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Khathutshelo Percy Mashige,1 Uchechukwu Levi Osuagwu,1,2 Sekar Ulagnathan,3 Bernadine N Ekpenyong,1,4 Emmanuel Kwasi Abu,5 Piwuna Christopher Goson,6 Raymond Langsi,7 Obinna Nwaeze,8 Chikasirimobi G Timothy,9 Deborah Donald Charwe,10 Richard Oloruntoba,11 Chundung Asabe Miner,12 Tanko Ishaya,13 Godwin O Ovenseri-Ogbomo,1,14 Kingsley E Agho1,15 1African Vision Research Institute (AVRI), School of Health Sciences, University of Kwazulu-Natal, Durban, 3629, South Africa; 2Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, New South Wales, Australia; 3Department of Optometry and Vision Sciences, Queensland University of Technology, Brisbane, Queensland, Australia; 4Department of Public Health, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria; 5School of Allied Health Sciences, Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana; 6Department of Psychiatry, College of Health Sciences, University of Jos, Jos, Nigeria; 7Health division, University of Bamenda, Bamenda, Cameroon; 8County Durham and Darlington National Health Service (NHS) Foundation, Darlington, Durham, UK; 9Department of Optometry and Vision Sciences, School of Public Health, Biomedical Sciences and Technology, Masinde Muliro University of Science and Technology, Kakamega, Kenya; 10Tanzania Food and Nutrition Center, Dar-es Salaam, Tanzania; 11Supply Chain Management, Curtin Business School, School of Management and Marketing, Curtin University, Perth, Western Australia, Australia; 12Department of Community Medicine, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria; 13Department of Computer Science, University of Jos, Jos, Plateau State, Nigeria; 14Department of Optometry, Centre for Life Sciences, University of the Highlands and Islands, Inverness, IV2 3JH, UK; 15School of Health Sciences, Western Sydney University, Sydney, New South Wales, AustraliaCorrespondence: Uchechukwu Levi OsuagwuTranslational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, AustraliaTel +61 401 193 234Email l.osuagwu@westernsydney.edu.auPurpose: The key preventive measures adopted to minimise the spread of the coronavirus disease (COVID-19) had significant health, economic and physical impacts mostly in developing countries. This study evaluated the health, economic and physical impacts of COVID-19 lockdown measures among sub-Saharan African (SSA) population and associated demographic variations.Methods: A total of 1970 respondents took part in this web-based cross-sectional survey during the mandatory lockdown period in most SSA. The dependent variables were health (COVID-19 infection, hospitalisation), socioeconomic (lost job, closed down business) and physical impacts (separated from family) of COVID-19. Univariate and bivariate logistic regression analyses were used to explore the factors associated with each of the dependent variables by the four sub-regions (Southern, Western, Central and East Africa).Results: The respondents were aged 34.1 ± 11.5 years (range: 18– 75 years) and mostly men (1099, 55%). 25.9% (n = 511) reported an impact of COVID-19 pandemic with significant regional variations (p < 0.0005, higher proportion were East 36.2% and Southern Africans 30.3%) but no gender (p = 0.334) and age group variations (p > 0.05). Among Central African respondents, more men than women lost their businesses (45.7% versus 14.3%, p = 0.002) and contracted COVID-19 infections (40.0% versus 18.2%, p = 0.024) during the study period. Multivariable analysis revealed that respondents from East (adjusted odds ratio [AOR] 1.95, 95% confidence interval [CI]: 1.42– 2.69), Southern (AOR 1.46, 95% CI: 1.09– 1.96) and Central Africa (AOR 1.47, 95% CI: 1.06– 2.03) reported significantly higher impact of COVID-19. Those who reported family separation during the lockdown were more likely to be older participants (39– 48 years, AOR 2.48, 95% CI: 1.11– 5.57).Conclusion: One in four SSA respondents, mostly East and Southern Africans, were adversely affected by the COVID-19 pandemic during the lockdown. Interventions in high-risk populations are needed to reduce the health, socioeconomic and gender disparities in the impacts of COVID-19.Keywords: job loss, infections, hospitalisation, family separation, lockdown, coronavirus infection, Africa

Background: Glaucoma is an optic neuropathy which causes irreversible vision loss. Standard perimetry, which is essential for glaucoma diagnosis, can only detect glaucomatous visual filed loss when considerable structural damage has occurred. Contrast sensitivity is one of the visual function tests that is reduced in eyes with glaucoma. It is known to be affected in pre-perimetric stages of glaucoma., Objective: The objective of this study was to investigate the discriminating ability of central contrast sensitivity perimetry in eyes with and without glaucoma., Design: The study employed a cross-sectional study design., Methods: The study participants were made of two groups; eyes diagnosed with glaucoma by an ophthalmologist based on visual field test and optical coherence tomography (OCT) and age- and sex-matched controls who were declared free from glaucoma. Static contrast sensitivity (CS) was measured in the central 10° of visual field using a custom psychophysical test., Results: There were 45 eyes with glaucoma and 45 age- and sex-matched controls in this study. The static CS in the glaucoma group was significantly reduced in 9 out of the 13 tested locations in the central 10° of the visual field. The mean static CS at 5°, 10°, superior hemifield and inferior hemifield were all significantly reduced in the glaucoma patients compared to the controls., Conclusion: Static CS measurement is a sensitive approach that can be utilized to aid in the detection of glaucoma. The use of static CS can be adopted in the development of a cost-effective yet sensitive screening tool for the detection of glaucoma., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2023.)

Purpose: To investigate the effect of filters and illumination on contrast sensitivity in persons with cataract, pseudophakia, maculopathy and glaucoma to provide a guide for eye care providers in low vision rehabilitation., Materials and Methods: A within-subjects experimental design with a counter-balanced presentation technique was employed in this study. The contrast sensitivity of eyes with cataract, pseudophakia, maculopathy and glaucoma was measured with filters (no filter, yellow, pink and orange) combined with increasing illumination levels (100 lx, 300 lx, 700 lx and 1000 lx) using the SpotChecks™ contrast sensitivity chart. The data were analyzed using descriptive statistics and two-way repeated measures ANOVA., Results: The yellow filter at 100 lx significantly improved contrast sensitivity in the maculopathy group. There were no significant improvements with either intervention in the rest of the groups. There was, however, a significant interaction between filters and illumination in the cataract group., Conclusion: There were small improvements in contrast sensitivity at low illumination levels with the yellow filter in the maculopathy group, and this could be considered in clinical practice and low vision rehabilitation. Overall, filters at most illumination levels did not benefit most groups., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Clinical Relevance: Inclusion of personality profile assessment and appropriate psychotherapeutic regimen in glaucoma diagnosis and management protocols could prove useful for enhanced medication adherence in patients living with glaucoma., Background: There is poor adherence to medication among patients with glaucoma, especially in people of African ancestry. The present study assessed the influence of personality traits on adherence to glaucoma medication among patients living with primary open-angle glaucoma (POAG) from an African population., Methods: A clinic-based cross-sectional study was conducted among patients with POAG attending a specialist eye-care facility. Adapted and validated questionnaires for personality trait (The Big Five Inventory) and medication adherence (Medication Adherence Report Scale 5) were used., Results: Self-reported adherence to glaucoma medication was 60.8%. The personality traits conscientiousness and agreeableness significantly predicted medication adherence but accounted for only 30.3% and 13.3% of the variance, respectively. Non-adherence to glaucoma medication was significantly predicted by the personality profiles neuroticism, extraversion and openness which, respectively, accounted for 61.7%, 20.3% and 13.3% of the variance in the personality trait assessment. Old age and longer use of glaucoma medications were also significantly associated with non-adherence to glaucoma medication., Conclusions: Personality trait dimensions were significantly associated with glaucoma medication adherence in this at-risk population.

