|Year : 2015 | Volume
| Issue : 2 | Page : 111-114
Prevalence of ocular morbidities among basic school children in the Kwabre East District of Ghana
Kumah David Ben1, Mohammed Abdul-Kabir1, Opoku-Yamoah Victor2, Adade Samuel1
1 Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
2 Eye Department, Obuasi Government Hospital, Obuasi, Ghana
|Date of Web Publication||10-Apr-2015|
Kumah David Ben
Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi
Source of Support: None, Conflict of Interest: None
Background: Many ocular conditions when detected at an early age such as basic school age through vision screening are amenable to interventional measures. Despite this, there are no eye screening programs for school children in Ghana. Objective: The study set out to determine the prevalence of ocular morbidity among basic school children in the Kwabre East District of Ghana. Methods: A descriptive, cross-sectional survey was carried out in March 2014. A multi-stage random sampling technique was used to select school children aged 6-16 years from five randomly selected schools in the district. Ocular history and basic ocular examinations were carried out on the children that were sampled. Results: A total of 456 children were examined; they comprised 170 (27.3%) males and 286 (62.7%) females with a mean age of 12.6 ± 2.25. 215 (47.1%) of the school children had various ocular morbidities. Refractive error was found to be the most predominant ocular morbidity among 120 (26.3%) school children, followed by allergic conjunctivitis 79 (17.3%). A total of 445 (97.6%) of the participants had a visual acuity (VA) of 6/5-6/12, 8 (1.8%) had a VA of < 6/12-6/36 and 3 (0.7%) had a VA of 6/60 - NPL in their right eye. Only 12.8% of the school children had knowledge about refractive errors. Conclusion: Uncorrected refractive error and allergic conjunctivitis were the leading ocular morbidities found among school children in this sample. A routine ocular health assessment among basic school children is recommended to prevent any visual impairment.
Keywords: Ocular morbidity, prevalence, school children
|How to cite this article:|
Ben KD, Abdul-Kabir M, Victor OY, Samuel A. Prevalence of ocular morbidities among basic school children in the Kwabre East District of Ghana. Int J Health Allied Sci 2015;4:111-4
|How to cite this URL:|
Ben KD, Abdul-Kabir M, Victor OY, Samuel A. Prevalence of ocular morbidities among basic school children in the Kwabre East District of Ghana. Int J Health Allied Sci [serial online] 2015 [cited 2022 Aug 11];4:111-4. Available from: https://www.ijhas.in/text.asp?2015/4/2/111/154912
| Introduction|| |
Some studies on eye diseases in children carried out in the United Kingdom, Canada, and United States (USA) showed that the common ocular disorders in these countries were congenital or hereditary.  Many ocular diseases may go unnoticed in children and could adversely affect the child's performance in school. Some of the eye conditions could cause severe functional visual disability in the later part of life.  Vision is important to people of all ages, especially children and adolescents given the fact that a visually impaired child has many "blind" years ahead to live with the disability. This comes with far reaching implications for educational and social development.  Only children with severe learning and behavioral disabilities are often brought to eye care personnel for evaluation. 
Given that about 75% of blindness, including cases of childhood blindness are preventable, the Vision 2020 initiative was established by the WHO in 1999 to prevent all forms of avoidable blindness.  This highlights the need for vision screening among children. Children suffer a myriad of eye conditions from causes such as Vitamin A deficiency, measles, and sickle cell diseases. Childhood eye conditions include refractive errors, xerophthalmia, and trachoma; refractive errors could be corrected to improve vision while xerophthalmia and trachoma are both preventable and treatable. It has been reported that school-going age children (6-16 years) form 25% of the population in developing countries.  They fall within the preventable blindness age group as they are easily accessible in schools that are good forum for imparting health education to the children. 
In Ghana, studies have revealed a high level of prevalence of refractive errors among school children with low uptake of refractive services among this group.  A study of the pattern of ocular diseases in children is very important because while some eye conditions are nonsight threatening, others invariably lead to blindness.  The prevention, early detection and prompt treatment of ocular diseases by regular screening of school children could significantly reduce ocular morbidity. This can enable them to perform optimally in their education. Periodic screening of school children is very essential to improve the quality of eye-sight. 
Epidemiological data on ocular disorders among school children in developing countries is relatively inadequate. ,,, The same issue exists in Ghana. This study therefore sought to estimate the prevalence of ocular morbidity among school children in the Kwabre East District of Ghana. It is anticipated that results of this study might provide the needed evidence to support the need for an eye screening program for schools.
| Methods|| |
The study was carried out in public schools in the Kwabre East District of Ghana. 
A cross-sectional descriptive study was carried out.
The study was carried out from March 10, 2014 to March 22, 2014 to assess the distribution and prevalence of ocular morbidities among school children in public basic schools in the district aged between 6 and 16 years. A multi-stage random sampling technique was used to select school children from 5 randomly selected schools from various circuits or zones in the district. Using the expression n = Z 2 (1 − p) (p)/b 2 (where n = minimum sample size, P = anticipated prevalence, b = desired error bound taken as 5% and Z = the standard score at 95%), a sample size of 500 was estimated.
