Impact assessment study after 27 years of community-directed treatment with ivermectin in Galadimawa, Kaduna State, Nigeria.

PURPOSE: To assess the impact on blindness after 27 years of community-directed treatment with ivermectin (CDTI) in the Galadimawa community of Kauru Local Government in Kaduna state, Nigeria. The population of Galadimawa constituted about 12% of the total population examined during the ivermectin randomised control trial (RCT) in 1989. The RCT population of 8000 individuals was scattered over 36 villages in Kaduna state. Thus, longitudinal data are available on blindness. MATERIALS AND METHODS: After 27 years of dosing with ivermectin, the people in the community of Galadimawa were re-examined for the prevalence and causes of blindness. This was achieved by an examination of the visually disabled. The findings were compared with the situation in 1989 before the dosing commenced. RESULTS: The population of the village increased from 711 to 1419. The prevalence of blindness dropped from 4.9 to 0.96%. The most common causes of blindness were now cataract (55.2%) and optic atrophy (27.6%), whereas the most common causes in 1989 were onchocerciasis (28.3%), glaucoma (17.4%) and cataract (10.9%). People with optic atrophy were more likely to have taken fewer doses of ivermectin over the years. The blind people encountered in 2016 were on average 17 years older than those seen in 1989, which suggests that blindness, when it occurs, is delayed by almost two decades. CONCLUSION: CDTI has reduced the prevalence of blindness significantly in Galadimawa and may reflect the situation elsewhere in the Kaduna state, which is an oncho-endemic zone.

Household coverage of ivermectin distribution in birnin kudu local government area of Jigawa State, Nigeria.

Purpose: To assess community-directed treatment coverage with Ivermectin (CDTI) in Onchocerciasis-endemic communities in Birnin Kudu local government area (LGA) Jigawa state. Subjects and Methods: This was a community-based multistaged cross-sectional survey based on probability proportional to size. The study involved the administration of a questionnaire on 2021 respondents from 207 households. Also, 30 Community Leaders and Community Directed Distributors (CDDs) were purposively selected for interview from the communities visited. Results: Overall, 2021 respondents from the 2031 sampled population took part in the study giving a response rate of 99.6%. Slightly above half, 1130 (55.9%) were males. The geographic and therapeutic coverage of mass drug administration of Ivermectin achieved in the LGA was 100% and 79.9%, respectively. The key factors affecting coverage includes the unavailability of drugs (48.8%), absenteeism of some of the household members (31%), and inadequate incentives to the CDDs by the government and poor record keeping by the CDDs. Conclusion: This study found that the minimum geographic and therapeutic coverage of Ivermectin distribution was achieved by CDD as recommended by the World Health Organization for the control of onchocerciasis. For this to be sustained and to achieve elimination, there must be an adequate supply of ivermectin, training of CDDs, retraining of CDDs, adequate supervision in record keeping, and health education to the community.

Résumé Objectif: Évaluer la couverture du traitement sous direction communautaire à l'ivermectine (TIDC) dans les communautés endémiques de l'onchocercose de la zone d'administration locale de Birnin Kudu (LGA) dans l'État de Jigawa. Sujets et méthodes: Il s'agissait d'une enquête transversale communautaire à plusieurs degrés basée sur une probabilité proportionnelle à la taille. L'étude a impliqué l'administration d'un questionnaire sur 2021 répondants de 207 ménages. De plus, 30 leaders communautaires et distributeurs dirigés par la communauté (CDD) ont été délibérément sélectionnés pour un entretien dans les communautés visitées. Résultats: Globalement, 2021 répondants sur la population échantillonnée de 2031 ont participé à l'étude, soit un taux de réponse de 99,6 %. Un peu plus de la moitié, 1130 (55,9 %) étaient des hommes. La couverture géographique et thérapeutique de l'administration massive d'ivermectine obtenue dans la LGA était de 100 % et de 79,9 %, respectivement. Les principaux facteurs affectant la couverture comprennent l'indisponibilité des médicaments (48,8%), l'absentéisme de certains membres du ménage (31%), et les incitations inadéquates aux DC par le gouvernement et la mauvaise tenue des dossiers par les DC. Conclusion: Cette étude a révélé que la couverture géographique et thérapeutique minimale de la distribution d'ivermectine était atteinte par le CDD tel que recommandé par l'Organisation mondiale de la santé pour le contrôle de l'onchocercose. Pour que cela soit durable et pour parvenir à l'élimination, il doit y avoir un approvisionnement adéquat en ivermectine, une formation des DC, un recyclage des DC, une supervision adéquate de la tenue des dossiers et une éducation sanitaire de la communauté. Mots-clés: Distributeurs communautaires, TIDC, ivermectine, onchocercose.

Comparing Central Corneal Thickness Using Ultrasound and Anterior Segment Optical Coherence Tomography Pachymetry in Adults Attending A Private Eye Clinic in Abuja.