Objective: Self-refracting spectacles (SRSs) have different optical and mechanical designs, which may affect the refractive outcome, depending on the experience of the end user. This study compared the performance of two SRS among children in Ghana., Methods and Analysis: A cross-sectional study of two Alvarez variable-focus SRS designs was conducted. A total of 167 children (mean age 13.6±1.6 years) identified as having refractive error were recruited from 2465 students who underwent screening. Subjects completed self-refraction using FocusSpecs, and Adlens, autorefraction and cycloplegic subjective refraction (CSR) (gold standard). Wilcoxon signed-rank test was used to compare visual outcomes and accuracy of refraction and graphically illustrated using Bland-Altman plots., Results: Eighty (47.9%) urban and 87 (52.1%) rural children were analysed and only about one-quarter 40 (24.0%) wore spectacles. The proportion who achieved visual acuity of ≥6/7.5 with FocusSpec, Adlens, autorefraction and CSR among urban schools were 92.6%, 92.4%, 60% and 92.6%, while those in rural schools were 81.6%, 86.2%, 54.0% and 95.4%, respectively. The mean±SD spherical equivalent errors for urban and rural schools using FocusSpec, Adlens and CSR were -1.05±0.61 D, -0.97±0.58 D and -0.78±0.53 D; and -0.47±0.51 D, -0.55±0.43 D and -0.27±0.11 D, respectively. The mean differences between the two self-refraction spectacles for urban and rural schools were not statistically different (p>0.00) but differed significantly when both were compared with the gold standard (CSR) (p<0.05)., Conclusion: Background and refraction experience of school children did not significantly affect self-refraction., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To ascertain the presence of Dry Eye Syndrome (DES) in patients being treated for glaucoma, using subjective and objective methods and to examine DES impact on their quality of life (QOL)., Method: A cross-sectional study was conducted by employing 156 glaucoma patients recruited from treatment centers in the Cape Coast Metropolis in Ghana. All the participants underwent dry eye examination and completed the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ), the Dry Eye-related Quality of Life Score (DEQS) and the Ocular Surface Disease Index (OSDI). Comparisons of the clinical tests, NEI VFQ-25 subscale item and composite scores and scores of DEQS and OSDI were made among subgroups divided according to the presence of dry eye symptoms or signs. Multivariate logistic regression analysis was performed to investigate the factors that influence DES related-QOL among the patients., Results: The study involved 156 subjects with a mean age of 47.88 ± 16.0 years and made up of 81 (51.9%) females and 75 (48.1%) males. A One-Way ANOVA was conducted, and the F-statistic (F) indicated that there was a significant difference in the mean scores of the groups. There were significantly lower Tear break-up time (TBUT) values found in the group with definite dry compared with the group without DES and the group that was symptomatic with no signs DES in both eyes, [(F(3,151) = 13.703, p<0.001 (RE): (F(3,152) = 18.992, p<0.001 (LE)]. Similar results were found for Schirmer test (ST) [(F (3,151) = 28.895, p<0.001 (RE): (F (3,152) = 17.410, p<0.001 (LE)]. There was statistically significant difference in the mean composite score (64.93 ± 20.27) for the NEI VFQ-25 and sub-scale score of ocular pain, which was significantly lower in the group with definite dry as compared to other sub-groups (F(3,152) = 4.559, p = 0.004). OSDI scores of the group with definite dry eye (47.69-19.17) and the group that was symptomatic but with no signs (38.90-22.44) were significantly higher than those without dry eye and those that were asymptomatic but had a sign (F(3,152) = 17.896, p<0.001), with a similar trend occurring in the groups with relation to DEQS scores (F(3,152) = 8.775, p<0.001). There was a strong correlation between the DEQS and the OSDI questionnaires, and a weak correlation between the DEQS and the NEI VFQ-25 questionnaire after adjusting for all other factors (all p < 0.01)., Conclusion: The study established a high presence of DES and consequently low DES related-QOL in glaucoma patients. Dry eye questionnaires are able to discriminate those who have definite dry eye from the other groups, showing its appropriateness for clinical use in glaucoma patients. Ocular surface evaluation should be conducted among glaucoma patients on topical anti-glaucoma therapy to ensure the timely detection and treatment of signs and symptoms of DES and improvement of dry-eye related QOL., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ocansey et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study aims to evaluate the acceptance and risk perception of pregnant and non pregnant women towards COVID-19 vaccines using a cross-sectional matched-sample study approach. A web-based questionnaire with closed- and open-ended questions was administered to adults older than 18 years in the sub-Saharan African (SSA) region. Respondents ( n = 131) were grouped based on their pregnancy status (54 pregnant and 77 non pregnant women) and matched for comparison by age. The matched groups were compared using the chi-square test and the t -test where appropriate. Compared to non pregnant women, pregnant women reported significantly lower risk perception scores of COVID-19 infection (3.74 vs. 5.78, p < 0.001) and were less likely to take the COVID-19 vaccine (odds ratio = 0.12, 95% confidence interval (CI) 0.06-0.27, p < 0.001). A similar proportion of pregnant and non pregnant women believed in false information about the COVID-19 vaccine, and 40% of unvaccinated pregnant women ( n = 40) were concerned about the safety of the vaccine. After adjustment, women's education, marital status, belief in misconceptions and risk perception were associated with non-vaccination among pregnant women. The content analysis revealed that pregnant women refused the vaccine due to mistrust of their countries' health systems, concerns about the country where the vaccines were manufactured and a lack of confidence in the production process of the vaccines. This study shows the poor acceptance of COVID-19 vaccines among pregnant women in SSA, who perceived a lower risk of COVID-19 infection. Understanding the reasons for non-acceptance and the motivation to accept the COVID-19 vaccine could guide the development of health education and promotion programmes, and aid governments and policymakers in implementing targeted policy changes.

Background: The COVID-19 vaccines are being rolled out across all the sub-Saharan Africa (SSA) countries, with countries setting targets for achieving full vaccination rates. The aim of this study was to compare the uptake of, resistance and hesitancy to the COVID-19 vaccine between SSA locally residents and in the diasporan dwellers., Methods: This was a cross-sectional study conducted using a web and paper-based questionnaire to obtain relevant information on COVID-19 vaccine acceptance. The survey items included questions on demography, uptake and planned acceptance or non-acceptance of the COVID-19 vaccines among SSAs. Multinomial logistic regression was used to determine probabilities of outcomes for factors associated with COVID-19 vaccination resistance and hesitancy among SSA respondents residing within and outside Africa., Results: Uptake of COVID-19 vaccines varied among the local (14.2%) and diasporan (25.3%) dwellers. There were more locals (68.1%) who were resistant to COVID-19 vaccine. Participants' sex [adjusted relative risk (ARR) = 0.73, 95% CI: 0.58 - 0.93], education [primary/less: ARR = 0.22, CI:0.12 - 0.40, and bachelor's degree: ARR = 0.58, CI: 0.43 - 0.77]), occupation [ARR = 0.32, CI: 0.25-0.40] and working status [ARR = 1.40, CI: 1.06-1.84] were associated with COVID-19 vaccine resistance among locals. Similar proportion of local and diasporan dwellers (~ 18% each) were hesitant to COVID-19 vaccine, and this was higher among health care workers [ARR = 0.25, CI: 0.10 - 0.62 and ARR = 0.24, CI:0.18-0.32, diaspora and locals respectively]. After adjusting for the potential confounders, local residents aged 29-38 years [ARR = 1.89, CI: 1.26-2.84] and lived in East Africa [ARR = 4.64, CI: 1.84-11.70] were more likely to report vaccine hesitancy. Knowledge of COVID vaccines was associated with hesitancy among local and diasporan dwellers, but perception was associated with vaccine resistance [ARR = 0.86,CI: 0.82 - 0.90] and hesitancy [ARR = 0.85, CI: 0.80 - 0.90], only among the local residents., Conclusions: Differences exist in the factors that influence COVID-19 vaccine acceptance between local SSA residents and thediasporan dwellers. Knowledge about COVID-19 vaccines affects the uptake, resistance, and hesitancy to the COVID-19 vaccine. Information campaigns focusing on the efficacy and safety of vaccines could lead to improved acceptance of COVID-19 vaccines., (© 2023. The Author(s).)

Background: Vaccination remains the most powerful weapon against the emergence of new variants of coronavirus (COVID-19). However, false information about COVID-19 vaccines through various platforms including social media remains a major threat to global public health. This study examined the impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-Saharan Africa (SSA)., Methods: A validated web-based cross-sectional study was conducted from 14 March to 16 May 2021, and was administered in both French and English to 2572 participants aged 18 years and over. Data on sociodemographic characteristics, medical and vaccination history, and the information sources (mainstream media and social media) used by the participants during the pandemic were obtained. There were three main outcomes: The vaccinated group were those who responded in the affirmation (Yes) to the question of whether they have been vaccinated against COVID-19. Those who responded 'not sure' or 'no' to the question were then asked if they were willing to be vaccinated when the vaccine became available in their home countries. The responses to this follow-up question were used to derive the second and third outcome variables of 'vaccine hesitancy' and 'vaccine resistance', respectively. A series of logistic regression analyses were used to examine the impact of information sources on the three main outcomes., Results: The prevalence of COVID-19 vaccine hesitancy among the participants was lowest among newspaper readers (42%) and highest among TV (72%) and social media users (73%). The prevalence of COVID-19 vaccine-resistance was also lowest among newspaper readers (37%) but highest among social media users (87%). Multivariate analyses revealed that compared to those who did not use these information sources, SSA participants who relied on the radio (aOR 0.83, 95%CI = 0.70, 0.99), TV (aOR 0.80, 95%CI = 0.65, 0.97) and social media (aOR 0.79, 95%CI = 0.65, 0.97) for information during the pandemic were less likely to be hesitant towards taking the vaccines. However, social media users (aOR 2.13, 95%CI = 1.62, 2.80), those who watched TV (aOR 1.40, 95%CI =1.08, 1.80), relied on healthcare workers (HCWs: aOR 1.32, 95%CI = 1.07, 1.63) and families/friends (aOR 1.31, 95%CI = 1.06, 1.61) for COVID-19 related information during the pandemic were more likely to resist taking the COVID vaccines in this study. Participants who relied on the newspaper for information during the pandemic were less likely to resist the vaccines (aOR 0.77, 95%CI = 0.62, 0.95) compared to non-readers of a newspaper., Conclusion: We found that all six information sources except radio were strong predictors of the resistance towards COVID-19 vaccination. Further research on how these channels can be used to improve the availability of reliable healthcare information is needed. Investments in these resources will protect people and empower them to make appropriate choices about their health., (© 2023. The Author(s).)