As part of the plan to sharpen the clinical skills of the team members and to obtain an estimate of the anticipated prevalence, a pilot study was carried out in a school not part of those in the study on March 3, 2014. The proforma was adjusted after the pilot study revealed short comings in it. Data collected included participants' history and demographics. A short talk on eye health was given to the children before the eye examination.
Distant visual acuity (VA) was measured using the Snellen's VA chart at 6 m. Children with poor VA (<6/9) underwent a pinhole vision to differentiate refractive errors from pathological conditions. Refractive error was diagnosed when a VA worse than 6/9 improved on pin-hole test. Examination of the eyelid margins, conjunctivae, the cornea and anterior segment of the eye was performed with the aid of a pen-torch and a magnifying loupe. Hirschberg test and cover-uncover test were also carried out to diagnose strabismus and latent squint. The posterior segment of the eyes of each participant was examined in a darkened room using the Welch Allyn direct ophthalmoscope. No drug was administered to any child. Those study participants with VA 6/18 or worse requiring further assessment and management were referred to the nearest hospital for further investigation and management.
All information was recorded in the proforma specifically designed for the purpose of this study.
Permission was sought from the head of the District Education Directorate in the Kwabre East District and the heads of the selected basic schools. Consent forms were given to guardians of the selected school children to approve of their wards' participation in the study.
Data processing and analysis
After the data had been collected, it was edited to thoroughly check for completeness of answers, accuracy, and consistency. Data were entered in the SPSS-version 20.0 (Statistical Product for Solution Services) for Windows and analyzed. Descriptive statistics was used to determine the ocular conditions detected among the school children.
| Results|| |
A total of 500 school children were enumerated for the study out of which 456 were examined, giving 91.2% response rate. Of the 456 examined, 170 (37.3%) were males and 286 (62.7%) females. The age of the children ranged from 6 to 16 years with the mean age being 12.6 ± 2.25. [Table 1] shows the age and gender distribution of the school children in the study.
It was observed that 72 (15.8%) of the total respondents have had eye health education before while 384 (84.2%) have never had any education on eye health. Only 79 (17.3%) of the respondents have had an eye examination prior to the study.
The study revealed that 445 (97.6%) of the participants had a VA measure of 6/5-6/12, 8 (1.8%) had a VA <6/12-6/36 and 3 (0.7%) had a VA of 6/60 -NPL in their right eye. Counts for left eye VA were 444 (97.4%) for 6/5-6/12, 10 (2.2%) for <6/12-6/36 and 2 (0.4%) for 6/60 - NPL.
Ocular symptoms including ocular pain, itching, tearing and blur vision were reported by 114 (25%) participants; [Table 2] summarizes these findings.
A total of 215 (47.1%) of the school children had various eye conditions. The predominant ocular conditions diagnosed were refractive error and allergic conjunctivitis. Other diagnosed conditions were strabismus, macular scar, ptosis, and glaucoma suspicion. The distribution of ocular conditions diagnosed is shown in [Table 3].
| Discussions|| |
The results of this study revealed a slight female preponderance among the study population as 286 (62.7%) of the pupil respondents were female while 170 (37.3%) were males (P < 0.05). These percentages are similar to results of a study done in South-Western Nigeria.  This could be attributed to the fact that the females showed more enthusiasm to undergo the screening program whereas most of the males in the sampled schools expressed disinterest. The study recorded increased frequencies for respondent of ages 12-14 years. This could be as a result of the increased enrollment of new entrants in the public schools following the Government of Ghana school feeding program to provide free meals in public schools.  This is in contrast with a study carried out among private school children that recorded reduced numbers for 12 years old. 
From the study, only 72 (15.8%) of the respondents had received education on eye health and 384 (84.2%) had no education on eye health. The few numbers of respondents with eye education may be due to distribution of respondents with respect to their educational level. Those who might have had eye education may be students in upper levels of basic education. The study showed that 79 (17.3%) of the respondents had had an eye check-up prior to the study while the remaining 377 (82.7%) have not had any eye check-up before. The proportion of children who had ever undergone eye check-up (17.3%) was higher than values previously reported in the Cape Coast Municipality in Ghana  but considerably less than those reported by a study in Tanzania.  This may be due to the difficulty in accessing eye care services within the district since there is no available eye care facility in the district. From the study, 11 (2.5%) students were found to have poor sight (VA ≤6/12) in the right eye and 12 (2.6%) students in the left eye. Bilateral vision impairment was recorded among seven (1.5%) students. The reported ocular symptoms were mostly allergic in nature and some referable to the asthenopia. The symptoms reported by the students were distributed as follows: 3 (0.7%) of the respondents experienced pain, 80 (17.3%) experienced itchiness which was slightly <24.73% as reported among primary school children in Ilorin, Nigeria,  30 (6.6%) experienced blur vision, 1 (0.2%) experienced tearing while 342 (75.0%) had no complaint. In our study, only a small proportion of the students examined complained of eye problems. Some students were not aware that they had an eye problem. This observation is similar to that of other works in different parts of the world. 
