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Purpose: To determine the prevalence and causes of blindness and visual impairment among adults in Kogi, Nigeria. Methods: A Rapid assessment of avoidable blindness (RAAB) protocol was used with additional tools measuring disability and household wealth to measure the prevalence of blindness and visual impairment (VI) and associations with sex, disability, wealth, cataract surgical coverage and its effectiveness. Results: Age- and sex-adjusted all-cause prevalence of bilateral blindness was 3.6% (95%CI 3.0–4.2%), prevalence of blindness among people living with additional, non-visual disabilities was 38.3% (95% CI 29.0–48.6%) compared to 1.6% (95%CI 1.2–2.1%; χ2 = 771.9, p<0.001) among people without additional disabilities. Cataract was the principal cause of bilateral blindness (55.3%). Cataract surgical coverage (CSC) at visual acuity (VA) 3/60 was 48.0%, higher among men than women (53.7% vs 40.3%); 12.0% among people with non-visual disabilities; 66.9% among people without non-visual disabilities, being higher among people in the wealthiest two quintiles (41.1%) compared to the lowest three (24.3%). Effective Cataract Surgical Coverage at Visual Acuity 6/60 was 31.0%, higher among males (34.9%) than females (25.5%), low among people with additional, non-visual disabilities (1.9%) compared to people with no additional disabilities (46.2%). Effective CDC was higher among people in the wealthiest two quintiles (411%) compared to the poorest three (24.3%). Good surgical outcome (VA>6/18) was seen in 61 eyes (52.6%) increasing to 71 (61.2%) eyes with best correction. Cost was identified as the main barrier to surgery. Conclusion: Findings suggest there exists inequalities in eye care with women, poorer people and people with disabilities having a lower Cataract Surgical Coverage, thereby, underscoring the importance of eye care programs to address these inequalities. [ABSTRACT FROM AUTHOR]

Introduction: Nigeria is one of the developing countries that have the highest challenge of Onchocerciasis and other Neglected Tropical Diseases (NTDs) in Africa. Objectives: This study aims at ascertaining the potency, gap and deficiencies of the media in regards to discharging their social responsibility of creating awareness on river blindness and the media's efforts in the actualization of Vision 2020. Methodology: This research study adopts a documentary research method where the researchers used the Google Scholar to retrieved relevant research journal articles, books, seminar papers and other relevant publications. In order to retrieve relevant materials the following steps were followed identification of keywords, Database Search, Inclusion and Exclusion Criteria, Screening and Selection and lastly Data Extraction and Synthesis. Results: the study found that river blindness (Onchocerciasis) has avalanche of adverse socio-economic effects on the populace of Nigeria. Furthermore, it was also found that media advocacy on Ochocerciasis is dormant and this has the potency to impede the actualization of the World Health Organization's Vision: 2020 in the country. Conclusion: Communicating information on river blindness using only the conventional media is not enough in a society like Nigeria; hence there is the need for a combination of the conventional and other interpersonal channels of communication like the church/mosque, market, traditional institutions, etc. [ABSTRACT FROM AUTHOR]

Objective: To determine the pattern of eye diseases at the general outpatient department (GOPD) of a Nigerian tertiary hospital. Materials and Methods: Patients selected by systematic random sampling at the GOPD of a Nigerian tertiary hospital were studied. Information on sociodemographics and ocular complaints were obtained using interviewer-administered questionnaire. Ocular examination included visual acuity measurement and anterior and posterior segments examinations. Data analysis was with Statistical Package for the Social Sciences. Results: Three hundred and eighty-two patients, comprising 124 (32.5%) males and 258 (67.5%) females, aged between 18 and 86 years, mean 44.8 ± 15.4 years, were studied; 112 (29.3%) had eye diseases but only 88 (78.6%) patients complained of ocular disorder(s). Common complaints were poor vision 53 (60.4%), red eye and grittiness 15 (17.0%) each. Common eye diseases were lens 52 (13.6%) and conjunctiva 46 (12.0%) disorders. Attaining higher education was protective against eye diseases (P < 0.05). Conclusion: Nearly a third of patients at the GOPD have eye diseases. Therefore, primary eye care should be integrated into the GOPD service with provision of relevant manpower and facilities for care of the ophthalmic patients. [ABSTRACT FROM AUTHOR]

Cataract is a leading cause of blindness in children worldwide. Blindness can be treated with effective surgery, but in low-resource settings this treatment can be difficult to access. In addition, positive outcomes of the surgery are heavily dependent on comprehensive postoperative care. To date in Nigeria and many other low-resource countries, robust electronic data-management systems that help facility teams to manage their patient data, especially when it comes to tracking children for follow-up visits after surgery, have either yet to be put into place or are in place but have yet to be refined to respond to the specific needs of eye care programs. Sightsavers has worked with multiple state ministries in Nigeria to set up and test a system that responds to those needs. [ABSTRACT FROM AUTHOR]

Objective: To assess safety practices among eye care workers in Nigeria during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This research was a cross-sectional study. A structured electronic questionnaire was distributed among eye care workers (ophthalmologists, optometrists, ophthalmic nurses) across the six geographical zones of Nigeria. Information on socio-demographics, COVID-19 infection, current working conditions and safety practices were obtained. Data analysis was done using Statistical Package for Social Sciences (SPSS Inc. Chicago Illinois, USA) for windows, version 22. Results: A total of 236 eye care workers participated in the study; their mean (±SD) age was 37.13 (±8.141) years, 125 (53%) were females, and 145 (61.4%) worked in a tertiary care hospital. All participants described COVID-19 as a viral disease and 98.3% agreed that the disease can affect the eyes. Outpatient clinic consultation was recorded as the highest (77.7%) service provided during the pandemic. Regarding preventive practices, 95% of eye care workers wore facemasks, 82.4% wore gloves during ophthalmic examination and Hazmat suit was the least used protective device (2.5%). About three-quarters (77.5%) reported feeling unsafe in their working environment and 63.9% were dissatisfied with the personal protective device provided by hospitals to eye care workers. Conclusion: COVID-19 pandemic presented an unprecedented challenge for eye care workers; with the practice of ophthalmology posing a high risk of transmission of the virus. Efforts should be made to provide the required personal protective devices needed for optimum protection of eye care workers in healthcare settings. [ABSTRACT FROM AUTHOR]