Background: The coronavirus disease (COVID-19) outbreak has caused a universal health crisis resulting in significant morbidities and mortalities particularly among high-risk groups. This study sought to determine regional factors associated with knowledge and attitude towards COVID-19 mitigation practices and risk perception of contracting the disease in Sub-Saharan African (SSA) countries. Methods: A cross-sectional anonymous online study was conducted among 1970 participants between April and May 2020, during the lockdown in many SSA countries. Recruitment of participants was via WhatsApp, Facebook and emails using authors' networks. The outcome variables were KAP (knowledge, attitudes and practice) of COVID-19 and analysis of variance (ANOVA) with post hoc test was run to assess the level of KAP by four regions in SSA. Simple and multiple linear regression (MLR) analyses were performed to examine factors associated with the outcome measures in the four SSA regions. Results: Mean knowledge ( P =0.707) and risk perception ( P =0.904) scores by four regions in SSA did not differ significantly. However, the mean attitude score was higher among West Africans compared with Southern ( P =0.019) and Central Africans ( P =0.003). MLR analysis revealed that among those living in West (adjusted coefficient β=-0.83 95% CI: -1.19, -0.48) and Southern Africa (β=-0.91 95% CI: -1.42, -0.40), having a primary or secondary education was associated with a decrease in knowledge scores while not being worried about COVID-19 decreased risk perception scores across the four SSA regions(West [β=-6.57, 95% CI: -7.53, -5.62], East [β=-6.24: 95% CI: -8.34,-4.15], Central [β=-6.51, 95% CI: -8.70, -4.31], and Southern Africa [β=-6.06: 95% CI: -7.51, -4.60]). Except among Southern Africans, participants who practiced self-isolation had positive attitude towards COVID-19. Conclusion: Future research on health education regarding COVID-19 or a future related pandemic in SSA should target people with lower education, those who do not self-isolate, those living in Southern and Western Africa and not worried about contracting COVID-19., (© 2022 The Author(s).)

Diabetes mellitus (DM) is associated with severe COVID-19 infection and complications. This study assesses COVID-19 vaccine acceptance and hesitancy in people with DM, and explores the reasons for not being vaccinated. This was a web-based cross-sectional survey using a mixed-method approach conducted in March-May 2021, corresponding to most Sub-Saharan African (SSA) countries' early vaccine rollout period. Participants were those aged ≥18 years with self-reported DM in 11 Sub-Saharan African (SSA) countries. Responses to comments on the reasons for vaccine hesitancy and facilitators for vaccine uptake were analyzed. Of the 73 participants with DM, 65.8% were males, older than 35 years (86.3%), had postsecondary education (90%), and a significant proportion were from South Africa (39.7%), Nigeria (28.8%) and Ghana (13.7%). At the time of this study, 64.4% experienced COVID-19 symptoms, 46.6% were tested for COVID-19, of which 19.2% tested positive. Few participants (6.8%) had received a COVID-19 vaccination, 65.8% were willing to take the vaccine when it becomes available in their country, while 26.0% either refused or remained hesitant towards taking the vaccine. The main identified reasons for not taking the vaccine were: advice from religious leaders; concerns about the safety, effects, and efficacy of the vaccines; mistrust of the pharmaceutical companies producing the vaccines and the process of production; the conspiracy theories around the vaccines; and the personal belief of the participants regarding vaccination. However, participants stated they would take the vaccine if they were more educated about it, received positive feedback from those vaccinated, were rewarded for taking the vaccine, or if vaccination became a condition for travel and employment. In conclusion, this study shows that the uptake of the COVID-19 vaccine was very low in this high-risk group. Efforts to increase the uptake of COVID-19 vaccines among people with diabetes are imperative, such as the provision of education and relevant information.

Objective: To evaluate dry eye disease and meibomian gland dysfunction among type 2 diabetes patients., Methods: A hospital-based cross-sectional study was conducted. Parameters assessed included meibum expressibility and quality, Schirmer test 1, tear breakup time (TBUT), ocular surface staining, blink rates and Ocular Surface Disease Index (OSDI) scores. Dry eye was diagnosed based on a combination of subjective symptoms, tear function and ocular surface staining., Results: Prevalence of DED and MGD were 72.3% and 55.3% respectively. Symptomatic dry eye (OSDI scores) was significantly associated with duration of diabetes (rs = 0.11, P = 0.028) and the presence of conjunctival disorders (OR = 2.09, P = 0.002). MGD was a risk factor for DED (OR = 1.99, P = 0.008); ocular surface damage, the presence of eye lid lesions, abnormal Schirmer test and reduced TBUT were significantly associated with MGD, the strongest predictor being ocular surface damage (OR = 3.21, P = 0.001). OSDI scores had no association with the presence of corneal lesions possibly due to reduced corneal sensitivity., Conclusion: DED and MGD were prevalent among the patients and therefore there is the need for dry eye assessment as a routine clinical management protocol for patients with type 2 diabetes., (© 2022 Abu EK et al.)

Background: The unprecedented outbreak of coronavirus disease (COVID-19) drastically spread worldwide, resulting in extraordinary measures put in place in various countries including Sub Saharan Africa (SSA) countries., Objective: To assess the factors associated with compliance with the public health measures imposed by various SSA countries., Method: Cross sectional study using self-administered surveys distributed on social media platforms between April 18th and May 16th, 2020, corresponding with the mandatory lockdown period in most SSA countries. Multivariate analysis examined the associated factors., Results: The prevalence of hand hygiene, quarantine, self isolation practices, wearing of face mask and attending large gatherings during COVID-19 were 94%, 39%, 31%, 64% and 14%, respectively. In multivariate models, older age 49+ years: adjusted OR 2.13, 95%CI 1.22,3.71), females (OR 1.41,95%CI 1.03,1.93), Central African countries (OR 3.73,95%CI 2.02,6.87) were associated with wearing face mask. Living alone (aOR 1.52,95%CI 1.04,2.24) during the lockdown was associated with avoiding large gatherings including religious events. Female respondents (aOR 1.61, 95%CI 1.30, 2.00), married (aOR 1.71,95%CI 1.33,2.21) and unemployed (aOR 1.62,95%CI 1.25,2.09) SSAs were more likely to practice self-quarantine measures., Conclusion: The low prevalence of mitigation practices suggest the need for targeted education campaign programs to sensitise the population., (© 2021 Nwaeze O et al.)

This study investigated risk perception of contracting and dying of SARS-CoV-2 in sub-Sahara Africa during and after the lockdown periods. Two online surveys were conducted one year apart, with participants 18 years and above living in sub-Sahara Africa or the diaspora. Each survey took four weeks. The first survey was taken from 18 April to 16 May 2020, i.e., during the lockdown. The second survey was taken from 14 April to 14 May 2021, i.e., after the lockdown. A cross-sectional study using adopted and modified questionnaires for both surveys were distributed through online platforms. Question about risks perception of contracting and dying of SARS-CoV-2 were asked. The Helsinki declaration was applied, and ethical approvals were obtained. Total responses for both surveys, i.e., both during and after the lockdown, was 4605. The mean age was similar in both surveys (18-28 years). The mean risk perception scores were higher after lockdown by 3.59%. Factors associated with risk perception of COVID-19 were survey period, age group, region of residence, and occupation. Non-health care workers had a lower risk perception of COVID-19. This first comparative study on the level of risk perception of Africans during and after the lockdown shows that one in every three and every four persons in sub-Sahara Africa felt at high risk of contracting COVID-19 and thought they could die from contracting the same, respectively.

Purpose: The purpose of this study was to investigate the utility of two ocular biometric measurements to obtain Hirschberg ratios (HRs) in a binocularly normal paediatric population, and to assess the repeatability of this approach., Methods: Ocular biometry data from 80 participants (aged 5 to 14 years) was obtained using the KM-1 LED manual keratometer and the Tomey Biometer AL-100 A-scan. HRs were calculated from corneal curvature and anterior chamber depth measurements in the horizontal and vertical meridians of each eye using a regression equation based on a geometric optics model. To assess intrasubject variability in the HRs obtained from biometry, measurements were repeated approximately 1 h later., Results: At the initial measurement, mean (SD, range) HRs were 10.77 (0.79, 9.14-12.73) and 11.02 (0.82, 9.48-13.32) °/mm for the horizontal and vertical meridians, respectively. There was a significant difference between the horizontal and vertical HRs (p < 0.0001). Mean intrasubject variability of HR was 0.06 °/mm (95% Limit of Agreement [LOA]: -0.82 to 0.94 °/mm), and 0.05 °/mm (95% LOA: -1.05 to 1.15 °/mm) for the horizontal and vertical meridians, respectively., Conclusion: The results indicated that HRs obtained through ocular biometry in a binocularly normal paediatric population are consistent with previous studies in both strabismic children and adult cohorts. The HRs obtained with this technique were highly repeatable in this study population. This approach to gaze position calibration could be used in lieu of other empirical techniques in children., (© 2021 The Authors Ophthalmic and Physiological Optics © 2021 The College of Optometrists.)

