical coverage was 41.2% (persons) and 38.5% (eyes). Of all operated eyes, 30% could not see at 6/60. Inability to afford the procedure (64.5%) and poor knowledge of cataract (29.8%) were the reasons why surgery had not been performed. Conclusions: Cataract blindness is a major health problem in the study area with low surgical uptake. There is backlog of cataract blindness in the study area that will increase with ageing. This backlog was also reflected in other developing countries. Awareness campaigns, reducing cost, and expansion of surgical services may help to increase the cataract surgical rate, and women should be offered more cataract surgery. These results will enable health managers to plan effective interventions in line with Vision 2020.
Article
Background: In developing countries major causes of visual impairment are known to be preventable, however there is no information about the situation in Ethiopia.Objective: To identify the major avoidable causes of visual impairment in elderly people.Methods: A survey was conducted between November and December 1997, in the slum of central Addis Ababa. Five hundred seventy one people above the age of 50 years underwent detailed eye examinations including visual acuity test and intra-ocular pressure measurements.Results: About 9% were blind [visual acuity <3/60] and 18% had poor vision [visual acuity >3/60 but <6/18] and. The leading causes of blindness were cataract, 48%; glaucoma, 15.3%; trachoma 11.5%; post-operative aphakia 11.5%; and age-related maculopathy, 5.8%. These etiologies and refractive errors were responsible for 90% of low vision. Cataract, 48.3%; trachoma, 14.9%; presbyopia, 12.6%; Glaucoma, 8.9%; and external eye infections, 7.8%; were the five top causes of eye morbidity.Conclusions: Most of (86%) the blindness in the elderly was due to avoidable causes. Intervention programs targeting cataract, glaucoma and trachoma may significantly decrease the burden of visual impairment in elderly people. (Ethiopian Journal of Health Development, 2001, 15(2): 139-144)
Article
A random sample of 9548 Palestinian Arabs living in the West Bank and Gaza Strip was identified, and 9054 (95.7%) were examined. Particular attention was directed to reduced visual acuity (VA) and its cause and to trachoma. Low visual acuity was defined as less than 6/18 in both eyes and binocular blindness as a VA less than 3/60 in both eyes. The overall incidence of low VA was 6.8% and of binocular blindness 1.7%. The three principal causes of blindness in order of frequency were cataract, trachoma, and corneal leucoma. These three conditions accounted for 66.7% of binocular blindness. Trachoma was present in 2568 (28.4%) of the 9054 people examined.
Article
The first survey of ocular problems in rural Lesotho was conducted by a visiting eye team and consisted of an examination of 1266 ophthalmic clinic patients at 15 representative sites throughout the country. The most common ocular conditions encountered were: conjunctivitis, refractive error, vernalis, senile cataract, glaucoma, corneal opacities and trauma. This disease pattern differs from most developing African nations for reasons of climate, geography and diet. The absence of disciform macular degeneration, narrow-angle glaucoma, and rarity of retinal detachment was noted. The educational impact of the survey, and its importance for future planning are suggested.
Article
To survey the spectrum of eye disease presenting to rural eye clinics in Cambodia. A total of 1381 patients seen consecutively at 13 eye clinics were examined and the findings recorded. 231 (16.7%) were bilaterally blind (visual acuity < 3/60 in both eyes); 263 (19%) were unilaterally blind, and 169 (12%) had low vision (visual acuity < 6/18 in the better eye). Cataract was the commonest cause of visual loss in all three categories and was responsible respectively in 69%, 40%, and 55% of each group. Trachoma was diagnosed in 13% of patients. Thirty three of them needed lid surgery for trichiasis. With the difficult practical and political situation in Cambodia there seems little prospect of making substantial inroads into the backlog of avoidable blindness in the near future.
Article
To determine the common eye diseases as well as the prevalence and causes of blindness and visual impairment in young adult residents of rural areas of Anambra State, Nigeria. Three rural villages in Anambra State, Nigeria were selected by simple random sampling. A structured questionnaire on demographic characteristics, symptoms and attitude to eye diseases was administered to residents aged 18-49 years. Ocular examination included visual acuity estimation, colour vision test, tonometry, refraction and ophthalmoscopy. Skin-snip was examined for microfilaria. The common ocular problems in the 510 young adults examined were presbyopia (33.3%), refractive errors (41.1%), allergic conjunctivitis (8.2%), pterygium (8.2%), pingueculum (5.9%) and colour vision defect (2.4%). Bilateral blindness occurred in 1.2%, uniocular blindness in 0.8% and 1.7% had visual impairment in their better eyes. Glaucoma and sequelae of congenital cataract caused bilateral blindness while visual impairment was due to refractive errors, cataract, corneal opacities and uveitis. Trauma predisposed to uniocular blindness and visual impairment. Eyeglasses alone would alleviate visual impairment and ensure good near vision in more than 47% of the subjects. The prevalence of blindness could be reduced through early detection of glaucoma, congenital cataract and ocular trauma.