Background: Over two-thirds of Africans have no access to eye care services. To increase access, the World Health Organization (WHO) recommends integrating eye care into primary health care, and the WHO Africa region recently developed a package for primary eye care. However, there are limited data on the capacities needed for delivery, to guide policymakers and implementers on the feasibility of integration. The overall purpose of this study was to assess the technical capacity of the health system at primary level to deliver the WHO primary eye care package. Findings with respect to service delivery, equipment and health management information systems (HMIS) are presented in this paper.Methods: This was a mixed-methods, cross sectional feasibility study in Anambra State, Nigeria. Methods included a desk review of relevant Nigerian policies; a survey of 48 primary health facilities in six districts randomly selected using two stage sampling, and semi-structured interviews with six supervisors and nine purposively selected facility heads. Quantitative study tools included observational checklists and questionnaires. Survey data were analysed descriptively using STATA V.15.1 (Statcorp, Texas). Differences between health centres and health posts were analysed using the z-test statistic. Interview data were analysed using thematic analysis assisted by Open Code Software V.4.02.Results: There are enabling national health policies for eye care, but no policy specifically for primary eye care. 85% of facilities had no medication for eye conditions and one in eight had no vitamin A in stock. Eyecare was available in < 10% of the facilities. The services delivered focussed on maternal and child health, with low attendance by adults aged over 50 years with over 50% of facilities reporting ≤10 attendances per year per 1000 catchment population. No facility reported data on patients with eye conditions in their patient registers.Conclusion: A policy for primary eye care is needed which aligns with existing eye health policies. There are currently substantial capacity gaps in service delivery, equipment and data management which will need to be addressed if eye care is to be successfully integrated into primary care in Nigeria. [ABSTRACT FROM AUTHOR]

Background: To increase access to eye care, the World Health Organization's Africa Region recently launched a primary eye care (PEC) package for sub-Saharan Africa. To determine the technical feasibility of implementing this package, the capacity of health systems at primary level needs to be assessed, to identify capacity gaps that would need to be addressed to deliver effective and sustainable PEC. This study reports on the human resource and governance challenges for delivering PEC in Anambra State, Nigeria.Methods: Design: This was a mixed methods feasibility study. A desk review of relevant Nigerian national health policy documents on both eye health and primary health care was conducted, and 48 primary health care facilities in Anambra state were surveyed. Data on human resource and governance in primary health facilities were collected using structured questionnaires and through observation with checklists. In-depth interviews were conducted with district supervisors and selected heads of facilities to explore the opportunities and challenges for the delivery of PEC in their facilities/districts. Data were analysed using the World Health Organization's health system framework.Results: A clear policy for PEC is lacking. Supervision was conducted at least quarterly in 54% of facilities and 56% of facilities did not use the standard clinical management guidelines. There were critical shortages of health workers with 82% of facilities working with less than 20% of the number recommended. Many facilities used volunteers and/or ad hoc workers to mitigate staff shortages.Conclusion: Our study highlights the policy, governance and health workforce gaps that will need to be addressed to deliver PEC in Nigeria. Developing and implementing a specific policy for PEC is recommended. Implementation of existing national health policies may help address health workforce shortages at the primary health care level. [ABSTRACT FROM AUTHOR]

Background: Uncorrected refractive error (URE) is a major cause of vision impairment in children worldwide. Cases are often detected through a school-based vision screening program and then treated in a follow-up appointment. This requires parents or guardians ('parents') to adhere to referrals for the eye exam and care plan. We aim to understand the reasons for parents' referral non-adherence in Cross River State, Nigeria, using qualitative methods. Methods: Ten focus groups were held with parents who had not adhered to the referral for a follow-up eye examination. Participants were recruited with help from staff in schools hosting the vision screening programme. Interviews were conducted using a semi-structured interview guide, audio taped and transcribed verbatim. After identifying relevant quotes, the researchers labelled each one with a descriptive code/subcode label. Then they clustered the data into categories and overarching themes. Results: Forty-four parents participated in 10 focus group discussions with 28 women and 16 men. Three themes and participated in the focus group discussions with 28 women (63%). Twelve themes were generated. The three megathemes were Modifiable Factors (with 4 themes), Contextual Factors (with 6 themes), and Recommendations (with 2 themes). Conclusion: Participants identified modifiable barriers that make it difficult for parents to adhere to a referral for a follow-up eye exam. These include not believing their child has a vision problem or the screening test, and issues with the referral letter. They also described important contextual factors such as poverty, logistical problems, parental attitudes towards their children and beliefs about appropriate care. Many of these issues could be addressed by following their recommendation to educate the public on the importance of child eye care and correct parents' misconceptions. These themes will be used by the Nigerian government to enhance and scale up its child eye health programme. [ABSTRACT FROM AUTHOR]

Introduction: Long waiting time in the out-patient clinic is a major cause of dissatisfaction in Eye care services. This study aimed to assess patients' waiting and service times in the out-patient Ophthalmology clinic of UITH. Methods: This was a descriptive cross-sectional study conducted in March and April 2019. A multi-staged sampling technique was used. A timing chart was used to record the time in and out of each service station. An experiencebased exit survey form was used to assess patients' experience at the clinic. The frequency and mean of variables were generated. Student t-test and Pearson's correlation were used to establish the association and relationship between the total clinic, service, waiting, and clinic arrival times. Ethical approval was granted by the Ethical Review Board of the UITH. Result: Two hundred and twenty-six patients were sampled. The mean total waiting time was 180.3± 84.3 minutes, while the mean total service time was 63.3±52.0 minutes. Patient's average total clinic time was 243.7±93.6 minutes. Patients' total clinic time was determined by the patients' clinic status and clinic arrival time. Majority of the patients (46.5%) described the time spent in the clinic as long but more than half (53.0%) expressed satisfaction at the total time spent at the clinic. Conclusion: Patients' clinic and waiting times were long, however, patients expressed satisfaction with the clinic times. [ABSTRACT FROM AUTHOR]