Background: Central Corneal Thickness (CCT) measurement is useful in the management of glaucoma, ocular hypertension, corneal lesions and kerato-refractive surgeries. The study aims to compare the CCT measurements between Ultrasound Sonography (USS) and Optical Coherence Tomography (OCT), to analyze correlation and agreement between these instruments as well as repeatability of each instrument. Methodology: A cross sectional comparative study carried in 100 eyes of 50 patients attending Rachel Eye Center in Abuja from January to March 2021. The CCT were taken using the USS and OCT. CCT was measured using the Pachscan ultrasound and the Optovue machine utilised for the OCT technique. Data was analysed using SPSS version 20 using Paired Sample t Test, Pearson's correlation, Interclass Correlation and Bland Altman Methods. Results: Patients were aged between 18 and 79 (mean age of 39.1), 72 males and 28 females. The mean CCT was 537.36 ±33.26 and 510.94 ±33.13 for USS and OCT respectively with a mean difference of (26.42±9.53 p<0.001). There was a very strong correlation of the 2 sets of measurement r = 0.997 p<0.001. There was a high average mean intraclass correlation coefficient of 0.843 between the two instruments and this was excellent (0.961) within the 95 percentile upper limit but poor in the (0.096) lower limit. There was a high correlation and no statistical significant difference in the comparing repeated mean USS and OCT measurements. There was an excellent average mean Intraclass Correlation Coefficient of 0.999/0.997 for the repeated OCT and USS values and this was found to be excellent(0.999/0.998) within the 95 percentile upper limit and (0.997/0.994)lower limit respectively. Conclusion: We find that measurements of CCT using the Pachscan ultrasound and the Optovue OCT correlate well, but the mean Pachscan measures were significantly higher than Optovue measures.

A case of Subconjunctival Filariasis in Abuja,Nigeria.

The report presents a case of subconjunctival filariasis in a 20-year-old female student who schools in Oye-Ekiti, Ekiti State, a known loa loa endemic region in Nigeria, and resident in Abuja. The patient presented on the 20th of February 2020, with a history of foreign body sensation and itching on two occasions within a 6-month period and had video evidence of a worm in her left eye. The worm was however not visualized in the clinic. She was placed on tabs Albendazole 20mg twice daily for 21 days and has not felt or seen the worm since she completed the medications. Subconjunctival filariasis is still an issue of concern in the rainforest region of Nigeria.

A Case of Frequent Blinking and Abnormal Eyeball Movement Associated with Generalized Epilepsy.

Eyelid myoclonus is an idiopathic generalized epileptic syndrome that can occur with or without absence seizures. The features include frequent blinking, an upward roll of the eyeballs, and slight backward movement of the head. It can be spontaneous or stimulated by light. Light and eyelid closure are triggers to the seizures. A 13-year-old young male student presented with a four months history of frequent blinking and abnormal eye movements. There was a positive history of leg tapping while asleep which started a year prior to presentation, but there was no loss of consciousness. On presentation, the patient was a young healthy looking myope who frequently blinks with sudden upward and left jerky movements of the eyeballs. Visual acuity was CF at 2 meters in both eyes improving with -4.50DS to 6/6. Intraocular pressures were 12 mmHg bilaterally. Anterior and posterior segment findings were normal. Brain MRI was normal, but EEG was abnormal with features suggestive of generalized epilepsy. He was co-managed with the neurologist and placed initially on Tabs Sodium valproate 250mg for 3 months. This was modified to Tabs Sodium Valproate (controlled release) 500mg at night since there was little change. This resulted in an appreciable reduction in blinking and abnormal eye movement. The leg tapping stopped on this dose. Eyelid myoclonus (EM) is a rare form of epilepsy. It is of utmost importance to create awareness of the disease among physicians. Early diagnosis and treatment are important prognostic factors of the disease. Key Messages: There is a need to create awareness of Eyelid Myoclonus among physicians as this can easily be missed or misdiagnosed.

Correlation between Health-Related Quality Of Life Scores and Measures of Visual Function in an Abuja Cohort of Primary Open Angle Glaucoma Patients.

Background: This study aims to correlate quality of life measures with visual function parameters and to determine the visual function parameters that independently affect the quality of Life in primary open angle glaucoma patients (POAG) in Abuja. Methodology: A cross sectional study carried out among 106 POAG patients attending Asokoro District Hospital, Abuja and Eye Foundation Hospital Abuja from Nov 2012 to April 2013. National Eye Institute Visual Function Questionnaire 25 (NEIVFQ25) and Glaucoma Symptom Scale (GSS) were used to assess Quality of Life (QoL) after biodata was obtained. The objective measures of visual function assessed include: visual acuity (VA), contrast sensitivity (CS), colour vision (CV) and visual fields (Mean Deviation). Data was analysed using SPSS Version 20 using Spearman Rho Correlation and linear regression. Results: There was a strong correlation between the NEIVFQ25 scores and all the measures of visual function. There was also a strong correlation between GSS and contrast sensitivity in both eyes, and mean deviation of the better eye while the others showed a moderate correlation with the scale. On multivariate analysis of the NEIVFQ25 scores by visual function, the independent visual functions that affects the NEIVFQ25 QoL measures were the visual acuity better eye and contrast sensitivity better eye. Contrast sensitivity in the better eye had a stronger correlation than visual acuity in the better eye. On multivariate analysis of GSS scores by visual function parameters, contrast sensitivity in the better and worse eye were the independent visual function parameters that affect the GSS. The contrast sensitivity of the better eye had a stronger correlation with NEIVFQ25 and GSS. Conclusion: The study revealed the impact of contrast sensitivity on the quality of life and glaucoma symptoms the patients have. It is important that measures of contrast sensitivity be incorporated into evaluating glaucoma patients. Key Messages: Contrast sensitivity of the better eye was the visual function parameter that affected the vision related quality of life scale the most.