Survey of Medical Officers Attitudes and Knowledge of Eye Conditions in Older Patients.

Aim: To assess medical officers’ attitude and knowledge of eye conditions in the elderly. Study Design: Convenient sampling technique. Place and Duration of Study: Department of Ophthalmology, Federal Medical Centre, Birnin Kebbi, Nigeria, November 2012. Methodology: Thirty four medical officers were shown 10 slides of common external eye conditions in the elderly and were asked to give the diagnosis of each slide and complete a selfadministered questionnaire during a hospital clinical presentation. The questionnaire and the answers to the 10 slides were collected immediately after the presentation. Results: All the medical officers agreed that eye examination is an important part of the general medical examination. However, only 16 (47.1%) routinely examined the eye of the elderly patient as part of the general medical examination. Fourteen medical officers (41.2%) were comfortably examining the eye of the elderly. Though 6 (17.6%) medical officers reported being sufficiently trained in the ocular examination but only 1 (2.9%) admitted being proficient in the ocular examination. The entire medical officers agreed that ageing is a risk factor for some ocular conditions, but only 18 (52.9%) ever inquired from the older patients if they had any specific eye conditions. Many of the medical officers wrongly diagnosed the presented slides. There were associations between duration of the medical practice and attitude with the medical officers of less years of practice not bothering about the eye examination in the elderly during the general medical examination (P<.05). Conclusion: Most studied medical officers were not routinely examining the eyes of the older patients and many were unable to diagnose common eye conditions in the elderly. Medical training should emphasize the ocular examination and diagnosis. The continuing eye medical education for medical officers can bridge the knowledge gaps in eye care and enhance early detection of the eye conditions.

Cataract Surgical Services in Kwara State, Nigeria.

Introduction: Service provision for tackling cataract blindness is a key priority and remains a challenge for eye care programs in Nigeria. At the moment, paucity of data on these services makes evaluation and effective planning difficult. Objective: To evaluate the infrastructure, equipment, and human resources for cataract surgical services, and determine the cataract surgical output in Kwara State, Nigeria. Materials and Method: A descriptive cross-sectional study of all cataract service institutions in Kwara state was conducted in May-July 2008 using pre-tested questionnaire and on-site review. Output data for 2003-2007 was collected and channels of yearly reporting of cataract surgical output for 2008-2009 established. Descriptive and analytical statistics were performed. For all comparisons, statistical significance was indicated by p<0.05. Results: There were 14 cataract surgical centres (9 Base Hospitals and 5 Surgical Outreach Centres); all the Base Hospitals were located in the urban centres with over two third cited in Ilorin, the state capital. The state had adequate equipment and infrastructures; however they are mal-distributed in favour of urban areas. A total of 157 eye care workers comprising 12(7.6%) ophthalmologists (consultants=8, Diplomates=4), 16(10.2%) trainee ophthalmologists, 94(59.9%) mid-level ophthalmic personnel and 35(22.3%) support staff serve the state’s 2.37million people. Eighty per cent of the eye care workers reside in the state capital where less than 30% of the population lives. Cataract surgical output increased from 218 in 2,003 to 1020 in 2009. Conclusion: There is adequacy of infrastructure, equipment and human resources with improving cataract surgical output. To attain vision 2020 target, mal-distribution of infrastructures, equipment and human resources and poor staff mix need to be addressed. There is urgent need for establishing state- and nation-wide systems for reporting cataract surgical output.

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

Challenges; Attitudes and Practices of the Spectacle Wearers in a Resource-Limited Economy

Purpose: To evaluate challenges; attitudes and practices among spectacle wearers to effect positive change when necessary; and determine positive change in a resource-limited economy. Materials and Methods: A multi-hospital descriptive; cross sectional survey of spectacle wearers was conducted between May 2007 and December 2008 in Nigeria. Results: A total of 214 wearers comprising 43.5males and 56.5females aged 18-84 years were surveyed. The majority of subjects (92.6) had at least secondary education. The wearers' challenges included expensive spectacles (43.0); falling/ scratched/broken lenses (29.4) and fear that spectacles would damage the eyes (23.8). The wearers' attitudes were comprised of consultations with 'road side dispensers' (7) and permitting other individuals to select spectacle frames for them (26). Care and maintaince practices included use of handkerchief; tissue paper; fingers and water to clean spectacles (49.5) and placing spectacles inside spectacle cases (30.4). There were no associations (P 0.05) between gender or literacy levels and who selected the frames for the subjects; caregivers consulted for spectacles; and cleaning materials for spectacles. The placement of spectacles when not in use was significantly associated (P 0.05) with the wearers' gender and literacy levels but not with the length of spectacle wear. Conclusion: Attitudes and practices requiring positive change crossed gender and educational levels among spectacle wearers. The cost of spectacles should be regulated and availability of standard eye care practices would reduce challenges including lens-related defects and quackery. During consultation with a recognized eye care professional; counseling of wearers on positive attitudes/practices as well as allaying fear of spectacle wear is required

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