Background: To describe factors which influence the age at detection and age at presentation of patients with childhood cataract at a tertiary eye care facility in Southwest Nigeria.Methods: A retrospective review of children who presented with cataract between 2011 and 2015. Case notes were reviewed and data on age at detection and presentation as well as other clinical information was collected and analyzed using Stata 12 statistical software.Results: A total of 164 cases were reviewed, 52.4% of them were boys. Median age at presentation was 48 months while the median age at detection was 13.5 months. Seventy-four (45.1%) children had congenital cataract, 31.1% had developmental cataract, and 21.3% had traumatic cataract. The child's mother detected the cataract in 116 (70.7%) of the patients. Median age at presentation for patients with congenital cataract was 18 months and 84 months for developmental cataract. The median age at presentation for congenital cataracts that were noticed by the mother was 17 months compared with 72 months for those noticed by other caregivers (p = 0.0085). The median age at presentation for developmental cataracts that were noticed by the mother was 72 months compared with 114 months for those noticed by other caregivers (p = 0.0065). Gender of the child did not significantly influence the age at detection or presentation. The source of referral and the location of domicile did not significantly affect the time interval between detection of the cataract and presentation to hospital.Conclusion: The average age of children presenting with cataracts in our setting is older than in high income countries. Detection of the cataract by the mother increases the likelihood of early presentation; thus, focused maternal education may promote earlier detection and presentation. [ABSTRACT FROM AUTHOR]

Objective: To determine the current status and challenges of subspecialty eye care service delivery in Nigeria Study Design: Cross sectional descriptive study Setting: Ophthalmological society of Nigeria (OSN) conference Subjects or participants: Nigerian Ophthalmologists participating in the annual OSN conference. Interventions: Data of current status of eye care services and challenges of subspecialty practice were collected using a pretested self-administered questionnaire. Chi-square test was used to determine associations at a P-value of 0.05 Results: There were a total of 136 respondents; 60 males and 76 females. Highest age range of respondents was 41-50years. About 44.1% had undergone some form of subspecialty training. The commonest area of specialization was Glaucoma (13.2%) while the least area was Neuro-ophthalmology (1.5%). There were more subspecialists in the western region of the country. The major constraint for undergoing subspecialty fellowship was lack of funds. The major barrier to setting up subspecialty practice on completion of training was Lack of equipment for subspecialty practice. Majority of the present subspecialists got international sponsorship for their subspecialty training while those without subspecialty training cited cost as a major impediment to training. Conclusion: Subspecialty training and implementation is still developing in Nigeria. A major intervention has been put in place by CEHC, ICO and Fred Hollows foundation training some number of ophthalmologists. Subspecialty [ABSTRACT FROM AUTHOR]

BACKGROUND: This study was undertaken to ascertain the current magnitude and causes of blindness and visual impairment in persons aged 50 years and over and to assess the impact of a 10-year eye care program in Sokoto State, Nigeria. METHODS: A rapid assessment of avoidable blindness (RAAB) survey (in persons 50 years and over) was conducted in 2016. Participants were selected in Wurno health zone using a two-stage cluster randomized sampling with probability proportional to size. Operational definitions were based on RAAB and World Health Organization eye examination record definitions. Eye care program documents were reviewed and data from a baseline survey undertaken in 2005 were reanalyzed. RESULTS: A response of 89.1% (2405 of 2700 participants) was obtained in the 2016 survey. With available correction, the unadjusted prevalence of blindness was 7.7% (95% confidence interval [CI]: 6.4, 8.9). The odds of blindness were 1.8 times higher in females than males (95% CI: 1.3, 2.4;P< 0.001). Major causes of blindness were cataract (48.9%) corneal disease (20.1%), glaucoma (10.3%), and uncorrected refractive error/aphakia (8.7%). The age- and sex-adjusted prevalence of blindness has declined from 11.6% (95% CI: 7.4, 17.0) in 2005 to 6.8% (95% CI: 5.6, 8.0%) in 2016. CONCLUSION: The blindness prevalence is high, and the major causes are avoidable in the health zone. The findings suggest that investments in the program over the last 10 years might have led to almost a halving in the prevalence of blindness in th e population. However, the small sample size of persons 50+ years from Wurno zone in the 2005 survey necessitate caution when comparing the 2005 and the 2016 surveys. [ABSTRACT FROM AUTHOR]

Background: The integration of eye care services into the primary health-care (PHC) system and the accessibility and quality of eye health in the community is hugely dependent on available resources. Objective: The aim was to assess the resources available for eye care delivery in public PHC facilities in Obokun Local Government Area (LGA), Osun State, Nigeria. Methodology: This was a descriptive cross-sectional study of public PHC facilities and workers in Obokun LGA, Nigeria. A PHC facility checklist was used to obtain data on available infrastructure, material resources, primary eye care (PEC) services, and human resources during a tour and inspection of each facility. Further data on human resources were obtained with a semi-structured questionnaire administered to PHC workers. Data included information on the age, sex, cadre, duration of service, PEC practices, and training of PHC workers. Results: There were 4 (10.0%) primary health (PH) centres, 19 (47.5%) PH clinics and 17 (42.5%) health posts. The number and distribution of PHC facilities, material resources, and PEC services were below-recommended guidelines. There were 12 (11.2%) nurses, 4 (3.7%) community health officers, 19 (17.8%) community health extension workers (CHEWs), 7 (6.5%) health technicians, 8 (7.5%) junior CHEWs, and 57 (53.3%) health assistants. There was a sufficient number of PHC workers and community services to build capacity for PEC delivery. Conclusions: Resources were available for PEC in Obokun LGA; however, some were insufficient or unevenly distributed. Further training of PHC workers in PEC and the provision of the minimum required infrastructure and material resources are recommended. [ABSTRACT FROM AUTHOR]