Background: Perceived risk towards the coronavirus pandemic is key to improved compliance with public health measures to reduce the infection rates. This study investigated how Sub-Saharan Africans (SSA) living in their respective countries and those in the diaspora perceive their risk of getting infected by the COVID-19 virus as well as the associated factors., Methods: A web-based cross-sectional survey on 1969 participants aged 18 years and above (55.1% male) was conducted between April 27th and May 17th 2020, corresponding to the mandatory lockdown in most SSA countries. The dependent variable was the perception of risk for contracting COVID-19 scores. Independent variables included demographic characteristics, and COVID-19 related knowledge and attitude scores. Univariate and multiple linear regression analyses identified the factors associated with risk perception towards COVID-19., Results: Among the respondents, majority were living in SSA (n = 1855, 92.8%) and 143 (7.2%) in the diaspora. There was no significant difference in the mean risk perception scores between the two groups (p = 0.117), however, those aged 18-28 years had lower risk perception scores (p = 0.003) than the older respondents, while those who were employed (p = 0.040) and had higher levels of education (p < 0.001) had significantly higher risk perception scores than other respondents. After adjusting for covariates, multivariable analyses revealed that SSA residents aged 39-48 years (adjusted coefficient, β = 0.06, 95% CI [0.01, 1.19]) and health care sector workers (β = 0.61, 95% CI [0.09, 1.14]) reported a higher perceived risk of COVID-19. Knowledge and attitude scores increased as perceived risk for COVID-19 increased for both SSAs in Africa (β = 1.19, 95% CI [1.05, 1.34] for knowledge; β = 0.63, 95% CI [0.58, 0.69] for attitude) and in Diaspora (β = 1.97, 95% CI [1.16, 2.41] for knowledge; β = 0.30, 95% CI [0.02, 0.58] for attitude)., Conclusions: There is a need to promote preventive measures focusing on increasing people's knowledge about COVID-19 and encouraging positive attitudes towards the mitigation measures such as vaccines and education. Such interventions should target the younger population, less educated and non-healthcare workers., (© 2021. The Author(s).)

Health education is key in the prevention of Ophthalmia Neonatorum (ON). However, health education in relation to eye care in Ghana is very low. To determine the knowledge, attitudes and practices (KAPs) of mothers on Ophthalmia Neonatorum (eye infection in newborns), a descriptive cross-sectional design was adopted, using a standardised interviewer-administered questionnaire to collect data. Using a consecutive sampling technique, we enrolled 407 mothers to participate in the study. The overall KAPs of the study participants were assessed using the sum score of each outcome based on Bloom's cut-off point. Completed data was then analysed using descriptive statistics with SPSS version 22.0 at the level of P < .05. Out of the 407 participants, 321 (78.9%) had not heard about Ophthalmia Neonatorum with nearly 93% having low levels of knowledge on the neonatal infection. We found a significant association between formal education ( P = .001), skilled occupation ( P = .008) and a high level of knowledge on Ophthalmia Neonatorum. The study highlights the need to find improved and alternative methods of educating mothers on Ophthalmia Neonatorum in the bid to reduce blindness attributed to the condition., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Due to the current COVID-19 pandemic and associated high mortality in sub-Saharan Africa, there is panic among healthcare workers because of the higher risk of being infected. This study compared knowledge, attitudes, and perceptions of COVID-19 among healthcare workers (HCWs) and non-healthcare workers (non-HCWs) and examined common associated factors. A web-based cross-sectional study of 1,871 respondents (430 HCWs and 1,441 non-HCWs) was conducted while lockdown measures were in place in 4 regions of sub-Saharan Africa. Data were obtained using a validated self-administered questionnaire via an online survey platform. Mean scores were calculated and summarized using a t test for both groups. Multivariate linear regression analysis was conducted to assess the unadjusted (B) and adjusted coefficients (β) with a confidence interval (CI) of 95%. The mean scores were slightly higher among HCWs than non-HCWs, but not statistically significant. Being worried about contracting COVID-19 was the only common factor associated with knowledge, attitudes, and perceptions between the 2 groups. Knowledge of COVID-19 was associated with attitudes and perceptions between the 2 groups. Other significant associated factors were: the sub-Saharan Africa region, ages 29 to 38 years (β = .32; 95% CI, 0.04 to 0.60 for knowledge among non-HCWs), education (β = -.43; 95% CI, -0.81 to -0.04; and β = -.95; 95% CI, -1.69 to -0.22, for knowledge among non-HCWs and HCWs, respectively), practice of self-isolation (β = .71; 95% CI, 0.41 to 1.02 for attitude among non-HCWs and HCWs (β = .97; 95% CI, 0.45 to 1.49), and home quarantine due to COVID-19, in both groups. Policymakers and healthcare providers should consider these factors when targeting interventions during COVID-19 and other future pandemics.

In developing countries such as Ghana, ophthalmia neonatorum (ON) remains a public health concern. This is because of its unknown etiology patterns, the growing concerns of antibiotic resistance strains and the contribution of ON to childhood blindness. This study was therefore conducted to determine the causative agents, risk factors and the antibiotic sensitivity patterns of micro-organisms associated with ON. A clinic-based prospective study was conducted in the Maternal and Child Health units of 6 health care facilities in the Central region of Ghana over a period of 17 months. Conjunctival swabs were taken from all neonates with clinical signs of ON. Isolation and characterization of bacteria were done using standard microbiological methods. Additionally, data were collected and analyzed on neonate's demographics and clinical features of ON. Microbial growth was recorded in 86 cases (52.4%) out of the 110 neonates assessed. Staphylococcus spp. (39.2% of all positive cultures) was the most common causative organism. No case of gonococcus was isolated. Delivery method, vaginal discharge, administration of prophylaxis and weight of neonate were the risk factors associated with the development of ON ( P  < .05). The level of resistance to Tetracycline was found to be 73%. Neonatal conjunctivitis is more likely to be acquired postnatal. Culture and sensitivity testing are required as an important guide for treatment. The commonest causative organism, Staphylococcus spp., were found to be resistant to Teteracyline, therefore is the need to consider alternatives measures in the prevention and control of ON., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background: Malaria and helminths diseases are co-endemic in most parts of sub-Saharan Africa. Immune responses from each of these pathogens interact, and these interactions may have implications on vaccines. The GMZ2 malaria vaccine candidate is a fusion protein of Plasmodium falciparum merozoite surface protein 3 (MSP3) and glutamate rich protein (GLURP R0). GMZ2 has recently showed modest efficacy in a phase IIb multicenter trial. Here, we assessed the effect of hookworm (Necator americanus) infection and anthelmintic treatment on naturally acquired antibody responses against GMZ2 and constituent antigens., Methods: This longitudinal cross-sectional study was conducted in the Kintampo North Municipality of Ghana. Blood and stool samples were taken from 158 individuals (4-88 years old) infected with either P. falciparum alone (n = 59) or both hookworm and P. falciparum (n = 63) and uninfected endemic controls (n = 36). Stool hookworm infection was detected by the Kato-Katz method and PCR. Malaria parasitaemia was detected by RDT, light microscopy and P. falciparum-specific 18S rRNA gene PCR. Serum samples were obtained prior to hookworm treatment with a single dose of albendazole (400 mg) and 3 weeks (21 days) after treatment. Levels of IgG1, IgG3 and IgM against GMZ2, MSP3 and GLURP R0 were measured by ELISA and compared among the groups, before and after treatment., Results: Participants with P. falciparum and hookworm co-infection had significantly higher IgG3 levels to GMZ2 than those with only P. falciparum infection and negative control (p < 0.05) at baseline. Treatment with albendazole led to a significant reduction in IgG3 levels against both GMZ2 and GLURP R0. Similarly, IgM and IgG1 levels against MSP3 also decreased following deworming treatment., Conclusion: Individuals with co-infection had higher antibody responses to GMZ2 antigen. Treatment of hookworm/malaria co-infection resulted in a reduction in antibody responses against GMZ2 and constituent antigens after albendazole treatment. Thus, hookworm infection and treatment could have a potential implication on malaria vaccine efficacy.

