Prevalence of visual impairment and blindness in a Nairobi urban population.

OBJECTIVE: To determine the prevalence and causes of visual impairment and blindness among Kibera slum dwellers. DESIGN: Population based Survey. SETTING: Kibera Slums, Kibera Division, Nairobi, Kenya. SUBJECTS: One thousand four hundred and thirty eight randomly selected slum dwellers. RESULTS: The prevalence of blindness and visual impairment was 0.6% (95% CI: 0.21 to 1.0), and 6.2% (95% CI: 4.95 to 7.15) respectively. 37.5% of those found blind were due to cataract followed by refractive errors 25.0%. 58.1% of those with visual impairment had refractive errors while 35.5% had cataracts. Females had a higher prevalence of visual impairment compared to males but the difference was not statistically significant (P = 0.104). CONCLUSIONS: Prevalence of blindness in Kibera slums is slightly lower than the estimated national average (0.7%) while that of visual impairment is almost three times higher. The leading causes of blindness are cataract followed by refractive errors. For visual impairment, refractive error was the leading cause followed by cataract. RECOMMENDATION: Kibera slum dwellers are in need of comprehensive eye care services offering cataract surgery and low cost spectacles.

Prevalence of trachoma in six districts of Kenya.

OBJECTIVES: To estimate the prevalence of active trachoma (TF) in children aged one to nine years and potentially blinding trachoma (TT) in adults aged 15 years and older in six known trachoma-endemic districts in Kenya. DESIGN: Community based survey. SETTING: Six known trachoma endemic districts in Kenya (Samburu, Narok, West Pokot, Kajiado Baringo and Meru North). SUBJECTS: A total of 6,982 children aged one to nine years and 8,045 adults aged 15 years and older were randomly selected in a two stage random cluster sampling method: Twenty sub-locations (clusters) per district and three villages per sub-location were randomly selected. Eligible children and adults were enumerated and examined for signs of trachoma. RESULTS: Blinding trachoma was found to be a public health problem in all the surveyed districts. Active trachoma was a district wide public health problem in four districts (Samburu, Narok, West Pokot and Kajiado) and only in some of the sub-locations of the other two (Baringo and Meru North). CONCLUSIONS: There is need for district trachoma control programmes preferably using the WHO recommended SAFE strategy in all the surveyed districts. Extrapolation of these survey results to the entire country could not be justified. There is need to survey the remaining 12 suspected endemic districts in Kenya.

Barriers to utilisation of eye care services in Kibera slums of Nairobi.

OBJECTIVES: To identify the main barriers to utilisation of eye care services among the slum population of Kibera in Nairobi, Kenya. DESIGN: Community based survey. SETTING: Kibera slums, Nairobi City, Kenya. SUBJECTS: Randomly selected 1,438 Kibera slum dwellers aged over two years. RESULTS: Majority of subjects (83.3%) do not utilise the nearby well-established eye clinics. Twenty one percent of those with poor vision do not seek treatment at all. The main barriers to seeking eye care services were lack of money, ignorance and the problem not causing much discomfort to warrant medical attention. There was significant, association between the level of education and health seeking behaviour (P = 0.008). CONCLUSION: Majority of Kibera slum dwellers have no access to eye care. RECOMMENDATION: There is need to establish a comprehensive primary eye care project to provide low cost but quality services affordable to Kibera slum dwellers.

Post kala-azar uveitis.

Three patients who developed bilateral anterior uveitis at the end of, or soon after, the apparently successful treatment of visceral leishmaniasis are described. The uveitis gave rise to secondary glaucoma in 2 of the patients, and in the third patient the eye lesions were associated with an episode of post kala-azar dermal leishmaniasis.

Ocular injuries in Africa.

Injuries to the eye can cause severe damage because of the delicate structure of ocular tissues. Such injuries may often cause impaired vision or sometimes total loss of vision, in addition to other incapacities. Traumatic blindness therefore assumes an unusual socio-economic dimension. In Africa, injuries have their own peculiarities regarding aetiology, severity and management. More than 80% of injuries occur in rural areas where the necessary services are generally unavailable. This paper surveys the types, occurrence and impact of ocular injuries and suggests how they should be treated.

Herpes Zoster Ophthalmicus in a child with acquired immune deficiency syndrome.

A case is described of an 8 year old child who presented with Herpes Zoster Ophthalmicus involving the left eye. He had a positive history of pulmonary tuberculosis, repeated hospital admissions and blood transfusion. He was confirmed to have Acquired Immune Deficiency Syndrome. During the course of his followup, he developed cotton-wool spots and perivasculitis in the right eye. The mother was found to be seropositive while the father was seronegative.

Chloroquine related complete heart block with blindness: case report.

A 27-year old African woman with history of regular chloroquine ingestion presented with progressive deterioration of vision, easy fatiguability, dyspnoea, dizziness progressing to syncopal attacks. Ophthalmological assessment revealed features of chloroquine retinopathy, cardiac assessment revealed features of heart failure and a complete heart block with right bundle branch block pattern. The heart block was treated by pacemaker insertion and the heart failure resolved spontaneously following chloroquine discontinuation. She however remains blind.

Conjunctival Kaposi's sarcoma in a patient with acquired immune deficiency syndrome.

A patient with confirmed acquired immune deficiency syndrome (AIDS) and disseminated Kaposi's sarcoma was seen in the Eye Clinic, Kenyatta National Hospital, and was found to have involvement of the conjunctiva and lids, confirmed by biopsy. He also had retinal haemorrhages and cotton-wool spots. Kaposi's sarcoma of the conjunctiva may be confused with a subconjunctival haemorrhage.

Vitamin A deficiency among Kenyan children as detected by conjunctival impression cytology.

OBJECTIVE: To determine the prevalence of Xerophthalmia among Kenyan children aged four to seven years in high risk using Conjuctival Impression Cytology and transfer. DESIGN: A cross sectional community based study. SETTING: Mathare slum in Nairobi and Tiva/Ithiani area of Kitui. SUBJECTS: Children aged four to seven years residing in the above areas were assessed for both clinical and cytological features of vitamin A deficiency. RESULTS: Of the 342 children included in this study, 316 (92.0%) were normal, five (1.5%) had XN, 19 (5.9% had XIA and two (0.6%) had XIB. No signs of corneal Xerophthalmia were seen in this study. Conjuctival impression cytology and transfer (CICT) was used to asses for squamous metaplastic changes associated with Vitamin A deficiency (VAD). Seventy five (23.1%) of the children were normal by CICT while 249 (76.9%) were abnormal. In comparing the two areas of study, only 13.2% of the children in Mathare had normal CICT compared to 50% in Kitui. For each of the age groups studied there was significant difference between the two areas with children from Mathare being more deficient than those from Kitui. CONCLUSION: VAD is a significant health problem in the high risk areas assessed by CICT in this study.

Traditional herbal eye medicine in Kenya.

A study was conducted in Kenya on 16 traditional healers in order to obtain information about their knowledge of eye conditions, the herbal medicines they used, and their indications for referral to ophthalmologists. Evidence remains scanty that traditional treatments are beneficial, and in some instances harmful effects have been reported. Nevertheless there is a solid case, based on economic and other grounds, for integrating traditional healers into the modern health care system.