Background: The eye-care seeking behaviour of parents for their children has a role to play in increasing or reducing the prevalence of childhood blindness. In Nigeria, little or no work has been done in this area. Hence, this study was carried out with a view to assisting eye-care professionals plan better program regimens and also to help them identify various elements that either facilitate or hinder eye-care seeking behaviour of parents for their school age children.Methods: This was a qualitative narrative study. Data were collected using in-depth interviews (IDIs) and focus group discussions (FGDs). Thirty-five parents and 10 eye-care practitioners were selected by random sampling and homogenous sampling methods, respectively. Parents were selected, based on those who sought care and those who did not seek care for their children after a school screening exercise. Collected data were analysed qualitatively by transcribing the voice recordings of interview sessions into textual data and themes were raised.Results: Four FGDs and 13 IDIs were conducted. Parents were more likely to seek care for manifest conditions than for conditions they could not perceive. A family history of ocular disease and repetitiveness of complaints facilitated parents to seek eye care for their children. The cost of eye-care services was a major barrier. Logistics such as fixing a doctor's appointment, getting time off work and long waiting periods at the clinic were also reported as barriers. Fear of treatment options and family interferences were also mentioned.Conclusion: Parents have some concerns and challenges in seeking eye care for their children. This study recommends that more work be done through planned awareness programs to educate parents and help them overcome the concerns and barriers that hinder them from seeking eye care for their children. [ABSTRACT FROM AUTHOR]

Background. Vision is critical in the development and performance of children. Factual knowledge of eye health is important for preventive and promotive eye health. Objectives. To identify eye health myths and misconceptions that are considered true in a population of Nigerian school children, with the aim of prioritizing eye health messages. Material and methods. In a cross-sectional survey, self-administered questionnaires were used to obtain pupils' views, which were elicited using statements presented as 22 ocular health myths/misconceptions and three facts in two selected secondary schools in Enugu state, Nigeria in October 2014. Frequency counts and percentages were generated using SPSS v18. A p-value of < 0.05 was considered statistically significant. Results. The sample comprised 404 males (48.5%) and 429 females (51.5%), age range 10-17 years, median 13-14 years; IQR -6). More pupils in the senior classes had previously listened to eye health talks. The most common beliefs concerned the statements "staying close to the television set will damage vision" 782 (93.9%), and "reading in dim light will damage vision" 758 (90.8%). The least commonly-held misconception was "children do not need regular eye checks" 119 (14.3%). The greatest amount of uncertainty concerned the statements "short-sightedness is worse than long-sightedness" 421 (51%), and "crossed-eye disorders cannot be corrected in children" 383 (46%). Conclusions. The majority of the children do not have information on eye health. Despite the persistence of these myths and misconceptions, this study has demonstrated that the children had a reasonable level of knowledge in terms of safe eye care practices. However, appropriate eye health messages still need to be provided. [ABSTRACT FROM AUTHOR]

Background. The provision of population-wide, accessible, affordable, acceptable and evenly distributed qualitative eye care services remains a recurrent challenge to eye care organizations worldwide. Objectives. To report the challenges encountered in setting up eye care service in a pre-existing primary health care facility in rural Nigeria and also audit the common causes of eye disorders in rural setting southeast of Nigeria. Material and methods. The study was an operations research study conducted at Akpuoga-Nike between February and April 2011. Demographic and ophthalmic clinical data were collected. Health system-, community- and patient-determined challenges were catalogued and analyzed using Epi Info Statistical software for Windows, version 6. Univariate analysis was performed for data distribution testing. Analytical statistics were performed, with p < 0.05 considered statistically significant. Results. A total of 481 (males, 144 (29.9%); females, 377(70.1%)) patients aged 42.3 ± 20.2 SD years (range 4-80 years) were seen. The leading eye disorders were refractive error - 28.9%, and cataract - 16.4%. The operations challenges encountered included difficulties with community sensitization/advocacies, inadequate infrastructure and mobile equipment, as well as lack of eye care manpower, consumables and funding deficits. Conclusions. Health system-related issues were the main challenges encountered. Recruitment of an adequate number of rural eye care workforce, provision of needed material resources, adequate funding and engendering community participation in rural eye care delivery through grass roots advocacy and health service public education would overcome the challenges. [ABSTRACT FROM AUTHOR]

Aim: To determine the perception and attitudes of a rural community regarding the etiology, prevention, and treatment of blindness in adults. Methods: A cross-sectional, descriptive study was performed in a rural community in Kwara State, Nigeria using semi-structured questionnaire. All adults aged 40 years or older who were residents for a minimum of 6 months in the community were included. Data were collected on patient demographics, knowledge, attitude, perception, and use of the eye care facility. Results: A total of 290 participants were interviewed. The male-to-female ratio was 1:2. Consumption of certain types of food was an important cause of blindness as perceived by 57.9% of the respondents, followed by supernatural forces (41.7%) and aging (19%). Sixty percent of respondents thought blindness could be prevented. Age (P = 0.04) and level of education (P = 0.003) significantly affected the beliefs on the prevention of blindness. Most respondents (79.3%) preferred orthodox eye care, but only 65% would accept surgical intervention if required. The level of education significantly affected the acceptance of surgery (P = 0.04). Reasons for refusing surgery were, fear (64%), previous poor outcomes in acquaintances (31%), belief that surgery is not required (3%), and cost (2%). About 65% used one form of traditional eye medication or the other. Over half (56.6%) believed that spectacles could cure all causes of blindness. Of those who had ocular complaints, 57.1% used orthodox care without combining with either traditional or spiritual remedies. Conclusion: This rural Nigerian community had some beliefs that were consistent with modern knowledge. However, the overall knowledge, attitude, and perceptions of this community need to be redirected to favor the eradication of avoidable blindness. Although an eye care facility was available, use by the community was suboptimal. Age and the level of education affected their overall perception and attitudes. [ABSTRACT FROM AUTHOR]