Purpose: To evaluate the impact of blood sugar level on ocular measures, including refractive error (RE), amplitude of accommodation (AoA), and lag of accommodation (LoA), in pre-presbyopes with type-1 diabetes., Method: The fasting blood sugar (FBS) and ocular measures of type-1 diabetes patients (age: 14-39 years; n = 30) on insulin treatment was recorded while they fasted on two separate visits, at baseline and 3 months later. The AoA and LoA was measured with the appropriate spectacle correction worn. The Welch's t-test was used for comparison of the baseline measures between the normal FBS ≤ 7 (n = 10) and higher FBS > 7 (n = 20) patients, and the paired t-test used to investigate for differences between the baseline and follow-up data in patients with changes in FBS., Results: On average, the spectacle correction for the normal FBS group was marginally more myopic (RE: -0.30 ± 0.67 D vs. +0.18 ± 1.00 D, p = 0.032), and they showed greater AoA (5.38 ± 1.08 D vs. 3.68 ± 1.43 D, p < 0.001) and lower LoA (1.00 ± 0.30 D vs. 1.30 ± 0.38 D, p = 0.004) compared with the higher FBS group at baseline. On the follow-up visit attended by 25 patients, the FBS of 15 patients was reduced by an average of 7.0 mmol/L, 8 patients had an average increase of 5.2 mmol/L, while 2 patients recorded no changes relative to the baseline. The patients whose FBS was reduced showed improvement in the mean AoA from 3.78 ± 1.58 D to 4.88 ± 1.61 D (p < 0.001) and a reduction in the mean LoA from 1.37 ± 0.40D to 0.87 ± 0.19D (p < 0.001), whereas those with deteriorated control of the FBS showed an opposite trend., Conclusions: Controlling hyperglycemia improves ocular accommodation in type-1 diabetes.

Purpose: To evaluate the awareness, knowledge and the perception of risks of glaucoma among rural and urban dwellers in Ghana, a high prevalent country, in order to provide information for health promotion planning., Method: In a population-based descriptive cross-sectional survey, 1200 adults were selected from household settings, using a two-stage cluster and simple systematic random sampling. Quantitative data collection, using interviewer-administered questionnaire, was employed. Descriptive statistics were performed using chi-square, ordinal univariate, multinomial and multivariate logistic regression models used to calculate odds ratio with 95% confidence interval (CI) to identify predictive factors., Results: Overall, only 326 (27.2%, 95% CI = 24.6-29.7) indicated they were aware of glaucoma, whereas 331 (27.6%, 95% CI = 24.6-29.7) had ever undergone an eye screening. Low knowledge was demonstrated in 152 (46.6%, 95% CI = 41.2-52.0) and high knowledge in 99 (30.4%, 95% CI = 25.4-35.4) glaucoma-aware participants. Only 238 (19.8%, 95% CI = 17.6-22.1) of respondents presumed themselves to be at risk of developing glaucoma. Having eye examination (within the last 6 months) was positively associated with knowledge (adjusted odds ratio (AOR) = 1.413; 95% CI = 0.9-1.896) and awareness (AOR = 1.13; 95% CI = 0.938-2.449). Three levels of education (no education (AOR = 0.041; 95% CI = 0.016-0.11), primary (AOR = 0.057; 95% CI = 0.018-0.179), and middle school (AOR = 0.254; 95% CI = 0.127-0.51)) were associated with low knowledge while all levels of education were inversely associated with awareness. Perceived risk of glaucoma was also influenced by area of residence (rural (AOR = 0.344; 95% CI = 0.21-0.57)), being young (18-24 years (AOR = 4.308; 95% CI = 2.36-7.88)) and having previously undergone screening for glaucoma (AOR = 13.200; 95% CI = 5.318-32.764)., Conclusion: The main modifiers of glaucoma awareness and knowledge were education and previous eye examination, but awareness had additional factor of area of residence. Perceived risk of glaucoma was influenced by being young and living in urban areas., Competing Interests: Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s), 2021.)

Mental health and emotional responses to the effects of COVID-19 lockdown in sub-Saharan Africa (SSA) are of serious public health concern and may negatively affect the mental health status of people. Hence, this study assessed the prevalence of mental health symptoms as well as emotional reactions among sub-Saharan Africans (SSAs) and associated factors among SSAs during the COVID-19 lockdown period. This was a web-based cross-sectional study on mental health and emotional features from 2005 respondents in seven SSA countries. This study was conducted between 17 April and 17 May 2020 corresponding to the lockdown period in most SSA countries. Respondents aged 18 years and above and the self-reported symptoms were feeling anxious, being worried, angry, bored and frustrated. These were the main outcomes and were treated as dichotomous variables. Univariate and multivariate logistic regression analyses were used to identify the factors associated with these symptoms. We found that over half (52.2%) of the participants reported any of the mental health symptoms and the prevalence of feeling bored was 70.5% followed by feeling anxious (59.1%), being worried (57.5%), frustrated (51.5%) and angry (22.3%) during the COVID-19 pandemic. Multivariate analysis revealed that males, those aged >28 years, those who lived in Central and Southern Africa, those who were not married, the unemployed, those living with more than six persons in a household, had higher odds of mental health and emotional symptoms. Similarly, people who perceived low risk of contracting the infection, and those who thought the pandemic would not continue after the lockdown had higher odds of mental health and emotional symptoms. Health care workers had lower odds for feeling angry than non-healthcare workers. During the COVID-19 lockdown periods in SSA, about one in two participants reported mental health and emotional symptoms. Public health measures can be effectively used to identify target groups for prevention and treatment of mental health and emotional symptoms. Such interventions should be an integral component of SSA governments' response and recovery strategies of any future pandemic.

Misinformation about coronavirus disease 2019 (COVID-19) is a significant threat to global public health because it can inadvertently exacerbate public health challenges by promoting spread of the disease. This study used a convenience sampling technique to examine factors associated with misinformation about COVID-19 in sub-Saharan Africa using an online cross-sectional survey. A link to the online self-administered questionnaire was distributed to 1,969 participants through social media platforms and the authors' email networks. Four false statements-informed by results from a pilot study-were included in the survey. The participants' responses were classified as "Agree," "Neutral," and "Disagree." A multinomial logistic regression was used to examine associated factors. Among those who responded to the survey, 19.3% believed that COVID-19 was designed to reduce world population, 22.2% thought the ability to hold your breath for 10 seconds meant that you do not have COVID-19, 27.8% believed drinking hot water flushes down the virus, and 13.9% thought that COVID-19 had little effect on Blacks compared with Whites. An average of 33.7% were unsure whether the 4 false statements were true. Multivariate analysis revealed that those who thought COVID-19 was unlikely to continue in their countries reported higher odds of believing in these 4 false statements. Other significant factors associated with belief in misinformation were age (older adults), employment status (unemployed), gender (female), education (bachelor's degree), and knowledge about the main clinical symptoms of COVID-19. Strategies to reduce the spread of false information about COVID-19 and other future pandemics should target these subpopulations, especially those with limited education. This will also enhance compliance with public health measures to reduce spread of further outbreaks.

The recently identified novel coronavirus (CoV), the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causes the coronavirus disease 2019 (COVID-19). While published data about other highly infectious human COVs [that is, the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV)] provide helpful information about the infectivity of SARS-CoV-2, there is limited understanding surrounding knowledge of ocular manifestation of the virus. This paper reviews published data which reveal the presence of SARS-CoV-2 RNA in tears and conjunctival scrappings of some COVID-19 patients by real-time-polymerase chain reaction assay, although the detection rate is low compared to samples from respiratory sites. Nevertheless, the ocular complications from SARS-CoV-2 infection are uncommon. The evidence partly supports the eye as a portal of entry for SARS-CoV-2 to infect respiratory cells or viral shedding from respiratory cells via the nasolacrimal duct unto the ocular surface. The possibility of ocular secretions as source for SARS-CoV-2 to spread externally has substantial public health implications.

Background: Autophagy has a crucial role in the defense against parasites. The interplay existing between host autophagy and parasites has varied outcomes due to the kind of host cell and microorganism. The presence of autophagic compartments disrupt a significant number of pathogens and are further cleared by xenophagy in an autolysosome. Another section of pathogens have the capacity to outwit the autophagic pathway to their own advantage., Result: To comprehend the interaction between pathogens and the host cells, it is significant to distinguish between starvation-induced autophagy and other autophagic pathways. Subversion of host autophagy by parasites is likely due to differences in cellular pathways from those of 'classical' autophagy and that they are controlled by parasites in a peculiar way. In xenophagy clearance at the intracellular level, the pathogens are first ubiquitinated before autophagy receptors acknowledgement, followed by labeling with light chain 3 (LC3) protein. The LC3 in LC3-associated phagocytosis (LAP) is added directly into vacuole membrane and functions regardless of the ULK, an initiation complex. The activation of the ULK complex composed of ATG13, FIP200 and ATG101causes the initiation of host autophagic response. Again, the recognition of PAMPs by conserved PRRs marks the first line of defense against pathogens, involving Toll-like receptors (TLRs). These all important immune-related receptors have been reported recently to regulate autophagy., Conclusion: In this review, we sum up recent advances in autophagy to acknowledge and understand the interplay between host and parasites, focusing on target proteins for the design of therapeutic drugs. The target host proteins on the initiation of the ULK complex and PRRs-mediated recognition of PAMPs may provide strong potential for the design of therapeutic drugs against parasitic infections., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Background: The role of optometrists in paediatric visual assessment must compliment the role of other eye-care practitioners at all levels of care. This study was undertaken to determine if optometrists in Ghana screen, diagnose and manage paediatric ocular conditions (for example, strabismus, amblyopia), and further assessed if optometrists in Ghana have the requisite paediatric instrumentation in their practices., Methods: This was a cross-sectional descriptive survey involving optometrists in both public and private eye-care sectors in Ghana. A paediatric visual assessment questionnaire was sent to all registered optometrists in Ghana. The contents of the questionnaire evaluated areas of vision assessment, refraction, and previous diagnosis and management, which were matched with practice characteristics such as location, type of practice and type of employment. Chi-squared statistic was used to test associations between variables., Results: Responses were obtained from 140 optometrists out of the 326 registered optometrists, representing a response rate of 46 per cent. Overall, less than half of respondents (64 which represents 46 per cent) assessed themselves as practising full-scope paediatric eye care. These self-assessment views were more common among optometrists at the regional level (111: 79.3 per cent), followed by the district (20: 14.3 per cent) and sub-district levels (nine: 6.4 per cent) (χ 2 = 4.774, p < 0.05), but was not influenced by type of employment, type of practice and level of training (p > 0.05). In addition, the study revealed that many respondents were more likely to assess pre-schoolers' visual acuity (VA) (121: 96.0 per cent), do refraction (109: 88.6 per cent) and perform binocular vision (BV) assessment (93: 76.9 per cent) compared to the toddlers' VA (72: 55.4 per cent), refraction (57: 46 per cent) and BV assessment (68: 56.2 per cent)., Conclusion: Full-scope paediatric eye care services among optometrists in Ghana is limited., (© 2019 Optometry Australia.)

