Ocular disorders among stroke patients in Federal Teaching Hospital, Lokoja, Nigeria

Objectives:To determine the pattern of ocular disorders among stroke patients in Federal Teaching Hospital, Lokoja (FTHL).Materials and Methods:Consecutive new stroke patients seen at the Federal Teaching Hospital, Lokoja over a 3-month period were studied. Data was collected with the use of a structured questionnaire divided into four major sections: bio-data, visual history, results of ocular assessment and NEI VFQ-25 quality of life questionnaire. Data analysis was done using SPSS for Windows, version 23.0. Univariate analyses were presented in the form of frequencies, percentages, means, ranges, and standard deviations, charts and tables.Results:Eighty-three patients were recruited with an age range of 40-71 years, a mean age of 55.3(±7.1) years. Thirty-nine patients (47.0%) were between the ages of 51 and 60 years. Thirty-four (41.0%) patients were females while 49(59.0%) were males. Of 46 (55.4%) patients that had neuro-imaging, stroke was ischaemic in 37(80.4%) and haemorrhagic in 9(19.6%). Of the 63 patients with left sided stroke, 2 (2.4%), 4(4.8%) and 57(68.7%) had severe, moderate and mild and normal visual impairment respectively while of the 20 patients with right sided stroke, 3(3.6%) each had severe and moderate visual impairment and 14(16.9%) had normal or mild visual impairment. Other ocular abnormalities included corneal anaesthesia and macular hole in 2(1.2%).Conclusion:Anterior and posterior segments, together with neuro-ophthalmic disorders were found among stroke patients in this study. Many of the ocular abnormalities are as a result of long-standing uncontrolled hypertension which caused the stroke. It is recommended that awareness should be created among the populace about uncontrolled hypertension. It is also advised that internists should refer hypertensive patients for routine ophthalmic screening.

Presentation and Outcome of Microbial Keratitis in Ilorin, Nigeria.

Aim: To determine the presentation and outcome of microbial keratitis among patients at University of Ilorin Teaching Hospital (UITH) in Ilorin, Nigeria. Methods: A 12-month, prospective, hospital-based longitudinal study was conducted by examining all patients with clinical features of infective keratitis, who met the inclusion criteria. A posttreatment evaluation was done at 6 weeks in all cases, during which visual acuity and any complications were re-assessed. The outcome measures included interval between onset and presentation, extent of corneal involvement and final visual acuity. The data was analysed with the SPSS version 20.0 software. Results: Fifty-five eyes of 54 patients were studied. There were 32 males (59.3%) and 22 females (40.7%). The mean age was 36.9 years (± 12.1). The predisposing factors were trauma in 30 (55.6%) cases, self-medication with topical steroids in 12 (22.2%) and the use of traditional eye medication in 12 (22.2%). All of the participants presented with pain, tearing, photophobia and reduction in vision. The right eye was involved in 37 patients (67.2%). The presenting visual acuity in the affected eyes was 6/60 or less in 31 (56.4%), 6/60–6/24 in 18 (32.7%) and 6/6–6/18 in 6 eyes (10.9%). At 6-week follow-up, 5 eyes (9.1%) had <6/60 visual acuity, 40 (72.7%) had 6/60– 6/24 and 10 (18.2%) had 6/6–6/18.The risk factors for poor outcome were a centrally located lesion (p=0.018), an area of corneal involvement greater than 4mm (p=0.007) and a lesion affecting the deeper layers of the cornea (p=0.002). Conclusion: Microbial keratitis is a significant cause of ocular morbidity, and public eye-health education is highly desirable as a preventive measure.

Survey of Medical Specialists on their Attitudes to and Resources for Health Research in Nigeria

