Associations between personality traits and adherence to treatment in patients with primary open-angle glaucoma in an African population.

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.

Public awareness and perception towards COVID-19 in Sub-Saharan African countries during the lockdown.

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 ß=-0.83 95% CI: -1.19, -0.48) and Southern Africa (ß=-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 [ß=-6.57, 95% CI: -7.53, -5.62], East [ß=-6.24: 95% CI: -8.34,-4.15], Central [ß=-6.51, 95% CI: -8.70, -4.31], and Southern Africa [ß=-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.

Dry eye disease and meibomian gland dysfunction among a clinical sample of type 2 diabetes patients in Ghana.

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.

Differences in Perceived Risk of Contracting SARS-CoV-2 during and after the Lockdown in Sub-Saharan African Countries.

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.

Application and repeatability of ocular biometric measures for gaze position calibration in children.

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.

Socio-demographic factors modify awareness, knowledge, and perceived risk of glaucoma in rural and urban residents in Ghana: a population-based survey.

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.

Factors affecting willingness to comply with public health measures during the pandemic among sub-Sahara Africans.

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.

Epidemiology and visual outcomes of ocular injuries in a low resource country.

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.

Profile, knowledge, and attitude of contact lens users regarding contact lens wear in Ghana.

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.

Comparing Different Methods of Measuring Accommodative Amplitude with Hofstetter's Normative Values in a Ghanaian Population.

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 Ë‚ 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.

Near vision spectacle coverage and barriers to near vision correction among adults in the Cape Coast Metropolis of Ghana.

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 (5th and 6th 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.

Anti-Cataract Potential of Heliotropium indicum Linn on Galactose-Induced Cataract in Sprague-Dawley Rats.

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 3rd and 4th 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.

Investigation of amplitude of accommodation among Ghanaian school children.

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.