To determine the barriers and incentives to eye care utilization (ECU) in Abagana, a rural south-eastern Nigerian community. The study was a population-based cross-sectional mixed method (quantitative and qualitative) survey of adult inhabitants of Abagana, in July-August, 2011. Data on respondents' socio-demographics, barriers and incentives to ECU were collected, and analysed using descriptive and comparative statistics. A p < 0.05 was considered statistically significant. Qualitative data were obtained from focus group discussions and in-depth interviews and analyzed using ATLAS.ti software. The 549 respondents (males 224) were aged 49.8 ± 15.9 SD years (range 18-93 years). Overall, orthodox eye care had ever been sought by 42.4 %, and 46.4 % of those who reported change in vision. Lack of awareness-31.8 %, cost-18.0 %, and fatalistic attitudes-15.9 % were the main ECU barriers. Possession of health insurance (OR 11.49; 95 % CI 4.21-31.34; p = 0.001), family history of eye disorder (OR 3.27, 95 % CI 2.03-5.26; p = 0.001), noticed change in vision (OR 11.30; 95 % CI 1.42-90.09; p = 0.022), current eye disease (OR 4.06; 95 % CI 2.29-7.19; p = 0.001) and systemic co-morbidity (OR 4.33; 95 % CI 2.67-7.02; p = 0.001) were the incentives to ECU. To enhance the low ECU in Abagana community, educational interventions on eye health maintenance and eye health seeking behaviours, and measures to reduce eye care cost are recommended. [ABSTRACT FROM AUTHOR]

Objective To assess knowledge and practice of primary eye care among primary healthcare workers known as community health extension workers in Funtua district of Nigeria. Methods Cross-sectional mixed method study among health workers employed in government-owned primary healthcare facilities. Quantitative data were obtained using self-administered questionnaires and checklists, while qualitative data by modified Delphi technique, role plays and observation. A score of 1 was given for each correct answer, while a total score of ≥60% was considered 'good'. Results Eighty three of 88 health workers participated (94%) in the questionnaire survey; while 16 of them were selected for the qualitative survey. Good scores regarding the knowledge of common eye diseases were obtained by 68.7%, but only 26.4% of them could identify their most important features. Participants could undertake 3 of 5 steps in visual acuity testing. Skills in recognising common eye diseases and their management were weak; while practice was often not according to the guidelines. Conclusion Community health extension workers displayed good knowledge of common eye diseases. Areas of weakness are recognition and interpretation of eye signs, and practice rarely follows the guidelines. Preventive medicine was neglected; community health extension workers require practical retraining and supervision to achieve integration of primary eye care into primary healthcare services. [ABSTRACT FROM AUTHOR]

Objective: The aim of the following study was to determine the types of intervention sought by the blind street beggars and assess the barriers to accessing available eye care services. Methods: This cross-sectional study was conducted among consenting blind street beggars in Sokoto, Nigeria between May and June, 2009. A semi-structured interview was conducted to probe issues on historical antecedents of the blindness and the eye heath seeking behavior including the use of traditional eye medications. Assessment of barriers to accessing curative services among the blind persons was explored. Questions were asked and the individual responses were recorded in the questionnaire under the appropriate sections. Results: Two hundred and two of 216 (94.7%) of the examined subjects were found to be blind and included in the analysis. The principal cause of blindness was corneal opacity. Overall 82% of the blindness was due to avoidable causes with majority irreversibly blind. Only 38 subjects (18.8%) sought for intervention in hospitals, others resorted to self-medication (42.1%), medicine store (31.2%) and traditional facility (7.9%). Those that accessed treatment at a hospital did so mainly at a primary health center (50.0%) and General Hospitals (34.2%). The barriers to accessing treatment at the hospital were mainly due to "not taken to any hospital" by the parents/relatives (50.3%) and "services not available" (25.2%). Conclusion: Most respondents resorted to ocular self-medication particularly traditional eye medicines. We advocate for a provision of affordable, accessible and qualitative eye care services with a strong health education component on avoidable causes of blindness. [ABSTRACT FROM AUTHOR]

Objective: To investigate the associations between time to presentation, and sociodemographic and clinical characteristics of new adult ophthalmic outpatients at the University of Nigeria Teaching Hospital (UNTH), Enugu, between March and August 2010. Study design: Hospital-based case-control study. Methods: Consecutive new ophthalmic outpatients at UNTH were categorized into controls (early presenters, i.e. <3 months after onset of current eye disease) and cases (late presenters, i.e. >3 months after onset of current eye disease). Relevant data were obtained from the participants' case notes and interviews. Descriptive statistics yielded frequency distributions; bivariate and multivariate comparisons were used to test the significance of associations. P < 0.05 was considered to indicate significance. Results: Eight hundred and twenty-four subjects [454 males and 370 females, mean age 39.2 (standard deviation 1.2) years, range 19-82 years] participated in this study. There were 370 early presenters and 454 late presenters. Multivariate analysis found that late presentation was significantly associated with age >50 years [odds ratio (OR) 1.34, 95% confidence interval (Cl) 1.28-2.22; P < 0.01], female gender (OR 1.63, 95% Cl 1.52-2.11; P < 0.01), residence >20 km from UNTH (OR 0.65, 95% Cl 0.38-0.89; P = 0.0212), individual-level deprivation (OR 0.69, 95% Cl 0.55-0.92; P = 0.0324) and subnormal visual acuity at presentation (OR 1.32, 95% Cl 1.05-1.76; P = 0.0353). Conclusions: At UNTH, most new adult ophthalmic outpatients present >3 months after onset of their current eye disease. Measures to overcome age-, gender- and distancerelated causes of late presentation, grassroots economic empowerment of the feeder population and public education about eye health are required. [ABSTRACT FROM AUTHOR]