Background: Ocular injury is a major cause of ocular morbidity and unilateral visual impairment and represents a considerable public health concern especially in low resource societies., Objective: To evaluate the epidemiology and visual outcomes of ocular injuries in southern Ghana., Methods: A retrospective hospital-based case series was conducted. Information on new cases of ocular injuries were retrieved and parameters including time between injury occurrence and reporting to the clinic, presenting visual acuity (VA), and the best corrected final VA were investigated and visual outcomes were assessed Results: Most (50.2%) of the patients reported to the hospital after a day of sustaining an ocular injury; workplace injuries, older patients and farm-related injuries were most likely to report after a day of sustaining an injury. A significant proportion (40.4%) of patients reported with good presenting vision (6/6-6/18) which increased to 56.7% after treatment; 45.3% of patients reported with visual impairment (<6/18) and reduced to 42.4% after treatment. Farming (AOR = 4.5, p = 0.02), reporting after a day of sustaining injury (AOR = 78, p< 0.001), workplace injuries (AOR = 3.1, p = 0.007) and roadside injuries (AOR = 3.1, p = 0.02) were associated with poor visual outcomes. Initial VA 6/18 or better was the highest predictor of good visual outcome., Conclusion: There is a shift in the pattern of ocular injury occurrence from work-related to home- related., (© 2020 bu EK et al.)

Aim: The aim of this study was to assess the prevalence of computer vision syndrome (CVS) and its associated ergonomic factors among university administrative staff in Ghana., Methods: A cross-sectional survey was conducted among 200 administrative staff of the University of Cape Coast. The procedure included a self-administered questionnaire, comprehensive ocular health examination, and assessment of computer workstation and lighting conditions. The prevalence of CVS among the subjects and the association between CVS and ergonomic practices were determined., Results: The mean age of the study sample was 31.0 ± 4.7 years, and the majority were males (56.0%). The prevalence of CVS was among 103 (51.5%)participants. Over a third of the respondents used computers for 6 or more hours daily. Significant association was found between CVS and poor ergonomic practices ( χ  = 15.175, p = 0.001)., Conclusion: In addition to poor ergonomic office setup, university administrative staff spend several hours behind computer screens leading to the development of CVS. Increased awareness of CVS and adherence to recommended ergonomic practices are necessary to reduce the prevalence of CVS and ultimately enhance work satisfaction and productivity., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Samuel Bert Boadi-Kusi et al.)

The protozoan parasites are evolutionarily divergent, unicellular eukaryotic pathogens representing one of the essential sources of parasitic diseases. These parasites significantly affect the economy and cause public health burdens globally. Protozoan parasites share many cellular features and pathways with their respective host cells. This includes autophagy, a process responsible for self-degradation of the cell's components. There is conservation of the central structural and functional machinery for autophagy in most of the eukaryotic phyla, however, Plasmodium and Toxoplasma possess a decreased number of recognizable autophagy-related proteins (ATG). Plasmodium noticeably lacks clear orthologs of the initiating kinase ATG1/ULK1/2, and both Plasmodium and Toxoplasma lack proteins involved in the nucleation of autophagosomes. These organisms have essential apicoplast, a plastid-like non-photosynthetic organelle, which is an adaptation that is used in penetrating the host cell. Furthermore, available evidence suggests that Leishmania, an intracellular protozoan parasite, induces autophagy in macrophages. The autophagic pathway in Trypanosoma cruzi is activated during metacyclogenesis, a process responsible for the infective forms of parasites. Therefore, numerous pathogens have developed strategies to impair the autophagic mechanism in phagocytes. Regulating autophagy is essential to maintain cellular health as adjustments in the autophagy pathway have been linked to the progression of several physiological and pathological conditions in humans. In this review, we report current advances in autophagy in parasites and their host cells, focusing on the ramifications of these studies in the design of potential anti-protozoan therapeutics., Competing Interests: Declaration of competing interest Authors declare no competing interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: To determine normative values of retinal nerve fibre layer thickness (RNFL) and optic nerve head (ONH) parameters and their association with routine clinical tests such as refractive error (RE), stereoacuity (SA), and contrast sensitivity (CS) in an African population., Methods: In a cross-sectional observational study, 100 normal subjects aged 20 to 78 years were evaluated using the Cirrus HD-OCT 5000 and matched with 200 glaucoma patients., Results: Average (±SD) RNFL thickness for normal subjects was found to be 102.37 ± 7.45 (range, 82-119 microns) compared with 90.74 ± 14.50 found for glaucoma subjects. Females had higher average RNFL values (104.84 ± 6.90) compared with males (99.80 ± 7.18). Significant associations were calculated between quadrant RNFL thickness and SA, SE, and CS (all p < 0.05). The mean cup to disc ratio (CDR) was 0.49 ± 0.12, and mean optic disc area (DA) was 2.08 mm 2  ± 0.40. Smaller DA was recorded for participants aged 60+ years (1.86 ± 0.25), followed by 40-59 age group (2.01 ± 0.41) and then 20-39 age group (2.19 ± 0.41). Significant associations were calculated between SA and ONH parameters, except rim area (all p < 0.05). The mean cup to disc ratio (CDR) was 0.49 ± 0.12, and mean optic disc area (DA) was 2.08 mm 2  ± 0.40. Smaller DA was recorded for participants aged 60+ years (1.86 ± 0.25), followed by 40-59 age group (2.01 ± 0.41) and then 20-39 age group (2.19 ± 0.41). Significant associations were calculated between SA and ONH parameters, except rim area (all p < 0.05). The mean cup to disc ratio (CDR) was 0.49 ± 0.12, and mean optic disc area (DA) was 2.08 mm 2  ± 0.40. Smaller DA was recorded for participants aged 60+ years (1.86 ± 0.25), followed by 40-59 age group (2.01 ± 0.41) and then 20-39 age group (2.19 ± 0.41). Significant associations were calculated between SA and ONH parameters, except rim area (all., Conclusion: RNFL thickness in healthy black Ghanaian population was significantly higher than that reported in other races. The values and associations reported in this study can inform clinical decision on the normal variation in RNFL and optic disc parameters., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2020 Stephen Ocansey et al.)

Background: Necator americanus (hookworm) and Plasmodium falciparum co-infections are common in endemic communities in rural Ghana. Human immune responses to P. falciparum and hookworm are complex, and the dynamics of cytokine levels and effector mediators are poorly understood. This study aimed to determine the effect of hookworm and P. falciparum co-infection on parasite intensities and cytokine profiles in individuals before and after deworming drug treatment., Methods: In this cross-sectional study conducted in the Kintampo North Municipality of Ghana blood and stool samples were analyzed from 984 participants (aged 4-88 years). Stool samples were collected at baseline from all participants and examined for the presence of hookworm using the Kato-Katz method. Blood and stool samples were analysed again two weeks after albendazole treatment of hookworm infected individuals. Malaria parasitaemia was estimated by light microscopy and P. falciparum -specific 18S rRNA gene PCR method used for species identification. Serum levels of circulating cytokines interleukins -5, -10 (IL-5, IL-10), tumor necrosis factor [TNF]-α, and eotaxin [CCL11] were determined using ELISA based methods., Results: Malaria parasitaemia was significantly reduced in hookworm and P. falciparum co-infected individuals (p = 0.0018) while hookworm intensity was similar between groups. IL-10 level was significantly higher in the co-infected individuals (39.9 ± 12.2 pg/ml) compared to the single infected or the uninfected group (10.7 ± 7.6 mg/ml). IL-5 level was higher in the hookworm only infected individual. TNF-α levels were higher in all infected groups compared to the uninfected controls. CCL11 levels were significantly higher in subjects infected with hookworm only or co-infected with hookworm and P. falciparum. There was a significantly negative correlation (r s  = -0.39, p = 0.021) between hookworm eggs per gram of stool and CCL11 levels in the group mono-infected with hookworm which was not affected by treatment. Treatment with albendazole led to a significant reduction of TNF-α (p = 0.041), IL-5 (p = 0.01) and IL-10 (p = 0.001) levels., Conclusion: This study shows that in the absence of other helminths, co-infection of hookworm with P. falciparum may modulate blood parasitemia levels and cytokine responses. Data also show that deworming drug treatment alters these cytokine profiles in hookworm infected subjects. Future studies to elucidate the potential mechanisms underlying these observations should include an assessment of parasite specific cellular responses., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2019 The Authors.)