Aim: To study the views of medical specialists on their attitude to and the resources for health research in Nigeria and draw appropriate policy implications. Materials and Methods: Structured questionnaires were distributed to consenting 90 randomly selected medical specialists practising in six Nigerian tertiary health institutions. Participants' background information; importance attached to research; motivations for conducting research; funding; ethical oversight; literature search; and statistical support were probed. The coded responses were stored and analyzed using the statistical SPSS software. Results: Fifty-one out of the 90 questionnaires distributed were returned; giving a response rate of 63.3. Research function was rated third by 64.7of the respondents after hospital service (72.5) and teaching (66.0). Advancement of knowledge was the strongest motivating factor for conducting research (78.4). Securing funding (94) and finding time (80) were their major constraints. Only a minority of the respondents; 20and 14; respectfully; positively rated the quality and promptness of the decisions of their institutions' ethical organs in the highest category. Most of their literature search was conducted on the internet (96.1) and they stored and analyzed their research data with commonly available statistical software. Conclusion: Our study respondents regarded research highly but were severely constrained in conducting research by lack of access to sources of funding from within and outside Nigeria and finding time from core hospital functions. We recommend periodic (re)training in research particularly on how to apply for research grants and giving some protected research time for Nigerian medical specialists in order to boost their research function

Observations of Teachers in llorin; Nigeria on their Practices of Corporal Punishment that are Potentially Injurious to their Pupils' Eyes

Objective: To document the observations of elementary school teachers (ESTs) in Ilorin; Nigeria on their practice of some types of corporal punishment (CP) that could result in eye injuries among their pupils. Materials and Methods: A short battery of questions that explored ESTs' observations on attitudes to; and knowledge of some commonly used CP practices was self-administered on 172 consenting teachers from six sampled schools. The potentials for their pupils to sustain eye injuries while receiving such CP practices were inferred from the usage of items with sharp and protruding ends to administer CP; and the application of CP onto pupils' body parts that are in close proximity to the eye such as the head and face. Results: Only 50 of the 172 ESTs favored the practice of CP of pupils by their teachers. Analyses of several potentially moderating variables on this response such as ESTs' ages; years of EST teaching experience; school; and class or grade that EST teaches did not prove significant. Over three-quarters of ESTs (80.2) had ever observed that pupils were being disciplined by ESTs with a cane. About a fifth of them had also bserved that ESTs applied CP to the head (19.8) and the face (16.3) of pupils. Conclusion: Findings suggest that ESTs' commonly employed CP practices have significant injurious potential to their pupils' eyes. It is recommended that CP be abolished in elementary schools; and instead alternative nonabusive methods of disciplining erring pupils by teachers be introduced

Utility and Effectiveness of Computerised Motion Sensitivity Screening Tests in Rural Onchocercal Community Survey

BACKGROUND: Non-invasive tool of community diagnosis for onchocercal endemicity needs to be identified and ascertained for their utility and effectivity in order to facilitate the control of onchocerciacis in sub-Saharan Africa OBJECTIVE: To determine the utility and effectiveness of the Wu-Jones Motion Sensitivity Screening Test (MSST) in detecting optic nerve diseases in onchocercal-endemic rural Africa. METHODS: MSST was applied to sampled subjects in the selected communities of Raja in Sudan; Bushenyi in Uganda; Morogoro in Tanzania; and of Ikom; Olamaboro and Gashaka in Nigeria. Basically; six points within the central field of vision were repeatedly tested at 1/3 meter from the screen of a laptop computer in a room darkened. Motion sensitivity was expressed as a percentage of motion detected in the individual eye and this was averaged for the community. RESULTS: A total of 3;858 eyes of 2;072 patients were examined. Seventy-six percent of the subjects completed the test; at an average test time of 120.4 (66.7) seconds. The overall mean motion sensitivity of all eyes tested was 88.49 (17.49). At a cut-off point of 50; 6.4of all subjects tested were subnormal; while at 70cutoff; 13.3were subnormal. The highest proportion of 50cutoff sub-normality was recorded at Morogoro at 12.7. CONCLUSION: Motion Sensitivity Screening Test was widely accepted and easily administered to the rural and largely illiterate subjects studied. Our data suggest that the proportion of severe field defects by MSST in a community; with cutoff at 33; best correlates with optic nerve disease prevalence; while proportion of defect from a higher cut-off level at about 50; best correlates with overall ocular morbidity

Causes and Prevalence of Ocular Morbidity among Primary School Children in Ilorin; Nigeria

