Prime Opticals and Eye Clinic, P.O. Box 538, Benin-City Nigeria
University of Benin Teaching Hospital, P.M.B. 1111, Benin-City.
Affiliation: Medical Women’s Association of Nigeria, Edo State Branch
Nigeria is the most populous Country in West Africa and although premium is placed on health, education & housing, none of these services are fully subsidized by the government. A survey was carried out on 571 female students in a state secondary school in Benin-City, Southern Nigeria. Ages of students ranged between 11-21 years. All tests were carried out on the school premises; each child had a general ocular exam, visual acuity tests followed by ophthalmoscopy . Those who needed further examination were referred to the nearest hospital.
137 children (24%) of these children had some form of eye problem. Gross defects were noticed in the optic nerves of eyes 37 or 6.4% of the children examined. 3.9% of children were found to have significant refractive errors. Only 4 or 0.7% of them had ever worn glasses before.
6.6% or were given treatment on the premises with simple drops and tablets provided free by the local branch of the Medical Women’s Association
The importance of a proper school health program cannot be overemphasized. As members our local branches of medical women we can help the children in our localities using our expertise as in Nigeria today over 50% of all ophthalmologists are women.
Key words:
school health, visual screening
Methods
Whole classes were taken at a time for convenience to make sure class lessons were not disrupted and a two strains of the four strains in each class was taken.
Snellens chart was used in the hall with normal daylight lighting. A pinhole was used to confirm refractive errors. A near vision chart was used.
Ophthalmoscopy was done by the ophthalmologist to ensure uniformity of results.
Simple antibiotic drops and astringents as well as mild steroidal drops were administered free as were vitamins and prescriptions given for other non -eye related problems.
Introduction
Imaguero College is an all-female State Secondary school in Benin-City, Nigeria with a population of almost 1200.
Pre school eye checks are not required before entry into primary schools in Nigeria; they are not mandatory in State Secondary schools although private schools and designated Federal colleges insist on pre-school check of the eyes.
In State schools, the children can barely afford to pay their school fees and large family sizes make it almost impossible to insist on these tests.
There was neither school nurse nor simple first aid facilities in the school.
Results are as shown on Table 1
Table 1
Diagnosis/Problem |
No of |
Percentage | |
Pale optic disc/temporal pallor |
37 |
6.4% | |
2. |
Mild refractive error at least 6/9 in the worse eye (not referred) |
37 |
6.4% |
3. |
Allergic Conjunctivitis/medication |
31 |
5.6% |
4. |
Significant Refractive errors worse than 6/9 in either eye |
22 |
3.9% |
5. |
Treatment for the minor eye problems and fevers |
5 |
1.00% |
6. |
Leukomas |
1 |
0.17% |
7. |
Squints |
1 |
0.17% |
8. |
Albinism |
1 |
0.17% |
9. |
Retinal Detachment |
1 |
0.17% |
10. |
Aphakia |
1 |
0.17% |
Visual screening in secondary school summary of visual outcome.
Table 2 summary of outcome of vision tests
Results/Discussion
The early years of life – from birth until age 5 – are crucial for a child’s visual development and eye health, because conditions such as strabismus or amblyopia cannot be treated when the child is older. A visual acuity of 6/9 was used as the minimum acceptable in the sub-optimum conditions we had on the premises
468 or 82% of these children had never visited any eye personnel prior to this visual screening.
Poor vision can be detrimental to a child’s capacity to learn and sometimes it can be very difficult to differentiate this from mental handicap. Poor school performance, lack of interest in schooling, and dropping out of school totally can be prevented when the cause is related to sub optimal vision.
Refractive errors and optic disc problems top the list of problems. The former can easily be treated by prescription lenses to prevent amblyopia, while the latter could lead to far leading consequences if not detected and managed early.
Refractive errors
Apart from the 3.9% of patients with refractive errors that definitely required correction another 6.4% may require correction in the future and were advised on a recheck in 18 months
This is because in other similar studies a quarter of the children who had glasses prescribed at a screening procedure were found to have normal vision without glasses at subsequent follow-up2.
Zhoa in his children in the Shunyi District says reduced vision from myopia is an important public health problem in school-age children, he found 9% of the children could benefit from prescription lenses3.
The provision of spectacle lenses would probably improve the academic performance of these children.
Glaucoma and Optic disc pallor
The normal optic disc shows great physiologic variation between one individual and another and the role of inheritance in determining the cup disc diameter ratio has been established by Armaly4 .
However, Glaucoma is real and recently younger patients are presenting with optic nerve abnormalities due to optic neuritis and severe glaucoma with field changes. The place of early usual screening and treatment cannot be overemphasized. All patients in this group were referred to see an ophthalmologist.
Allergic Conjunctivitis
Many children presented with red itchy eyes and signs of asthenopia. These required some drops and counseling to the patients involved. Our environment is dusty and this is a common problem. No particular seasonal variations are seen in our environment 5.
Others problems found squints, albinism - a hereditary problem and retinal detachment required referrals.
The patient with retinal detachment had never even mentioned the fact that she could only see with one eye to her parents.
Leukoma (corneal scarring)
Most cases in Nigeria were previously due to measles, now with widespread free immunizations incidences are gradually reducing and this will hopefully become a thing of the past.
Conclusion
Basic visual screening in children is not considered a priority in Nigeria. We have to make the general public aware of its importance early in life as a lot of development of the eye takes place then.
There is need to provide effective health education and train staff in the school environment to do a quick simple test for newly enrolled primary school children. Early diagnosis and proper management through public health measures can improve the ocular health status of school children6. Provision of simple first aid facilities and a school nurse should be mandatory in all State schools.
As medical women who care for women and children we must make our expertise available freely to those who require it.
References
1. G.E Cummings Vision screening in junior schools. Public Health (1996) 110 369-372 1996
2. Peckam CS, Gardner PA, Tibbenham A. Vision screening in adolescents and their use of glasses. BMJ 1979; 1312-1314.
3. Zhao Myopia in School children in the Shungi district China A.JO. 2000 04, 129: 427-35
4. .H Erkkila L. Laatikainen Characteristics of Optic Discs in Healthy School children A Acta Ophthalmologica VOL 57 1979
5. Anyanru ; Environment, Culture & Eye Disease experience in Benin- City Nigeria 1985
6. B. Thylefors: Much Blindness is preventable world Health Forum Vol. 12 1991 78-85