To assess eye care service utilization, and identify access barriers in a south-eastern Nigerian albino population. The study was a population-based, cross-sectional survey conducted in Enugu state between August, 2011 and January, 2012. Using the data base of the state's Albino Foundation and tailored awareness creation, persons living with albinism were identified and recruited at two study centres. Data on participants' socio-demographics, perception of vision, visual needs, previous eye examination and or low vision assessment, use of glasses or low vision devices were collected. Reasons for non-utilisation of available vision care services were also obtained. Descriptive and comparative statistics were performed. A p < 0.05 was considered statistically significant. The participants (n = 153; males 70; females 83; sex ratio: 1:1.1) were aged 23.46 + 10.44 SD years (range 6-60 years). Most-95.4 % of the participants had no previous low vision assessment and none-0.0 % had used low vision device. Of the participants, 82.4 % reported previous eye examination, 33.3 % had not used spectacles previously, despite the existing need. Ignorance-88.9 % and poor access-8.5 % were the main barriers to uptake of vision care services. In Enugu, Nigeria, there is poor awareness and low utilization of vision care services among people with albinism. The identified barriers to vision care access are amenable to awareness creation and logistic change in the provision of appropriate vision care services. [ABSTRACT FROM AUTHOR]

Background/Purpose: This study compared the degree of patients' satisfaction with cataract surgical services at a private, semi urban secondary eye care hospital - St Mary's Catholic Eye Hospital, Ago Iwoye, (SMEH) and a public tertiary hospital-University College Hospital Ibadan (UCH) in South Western Nigeria. Materials and Methods: A prospective, observational study of consecutive patients undergoing cataract surgery at SMEH and UCH was conducted between May and October 2007. Questionnaires were administered to a total of 366 patients preoperatively, 1st day and 8th week postoperatively. Results were analyzed using the SPSS statistical software. Results: Evaluation of patients' satisfaction with preoperative care showed that patients were more satisfied with the pre-consultation time (P=0.006) and cost of surgery (P<0.001) at SMEH than in UCH. There was no statistically significant difference with respect to satisfaction of patients with vision in both hospitals (P=0.09). More patients were satisfied with overall care at SMEH than UCH and were therefore more likely to recommend the hospital. Conclusion: This study compared patients' satisfaction with cataract surgical services in two hospitals. Patients from the private secondary eye care hospital were more satisfied than patients from the public tertiary hospital. Satisfied patients have a great role to play in increasing cataract surgical uptake. [ABSTRACT FROM AUTHOR]

Glaucoma is a major public health problem and is one of the leading causes of blindness worldwide. Many patients present late for medical attention when the eye condition is already advanced, possibly due to lack of knowledge about glaucoma (Cook, 2009:126). The purpose of the study was to assess the level of knowledge about glaucoma amongst patients attending the Central Bank of Nigeria's (CBN) staff eye clinic in Abuja. A descriptive and cross-sectional study was conducted on adult CBN staff members and their eligible dependants. Purposive sampling was used to recruit 145 respondents. Data on demographics and knowledge about glaucoma were collected using a pre-tested structured questionnaire. Validity was assured by using questions from various instruments used in similar studies to formulate the multiple choice questions. Test re-test reliability was done to assess the stability and consistency of the tool. Data were analysed with a statistician's help using descriptive and inferential statistics. Chi-square analysis was used to test for relationships between knowledge of glaucoma and demographic factors. A two-tailed p-value of less than 0.05 was considered statistically significant. Of 145 respondents, 74.5% (n = 108) claimed they had heard about glaucoma but only 14.5% (n = 21) had knowledge of glaucoma. Glaucoma knowledge was inadequate and independent of age, gender, ethnicity and educational level. Recommendations include that enhanced health education about glaucoma should be provided to all CBN staff members. More knowledge about glaucoma should enable CBN staff members to obtain timely treatment for glaucoma, thus preventing blindness. Based on the research findings, an information pamphlet was developed. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the prevalence of low vision and blindness, identify the causes, and suggest policies for an effective eye care program based on 2005 data from Sokoto State, Nigeria. Materials and Methods: A stratified two-stage cluster sampling method was used to quantify the prevalence of blindness and the causes from 4 health zones in Sokoto State. Subjects were evaluated using a magnifying loupe, direct ophthalmoscope and torchlight. Data were collected based on the World Health Organization prevention of blindness coding for an eye examination. Prevalences with 95% confidence intervals (CI) were calculated and surgical coverage for causes of blindness was also analyzed. Results: The response rate was 91%. The prevalence of bilateral blindness was 1.9% (95% CI: 1.5-2.3%) ranging from 1.6% to 2.0% across the four health zones. The prevalence was 2.1% (95% CI: 1.6-2.6%) in males and 1.6% (95% CI: 1.1-2.1%) in females. The leading cause of bilateral blindness was cataract (51.6%), followed by uncorrected aphakia (20.9%) and glaucoma (11%). The prevalence of bilateral operable cataract was 1.9% (95% CI: 1.5-2.3%). The cataract surgical coverage (individuals with visual acuity <6/60) for the study was lower than the couching coverage (4.4% vs. 14.9%, respectively). Surgical coverage for trichiasis was 4.4%. The major barrier to cataract and glaucoma management was cost. Conclusions: The prevalence of blindness in Sokoto State is high yet the main causes are largely avoidable. Barriers can be reduced by appropriate health education regarding the eye care program and the provision of integrated, sustainable, affordable and equitable services. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to determine the rate and pattern of vitreo-retinal diseases at a tertiary eye care center in South-eastern Nigeria. Materials and Methods: The outpatient register at the Eye Clinic of the University of Nigeria Teaching Hospital, Enugu, was retrospectively examined to identify all new patients registered between January 2004 and December 2008. A chart review of subjects with vitreo-retinal disease was conducted to record relevant demographic and clinical data including the needs for vitreo-retinal care. Descriptive and analytical statistics were performed. A P-value <0.001 (one degree of freedom) was considered statistically significant. Results: Of the 8,239 new patients reported during the period, 326 subjects (males- 59.3%; females- 40.7%; sex ratio = 1.1:1) aged 49.3 ± 16.8 years (range 3-82 years) had vitreo-retinal disease. The rate of vitreo-retinal disease was 3.9%. The rate was higher in subjects above 40 years old (P < 0.001), but did not differ between sexes (P = 0.469). Diabetic retinopathy (24.9%), hypertensive retinopathy (13.3%), and age-related macular degeneration (10.7%) were the leading vitreo-retinal diseases. Blindness from vitreo-retinal disease was bilateral in 6.1% of subjects and unilateral in 17.5% of subjects. The common co-morbidities were ocular conditions such as refractive error (19.8%), cataract (14.2%), and glaucoma (10.4%); and systemic conditions such as diabetes mellitus (14.6%) and hypertension (13.2%). Conclusions: The rate of vitreo-retinal diseases among new ophthalmic outpatients at UNTH, Enugu, is 3.9%. Retinal vascular disorders and age-related maculopathy are the leading retinal diseases. At UNTH, resource needs for vitreo-retinal care are urgent including retinal photography/angiography, laser photocoagulation, intra-vitreal pharmacotherapy, and vitreo-retinal surgery. [ABSTRACT FROM AUTHOR]