Background: Contact lenses are gaining popularity in developing countries as an alternative to spectacles for the correction of refractive errors. It is needful, therefore, to generate information to guide the mode of practice, and assist the industry in developing products for the increasing contact-lenses-user population. The purpose of this study was to identify the demographic profile, as well as the knowledge, attitude to wear and care regimen of wearers of contact lenses in Ghana., Methods: In a cross-sectional study, case folders of 87 users of contact lenses were selected from the database eye contact lenses practices. The folders were reviewed for the demographic profile, type, and purpose for which the contact lenses were prescribed. Forty-two (42) contact lenses users were then randomly surveyed, using a semi-structured questionnaire to collect information on their knowledge, lens wear regimen, and attitudes regarding lens hygiene. Chi-square test was used to test associations between demographics and lens wear variables., Results: Out of the 87 cases reviewed, 46 (52.9%) were females and 41 (47.1%) males. Their ages ranged from 15 to 68 years with a mean age of 28.62 ± 9.38 years. The majority- 65 (75%) - were youthful (≤ 40 years), with the highest proportion of them - 46 (53%) - being between 20-29 years. The majority - 60 (68.9%) - had a tertiary level of education. Soft contact lenses were commonly worn by 68 (78.2%) users while 19 (21.8%) wore rigid gas permeable lenses. The purpose for wearing contact lenses included for vision correction - 46 (52.9%), followed by for cosmesis - 23 (26.4%) - and therapeutic reasons -18 (20.7%). The commonest refractive error corrected was myopia - 38 (43.7%), followed by astigmatism -19 (21.8%) and hyperopia 6 (6.9%). Among the 42 users who responded to the questionnaire, by proportion, the majority -17 users (40.5%) - were introduced to contact lenses by optometrists. All respondents reported previous symptoms associated with the use of their contact lenses, but slightly more than half, 25 (57.1%) did yearly follow-up visits., Conclusion: The majority of contact lenses used in Ghana are soft lenses, for the purpose of vision correction. The use of contact lenses was common among individuals in their early adulthood and those with tertiary education., (Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Aim: Amplitude of accommodation (AoA) can be determined clinically using different methods. Some methods are known to be more reliable than others for measuring AoA in different age categories. The purpose of this study was to compare Hofstetter's age-expected norms with five recommended methods of measuring AoA in order to determine age-appropriate techniques for a Ghanaian population., Materials and Methods: AoA was measured using four subjective methods (push-up, push-down, minus lens, and modified push-up) and one objective method, the modified dynamic retinoscopy. The amplitudes obtained by each technique were compared to each other and also compared to the age-expected amplitudes as predicted by Hofstetter's equations., Results: 352 non-presbyopes aged 10-39 years were included in this study. All five methods except the push-up (p = 0.089) and modified push-up (p = 0.081) differed significantly from Hofstetter's data, while the modified dynamic retinoscopy recorded the strongest agreement with Hofstetter's average (ICC = 0.78, p ˂ 0.001). With reference to Hofstetter's expected AoA, the minus lens, push-down, modified dynamic retinoscopy, and modified push-up methods underestimated AoA by -4.18D, -1.99D, -0.48D, and -0.43D, respectively. As age increased, underestimated AoA values by the minus lens (10-19 years: -5.57D, 20-29 years: -3.50D, 30-39 years: -2.39D), modified push-up (10-19 years: -1.51D, 20-29 years: +0.40D, 30-39 years: +0.56D), and push-down (10-19 years: -2.90D, 20-29 years: -1.07D, 30-39 years: -1.46D) methods decreased but the modified push-up in relation to Hofstetter's expected was most accurate for the older age. The push-up, on the other hand, overestimated accommodation in all age categories by +0.42D (10-19 years: +0.01D, 20-29 years: +0.82D, 30-39 years: 0.67D). Thus, the push-up method became more accurate as age decreased., Conclusion: This study suggested that Hofstetter's formulae could be used to predict the amplitudes of Ghanaian non-presbyopes aged 10-39 years using the push-up and modified push-up. With regard to Hofstetter's data, the push-up method was more accurate for the younger age-group 10-19 years while the modified push-up was more accurate for the older age-group 20-39.

Purpose: To evaluate associations between IFN-γ +874T/A and TNF-α-308G/A polymorphism with the development of Toxoplasma retinochoroiditis., Methods: By ARMS-PCR, a cross-sectional genetic study involving 30 patients with Toxoplasma retinochoroiditis and 87 controls was carried out., Results: IFN-γ +874: by comparing with the AA genotype, individuals with the TT genotype had a 3.4 odds ratio (OR); AT had a 1.6 OR; and the T allele had a higher OR (1.6), indicating a likely susceptibility of IFN-γ +874T to the infection, though the overall distribution was not significant (p = 0.259). For TNF-α-308G/A, individuals with both GA and AA genotypes had lower ORs when compared with the GG genotype, implying the A allele could confer protection against Toxoplasma ocular lesions., Conclusions: IFN-γ +874T allele may increase the risk of ocular lesions in Toxoplasma infection. The principle of natural selection seems to also play a role. The less common TNF-308A allelic form could be protective against the development of Toxoplasma ocular infection.

Purpose: To determine the near vision spectacle coverage and barriers to obtaining near vision correction among adults aged 35 years and older in the Cape Coast Metropolis of Ghana., Methods: A population-based cross-sectional study design was adopted and 500 out of 576 participants aged 35 years and older were examined from 12 randomly selected clusters in Cape Coast, Ghana. All participants underwent a comprehensive eye examination which included: distance and near visual acuities measurements and external and internal ocular health assessments. Distance and near refractions were performed using subjective refraction technique. Information on participants' demographics, near vision correction status, near visual needs and barriers to acquiring near vision correction were obtained through a questionnaire administered as part of the study., Results: The mean age of participants was 52.3±10.3 years of whom 280 (56%) were females and 220 (44%) were males. The near vision spectacle coverage was 25%, 33% "met need" for near vision correction in the presbyopic population, and 64% unmet need in the entire study population. After controlling for other variables, age (5 th and 6 th decades) and educational level were associated with "met need" for near vision correction (OR=2.7 (1.55-4.68), p =0.00, and OR=2.36 (1.18-4.72), p=0.02 respectively). Among those who needed but did not have near vision correction, 64 (26%) did not feel the need for correction, 55 (22%) stated that they were unaware of available interventions, and 53 (21%) found the cost of near vision correction prohibitive., Conclusion: There was a low near vision spectacle coverage in this population which suggests the need for strategies on health education and promotion to address the lack of awareness of spectacle need and cost of services.

Objective: To evaluate the anti-cataract potential of an aqueous whole plant extract of Heliotropium indicum (HIE) on galactose-induced cataract in Sprague-Dawley rats., Materials and Methods: Cataract scores were recorded in 3-week-old Sprague-Dawley rats in which cataract was being induced by an oral administration of 1500 mgkg -1 galactose twice daily for 4 weeks, and concurrently being treated with 30, 100, or 300 mgkg -1 HIE daily over the induction period. Fasting blood glucose was monitored at weekly intervals. Changes in body weight as well as total lens protein, lens glutathione, and superoxide dismutase (SOD) were determined initially, and at the end of the experimental period. Crystalline lens weight-to-body-weight ratio was also determined for the various treatment groups at the end of the experimental period. Preliminary phytochemical screening, total antioxidant capacity, and reducing power assays were conducted on HIE., Results: The 30 and 100 mgkg -1 HIE-treated rats recorded significantly lower (p ≤ 0.05-0.001) cataract scores (indicating very significant delays in cataractogenesis by the 3 rd and 4 th weeks of treatment) and blood glucose levels. Rats with delayed cataractogenesis also exhibited significant (p ≤ 0.05-0.001) weight gain, and reduction in lens weight. Total lens proteins glutathione and SOD levels in the crystalline lens were also significantly preserved (p ≤ 0.01-0.001). HIE showed substantial antioxidant capacity and reducing power., Conclusion: The aqueous whole plant extract of Heliotropium indicum delays cataractogenesis at an optimum dose of 30 mgkg -1 in Sprague-Dawley rats.