The study further revealed that 215 (47.1%) had various ocular morbidities whereas 241 (52.9%) of the students had no ocular morbidities. The most prevalent condition among the students was refractive error (26.3%), followed by allergic conjunctivitis (17.3%). Strabismus, macular scar, glaucoma suspicion, unilateral ptosis and phthisis bulbi contributed 3.5% of the eye conditions. Similar prevalence of refractive error has been reported by a study done in the Cape Coast Municipality in 2010.  Prevalence of refractive errors in this study is higher than that reported by Kumah et al.  and another reported in a school eye screening in Kaduna, Nigeria.  Similar findings among school adolescents of Gandhinagar District, Gujarat in India were also reported where refractive error was the most common ocular morbidity among 40% of boys and girls.  Contrary to our findings, another study reported a 10.12% prevalence rate of refractive errors among school children in Maharashtra, India.  The differences in prevalence may be attributed to differences in population characteristics per study.
The prevalence of allergic conjunctivitis (17.3%) was found to be higher than what has been indicated among students in South-Western Nigeria.  The high prevalence of allergic conjunctivitis in this study may be due to the fact that the work was carried out during the dry season suggesting the presence of high concentration of allergens such as dust from untarred roads and school compounds and pollen grains from flowering plants. Allergic conjunctivitis was mostly recorded among students within the age range of 12-14 years. This could be related to the occurrence of vernal conjunctivitis, which is common in children and young adults.  The high prevalence of ocular morbidities among the students strongly indicate the need to establish an early and continuous system of examining school children so as to prevent and minimize the occurrence of ocular morbidity and ultimately manage these eye conditions among children. 
| Conclusion|| |
The most common ocular morbidity was uncorrected refractive error with a prevalence of 26.3%. This was followed by allergic conjunctivitis (17.3%). It was noticed that a greater proportion (48.0%) of students were identified to have an ocular condition among the age group 12-14 years. We therefore recommend that there be increased awareness and sensitization in the prevention of childhood blindness and visual impairment through public education and an eye screening program incorporated into the School Health Education Program spearheaded by the Parent and Teacher Associations in various basic schools. Parents must be educated on the eye health of their children. Basic eye health care must also be taught in pre and postnatal clinics to create the awareness of parents on ocular conditions among children.
| Acknowledgments|| |
Authors are thankful to the District Education Directorate of the Kwabre-East District and the heads of the selected basic schools for giving permission to conduct the study. We appreciate the co-operation of all the children who participated in the study.
| References|| |
Onwasigwe E, Umeh R, Onwasigwe C, Aniebue P. Referral pattern of children to the eye department of the University of Nigeria Teaching Hospital, Enugu, Nigeria. Niger J Ophthamol 1996;1:5-6.
Deshpande JD, Malathi K. Prevalence of ocular morbidities among school children in rural area of North Maharashtra in India. Natl J Community Med 2011;2:302-4.
Cass HD, Sonksen PM, McConachie HR. Developmental setback in severe visual impairment. Arch Dis Child 1994;70:192-6.
Prendergast C. Issues of growth and development for blind and visually impaired children. In: Albert DM, Jackobiec, editors. Principles and Practice of Ophthalmology. Ch. 401. USA: W. B. Saunders Company; 2000.
Park K. Park′s Textbook of Preventive and Social Medicine. India: Bhanot; 2007.
Ovenseri-Ogbomo G, Omuemu V. Prevalence of refractive error among school children in the Cape Coast Municipality, Ghana. Clin Optom 2010;2:59-66.
Ajaiyeoba A, Isawumi M, Adeoye A, Oluleye T. Prevalence and Causes of Eye Diseases among Students in South-Western Nigeria. Ann Afr Med 2006;5:197-203.
Pi LH, Chen L, Liu Q, Ke N, Fang J, Zhang S, et al.
Refractive status and prevalence of refractive errors in suburban school-age children. Int J Med Sci 2010;7:342-53.
Prajapati P, Oza J, Prajapati J, Kedia G, Chudasama RK. Prevalence of ocular morbidity among school adolescents of Gandhinagar district, Gujarat. Online J Health Allied Sci 2011;9:4.
Wedner SH, Ross DA, Balira R, Kaji L, Foster A. Prevalence of eye diseases in primary school children in a rural area of Tanzania. Br J Ophthalmol 2000;84:1291-7.
Ayanniyi A, Mahmoud AO, Olatunji FO. Causes and prevalence of ocular morbidity among primary school children in Ilorin, Nigeria. Niger J Clin Pract 2010;13:248-53.
Kumah BD, Ebri A, Abdul-Kabir M, Ahmed AS, Koomson NY, Aikins S, et al.
Refractive error and visual impairment in private school children in Ghana. Optom Vis Sci 2013;90:1456-61.
Kehinde A, Ogwurike S, Eruchalu U, Pam V, Samaila E. School eye health screening in Kaduna-Northern Nigeria. Niger J Surg Res 2006;7:191-4.
[Table 1], [Table 2], [Table 3]