AIM: A blindness prevalence survey in 1996 indicated that estimates of 40000 are blind from cataracts in Kano state, northwestern Nigeria. Many more were severely visually impaired. Eye care personnel and other resources for eye care delivery are located at the state capital. The state Ministry of Health organized an outreach program. The aim was to operate on 750 cataract patients and measure the visual acuity at two weeks follow up. METHOD: Patients were registered and examined. Cataract patients with accurate four quadrant light projection, briskly reacting pupils and normal intra ocular pressures were selected and had manual extra capsular cataract extraction with posterior chamber intra ocular lens implantation. Post operative medications were administered. Patients were reviewed at 2 weeks follow up after discharge during which their visual acuity was measured and recorded. RESULTS: 868 cataract patients were operated. Thirty two percent of the patients were blind before surgery and 77% of these had bilateral cataracts. The proportion of those who had posterior chamber intra ocular lens (PC IOL) was 85%. The proportion of patients who regained normal vision was 43% and overall, 94% had vision of 6/60 or, better after surgery compared with 20% in this category before surgery, (WHO vision category 0 and 1). CONCLUSION: Cataract outreach service is essential in reducing cataract blindness. There is need to follow up patients although the vision recorded for this study was obtained at two weeks follow up. [ABSTRACT FROM AUTHOR]

Background: The availability and distribution of an appropriate eye care workforce are fundamental to reaching the goals of "VISION 2020: The right to sight", the global initiative for the elimination of avoidable blindness launched jointly by the World Health Organization and the International Agency for the Prevention of Blindness with an international membership of nongovernmental organizations, professional associations, eye care institutions and corporations. Periodic evaluation of these parameters is important in the journey towards achieving these goals. The objectives of the study were to determine the availability and distribution of human resources for eye care delivery in Enugu Urban, south-eastern Nigeria. Methods: The study was designed as a cross-sectional descriptive survey, the setting for which was all public and privately owned eye care facilities in Enugu Urban, Enugu State, south-eastern Nigeria, in October 2006. The health map of Enugu Urban and the hospital register of the Public Health Department of the Enugu State Ministry of Health were used to identify the eye health care facilities in Enugu Urban. A structured, pretested, researcher-administered questionnaire was used to capture data on cadre and distribution of the eye care personnel in these facilities. Relevant population data were obtained from the Enugu Regional Office of the National Population Commission. Descriptive statistical analysis was used to generate percentages and proportions. Eye care personnel-to-population ratios were calculated and compared to World Health Organization recommendations. Results: Out of Enugu State's population of three million, Enugu Urban accounts for 22%. The population of Enugu Urban is distributed between the three-component Local Government Areas comprising Enugu North (31%), Enugu South (30%) and Enugu East (39%). There are 45 eye care facilities (public: 31 (69%); private: 14 (31%)) employing 252 eye care workers (public: 226 (90%); private: 26 (10%)) aged 18 to 63 (mean = 36.1 years, SD = 2 years) comprising males (36: 14%) and females (216: 86%), giving a male-to-female sex ratio of 1:6. The available eye care workforce is unevenly distributed between Enugu North (128: 51%), Enugu South (65: 26%) and Enugu East (59: 23%) Local Government Areas. Conclusion: Using broad and crude World Health Organization standards for minimum provider-topopulation ratios, there is a sufficient eye care workforce in Enugu Urban. However, the maldistribution of the workforce creates a major barrier to uptake of eye care services. Policy modifications could reverse this maldistribution. [ABSTRACT FROM AUTHOR]

Objectives: To identify the perceived barriers to the provision of clinical low-vision service among ophthalmologists in Nigeria, with a view to proffering measures for their removal. Methods: A cross-sectional survey of ophthalmologists attending the Annual Ophthalmological Society of Nigeria Congress in September 2005 was conducted. Using self-administered questionnaires, information relevant to low-vision practice and the perceived barriers to the provision of low-vision services was garnered. Results: Eighty-three (70.9%) ophthalmologists out of 117 eligible participants at the congress responded to all of the questions and returned the study questionnaires. Non-availability of low-vision devices within the country (88%), lack of training in low-vision care (73.5%), lack of public awareness of low-vision care and its practitioners (60.2%), and the ophthalmologists' preoccupation with general ophthalmic practice (56.6%) were cited as the major barriers. With regard to the fellows and the residents in training, there was a statistically significant difference in their perception of two of the investigated barriers, namely, that low-vision care is not lucrative (T value: 4.46; 95% CI: 0.16± 0.07) and low-vision care is time-consuming (T value: 2.05; 95% CI: 0.145± 0.14). Conclusion: Training in low-vision care should be provided within the country for interested relevant personnel at all levels. Moreover, low-vision devices should be made accessible and available to the practitioners. There is a need in Nigeria for widespread health education/awareness campaigns in low-vision care, targeted primarily at ophthalmologists, allied eye-care providers, and the general public. There is a need to include low-vision practice in the curriculum of the ophthalmology residency program in Nigeria. Further qualitative research may need to be conducted to explain the differences in responses between subsets of the study population. [ABSTRACT FROM AUTHOR]