Purpose: To conduct the first ever population-based survey on ocular toxoplasmosis in the Central Region of Ghana., Methods: A cross-sectional population-based study was conducted in three randomly selected communities in the Central Region, Ghana. Visual acuity (VA) measurement, dilated fundus examination by indirect ophthalmoscopy and serology testing were performed on all participants. Ocular toxoplasmosis was diagnosed based on characteristic retinal lesions and supported by positive serologic testing using commercial enzyme-linked immunosorbent assay (ELISA) kits., Results: A total of 390 subjects aged 10-100 years (mean age 47 years) were examined; 118 (30.3%) were male and 272 (69.7%) female. Ten subjects (6 females and 4 males) had toxoplasmic ocular lesions (prevalence 2.6%). Of these, two had bilateral lesions and eight had unilateral lesions. Subjects with toxoplasmic ocular lesions were older than those without lesions (p = 0.028). The development of ocular toxoplasmosis was not associated with rural dwelling, sex, keeping cats, or consumption of meat., Conclusion: The prevalence of ocular toxoplasmosis in our Ghanaian study population was lower than findings from Southern Brazil, where there is a similar prevalence of infection in the general population.

Purpose . The purpose of this study was to evaluate the ocular disorders in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. Methods . A cross-sectional study using systematic random sampling was conducted on 295 HIV positive patients. Data collection consisted of semistructured questionnaires, laboratory investigation, medical profile, and ophthalmic examination. Statistical association tests including χ 2 , independent t -test, and ANOVA were done. A p value ≤ 0.05 was considered statistically significant. Results . Of the 295 participants, 205 (69.5%) were on antiretroviral therapy while 90 (30.3%) were not on therapy. Majority of the participants (162, 54.9%) were in clinical stage two, followed by stages three (68, 23.1%), one (62, 21%), and four (3, 1%), respectively. The overall prevalence of ocular disorders was 5.8%. The most common HIV related ocular disorder was HIV retinal microvasculopathy (58.8%), followed by herpes zoster ophthalmicus and Toxoplasma retinochoroiditis, both representing 11.8% of ocular disorders seen. Cytomegalovirus retinitis, Bell's palsy, and optic neuritis were the least common (5.9%). CMV retinitis recorded the highest viral load of 1,474,676 copies/mL and mean CD4 count of 136 cells/mm 3 . The mean CD4 count for participants with HIV related ocular disorders was significantly lower compared to participants without disorders ( t = 2.5, p = 0.012). Participants with ocular disorders also recorded significantly higher mean viral loads than those who did not have ocular disorders ( t = 2.8, p = 0.006). Conclusion . Lower CD4 counts and high viral load copies were associated with the manifestation of HIV related ocular disorders., Competing Interests: The authors declare that they have no competing interests.

Purpose: To determine the prevalence of visual impairment attributable to refractive error and other causes in a youthful Ghanaian population., Methods: A prospective survey of all consecutive visits by first-year tertiary students to the Optometry clinic between August, 2013 and April, 2014. Of the 4378 first-year students aged 16-39 years enumerated, 3437 (78.5%) underwent the eye examination. The examination protocol included presenting visual acuity (PVA), ocular motility, and slit-lamp examination of the external eye, anterior segment and media, and non-dilated fundus examination. Pinhole acuity and fundus examination were performed when the PVA≤6/12 in one or both eyes to determine the principal cause of the vision loss., Results: The mean age of participants was 21.86 years (95% CI: 21.72-21.99). The prevalence of bilateral visual impairment (BVI; PVA in the better eye ≤6/12) and unilateral visual impairment UVI; PVA in the worse eye ≤6/12) were 3.08% (95% CI: 2.56-3.72) and 0.79% (95% CI: 0.54-1.14), respectively. Among 106 participants with BVI, refractive error (96.2%) and corneal opacity (3.8%) were the causes. Of the 27 participants with UVI, refractive error (44.4%), maculopathy (18.5%) and retinal disease (14.8%) were the major causes. There was unequal distribution of BVI in the different age groups, with those above 20 years having a lesser burden., Conclusion: Eye screening and provision of affordable spectacle correction to the youth could be timely to eliminate visual impairment., (Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.)

Purpose: To conduct an ocular health and safety assessment among mechanics in the Cape Coast Metropolis, Ghana., Methods: This descriptive cross sectional study included 500 mechanics using multistage sampling. All participants filled a structured questionnaire on demographic data, occupational history and ocular health history. Study participants underwent determination of visual acuity (VA) using LogMAR chart, external eye examination with a handheld slit lamp biomicroscope, dilated fundus examination, applanation tonometry and refraction., Results: Out of 500 mechanics, 433 were examined (response rate, 87%) comprised of 408 (94.2%) male and 25 (5.8%) female subjects. The prevalence of visual impairment (i.e. presenting VA < 6/18) among the respondents was 2.1%. Eye injuries were reported in 171 (39.5%) mechanics probably due to the large number of workers, 314 (72.5%), who did not use eye protective devices. Mechanics in the auto welding category were at the highest risk of sustaining an eye injury (odds ratio [OR], 13.4; P < 0.001). Anterior segment ocular disorders were mostly pterygia while posterior segment eye disorders included glaucoma suspects and retinochoroidal lesions. The development of pterygia was associated with the number of years a mechanic stayed on the job. Eye care seeking behavior among the participants was poor., Conclusion: Eye injuries were prevalent among the mechanics as the use of eye protection was low. Eye safety should be made an integral part of the public health agenda in the Cape Coast Metropolis.

About 20-90% of the world's population has had contact with Toxoplasma gondii parasites. The aim of this study was to determine the seroprevalence and risk factors associated with T. gondii infection in the Central Region, Ghana. A community-based cross-sectional study was conducted in three selected communities. Serum samples were tested for the presence of anti-T. gondii IgG and IgM antibodies by ELISA. A serological criterion for seropositivity was a positive test result for any of the two anti-Toxoplasma IgG or IgM antibodies or a combination of both. In all, 390 participants of mean age 47.0 years consisting of 118 (30.%) males and 272 (69.7%) females were tested. The overall seroprevalence of T. gondii was 85% (333/390) where fishermen, farmers and fishmongers, respectively, had the highest seropositivity. IgG and IgM antibodies were detected in 329 (84%) and 25 (6%), respectively, while both IgG and IgM antibodies were detected in 21 (5%) of the participants. Respectively, 1% (4/390) and 79% (308/390) of participants tested positive for IgM-only and IgG-only antibodies. There was a significant relationship between Toxoplasma seropositivity and contact with soil, presence of a cat in the surrounding area, age, sources of drinking water, level of formal education, and socioeconomic status. The results suggest that the seashore may serve as a good ground for sporulation and survival of Toxoplasma oocysts.

Optometry is only provided at tertiary level in two institutions in Ghana, with an average of 50 students graduating each year for a population of approximately 24.6 million. No information on the demography of optometry students and factors that influence their choice of optometry as a career and institution of learning is available. This information is important as it will assist optometry institutions to formulate effective student recruitment strategies. To assess the demographic characteristics of Ghanaian optometry students, the factors that influence their selection of optometry as a career and institution of learning. We conducted a cross sectional study among Ghanaian optometry students using a structured questionnaire to collect data on the demographic characteristics and factors that might influence their choice of optometry as a career as well as choice of institution of learning. Two hundred and eighty students from the two optometry training institutions in Ghana; University of Cape Coast (48.2%) and Kwame Nkrumah University of Science and Technology (51.8%) responded to the questionnaire. Their ages ranged from 17 to 28 years with most being males (72.5%), and the majority (79%) being from urban areas. The main factors that influenced their career choice were job availability after graduation (90%) and desire to help other people (89.2%). Factors that influenced their institution choice were preference for an institution (36.8%) and proximity to home (24.4%). In the absence of adequate optometry jobs in the public health sector, women will remain marginalised specifically those in rural areas. This marginalisation is however, a reflection of a broader societal disadvantage for women. Greater effort needs to be made to recruit high school students from rural areas to study optometry and more institutions need to provide optometry instruction throughout the country.

Background: Deficient amplitude of accommodation is the most frequently used criteria in an optometric practice in diagnosing whether a patient has accommodative insufficiency. This deficiency is determined based on an age-related expected finding calculated using Hofstetter's equation derived from Donder's and Duane's data. The aim of the present study was to investigate the amplitude of accommodation among Ghanaian school children and to compare the findings with age-expected norms predicted by Hofstetter's equation., Methods: The amplitude of accommodation was measured using the push-up method in a random sample of 435 school children from the Cape Coast Municipality. The mean amplitude of accommodation was compared with the age-expected amplitude of accommodation as predicted by Hofstetter's equation for average amplitude of accommodation., Results: The mean amplitude of accommodation was 16.86 ± 3.07 D (95% CI = 16.57, 17.15). This is significantly higher than age-expected norms calculated using Hofstetter's equation. The amplitude of accommodation showed the characteristic decline with age., Conclusion: From the results, we conclude that the age-expected norms for amplitude of accommodation using Hofstetter's equation might not be accurate for Ghanaian children., (© 2012 The Authors. Clinical and Experimental Optometry © 2012 Optometrists Association Australia.)