Objective: To determine the causes and prevalence of ocular morbidity among primary school children in Ilorin; Nigeria. Materials and Methods: A cross sectional survey of primary school children in 10 randomly selected primary schools within Ilorin; Nigeria was carried out between July 2005 and January 2006. Relevant ocular history and basic ocular examinations were carried out on the children that were selected from a multi-stage sampling process. Results: One thousand three hundred and ninety three pupils were surveyed. There were 689 (49.4) boys and 704 (50.6) girls. The age range was between 4 and 15 years. The mean and modal ages were 10.16 SD 2.5 and 10 respectively. Two hundred and seventy seven pupils had ocular pathology giving a prevalence of 19.9. The two most common ocular disorders found among the pupils were refractive errors and vernal conjunctivitis with prevalence of 6.9and 6.7respectively. Others included genetic / congenital / developmental ocular disorders 39 (2.8); glaucoma / glaucoma suspect 20 (1.4); ocular infections 18 (1.3); and ocular trauma 11 (0.8). More than three-quarters (86.7) of the causes of visual impairment and blindness among the pupils were avoidable (preventable or treatable). Conclusion: The sheer magnitude of avoidable causes of visual impairment and blindness in the study underscores the need for effective school eye-health programmes in developing countries

Appropriateness of Ophthalmic Cases Presenting to a Nigerian Tertiary Health Facility: Implications for Service Delivery in a Developing Country

To assesswhether the ophthalmic cases presenting at aNigerian tertiary eye unit are appropriate for such level of care and also drawnecessary implications for service delivery. : Data on 1;321 consecutive new patients that presented at the ophthalmic clinic of the University of Teaching Hospital; Ilorin; Nigeria between February and July 2005 were reviewed on demographics; referral routes; and reasons for patronage; diagnoses and disease categories. Information on the general situation of health infrastructures prevailing at the surrounding health facilitieswas collected fromkey-informants. One thousand and ninety-one (82.6) presentedwithout any referral and 1;095 (82.9) patronized in order to access perceived good quality of eye care service being rendered. However; only a small proportion of their ailments (191; 14.5) actually required attention at the tertiary level of eye care. The key informants painted a picture of severely-challenged general and health infrastructures particularly at the primary health care facility level An overwhelming majority of ophthalmic patients directly accessed eye care at the tertiary level; even though most of their ailments could have been satisfactorily treated at the lower facilities of health care were the latter to be functioning optimally. A better coordinated and strengthened health care system; particularly at the primary and secondary health care facilities would ease the burden of inappropriate presentations on tertiary health facilities inNigeria

Apoc impact assessment study: baseline prevalence and distribution of ocular Onchocerciasis in three ecological zones in Nigeria

During the APOC/WHO Impact Assessment studies in Nigeria held in 1998 and 1999, one thousand and sixty four randomly selected subjects underwent detailed eye examination in three selected sites namely, Cross River State (rain forest ecological zone), Taraba State (savanna ecological zone) and Kogi State (forest- savanna ecological zone). The general objective of the impact assessment studies was to evaluate the ophthalmological impact of onchocerciasis control (CDTI) in Nigeria, this paper highlights the public health significance of ocular onchocerciasis in three different ecological zones in Nigeria. The presence of ocular onchocerciasis was established in all the study sites, with a predominance of posterior segment manifestations, in the rain forest zone. A blindness prevalenc e of 2.4o/o was recorded in the study, with onchocerciasis being responsible for 13 out of the 43 (30.2%) bilaterally blind subjects identified. Onchocerciasis-induced blindness prevalence was relatively high in the rain forest and forest savanna zones of Cross River and Kogi States with Cross River State having the highest site-specific- prevalence (5/10) 50.0% of onchocercal blindness followed by Kogr with (5/12) 41.7%. Taraba site recorded only 27.3% (3121). Other conditions identified included glaucoma, optic nerve disease and cataract rates of which were also found to be high among the population (6.90/o,6.5 % and8.9oh respectively). Anterior segment onchocercal lesions, punctate and sclerosing keratitis were the predominant features of the infection in Taraba site (14.1o/o and 6.3% respectively), a savanna zone while posterior segment lesions were much more common in the forest zone of Cross-River site. Visual field measurements reflected the predominant posterior segment disease. The need to sustain the present efforts aimed at controlling onchocerciasis through mass ivermectin distribution is fuither highlighted. Integration of other Eye Care Programme for the conffol of glaucoma and cataract, into the community directed treatment initiative of APOC for onchocerciasis control should also be strongly considered, in order to drastically reduce the prevalence and incidence of ocular morbidity and blindness, in Nigeria, especially in the onchocerciasis endemic areas.