A clinical study of the refractive errors of 349 females aged between 5 and 69 years and 473 males aged between 3 and 62 years was undertaken. This report describes the prevalence of the different types of refractive errors with regard to sex and age. [ABSTRACT FROM AUTHOR]

Corneal blindness is second only to cataract as a cause of blindness in leprosy patients. Eyelid surgery provided by trained paramedical staff can often prevent blindness in these patients. We sought to determine the extent to which paramedic personnel are meeting the eyelid surgical needs of these patients and to investigate the barriers that may be preventing them from seeking surgery. A total of eight leprosy settlements in north-eastern Nigeria were selected for this study. In these villages, 480 residents who were 30 years of age or older who had been diagnosed as having leprosy had their eyes examined for the presence of lagophthalmos, entropion/trichiasis and evidence of surgery for either of these conditions. Patients who had not been operated on for either of these conditions were questioned to determine their reasons for not seeking surgery. One hundred and sixteen (12.1 %) eyes were in need of surgery while 5.1 % of eyes had been operated upon. The surgical coverage for eyelid surgery was 30%; lagophthalmos had a better surgical coverage of 44.4% compared to entropion/trichiasis, which had 24.7% coverage. Lack of awareness about the treatment available was the most common reason given for not seeking surgery. This study shows that despite the presence of trained paramedical staff in the community, the eyelid surgical needs of these patients are not being met primarily because the level of awareness about the availability of effective treatment still remains low. In addition, the readiness of eye-care staff to visit these settlements was disappointing. Extra efforts will have to be made. [ABSTRACT FROM AUTHOR]

Background and context: Mass medical mission is a nonprofit, public health charity aimed at complementing the effort of government in improving the health indices of Nigerians. Its core initiative is the National Cancer Prevention Program (NCPP), a foremost effort toward national cancer control in Nigeria. In 2007, NCPP spearheaded community-based mass cervical cancer screening in Nigeria, initially known as National Cervical Cancer Prevention Program (NCCPP). This effort has contributed to a 15% reduction of cervical cancer mortality in Nigeria, from 9659 deaths to 8240 deaths, between 2008 and 2012 (GLOBOCAN data). The improvement in cervical cancer survivorship in Nigeria was proof positive that winning the fight against cancer was possible if the effort could be scaled up. Consequently, mass medical mission escalated its advocacy drive, which was tagged the Big War Against Cancer in Nigeria. Aim: The short-term goal was to raise funds toward the provision one Mobile Cancer Centres (MCC) for each state and a Comprehensive Cancer Centre for each of the six geopolitical zones in the long-term. Strategy/Tactics: Mass medical mission initiated the establishment of a fundraising platform known as the Committee Encouraging Corporate Philanthropy (CECP-Nigeria). A private sector led initiative to promote concerted and synergistic philanthropy for the common good through public-social-private partnership. The President of Nigeria is the grand patron while the Vice President, the National Patron. Returns: Through this effort, four of the pilot set of MCC (known as PinkCruise) are now in Nigeria, one of which was donated by the Lagos State Governor. The fixed centers from which the PinkCruise operate have also been set up in four selected cities representing the four old regions of Nigeria. These mobile units are unique as they are multifunctional with state-of-the-art facilities for screening, follow-up and treatment (including mammography, endoscopy, colonoscopy, colposcopy, cryotherapy, laboratory, vaccination and surgeries for precancer and early cancer). The PinkCruise have been deployed to carry out systematic mobile health outreaches, known as Mission PinkCruise, which also have an eye-care aspect known as Mission PinkVISSION. PinkVISSION is also an initiative of mass medical mission (mmm), aimed at achieving the goals of "Vision 2020: The Right to Sight", by incorporating preventive eye care into cancer prevention and general health promotion. The acronym, VISSION, stands for Voluntary Integrated Sight Saving Initiative Of Nigeria. Both Mission PinkCruise and Mission PinkVISSION are free of charge to the hosts and the beneficiaries. What was learned: The synergy between PinkVISSION and PinkCruise results in improved uptake, impact and cost effectiveness of both the cancer campaign and the eye campaign. [ABSTRACT FROM AUTHOR]

Background: Hospitalization for eye care is required for different reasons. The pattern of admissions into the ophthalmic wards of a sub-urban tertiary hospital was studied., Methodology: Records of patients admitted into the Ophthalmology wards of the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife from January 2004 to December 2007 were reviewed and the age, sex, duration of admission and diagnosis recorded. Data was analyzed with SPSS version 13 and statistical significance inferred at P<0.05., Results: Of the 523 patients admitted, 60.2% were males while 39.8% were females (P<0.0001); the male preponderance becomes less prominent with increasing age (P=0.001). The duration of admission ranged between 2 and 24 days with a mean of 2.86+/- 1.95 days and 63% were admitted for 3 days. The main indications for admission were cataract (58.3%), ocular trauma (14.3%) and glaucoma (13.4%). Eye injuries were more common among children and young adults while cataract and glaucoma were the leading indications in the middle aged and elderly., Conclusion: Cataract, trauma and glaucoma were the leading indications for ophthalmic hospitalization. Human and infrastructural development of the ophthalmology unit should lay emphasis on the more prevalent needs to enhance effective and efficient management of these diseases.