The Value of Internet Tools in Undergraduate Surgical Education: Perspective of Medical Students in a Developing Country.

OBJECTIVE: Advances in information technology (IT) in the past decade present opportunities and challenges in undergraduate surgical education. There may be need to evaluate the knowledge base and the use of Internet tools among medical students in settings where traditional mode of education is preeminent. This may help to establish a conceptual framework for integrating e-learning into the traditional teaching to enhance learning experience. In this study, we evaluated the medical students' knowledge and use of Internet tools, and their opinion on the application of these tools in surgical education. METHODS: We undertook a cross-sectional survey of 2013 and 2014 graduating medical class of College of Medicine University of Nigeria, Enugu using structured self-administered questionnaire. The survey assessed the knowledge, utility, and application of Internet tools in surgical education using 5-point Likert scale. RESULTS: Overall response rate was 78% (227/291) comprising 151 (66.5%) males and 76 (33.5%) females. The median age was 24 years (range 20-33 years). Although 106 (46.7%) had formal training on information technology, 223 (98.2%) can access Internet, and 162 (71.4%) use one or more of the Internet tools, 90.6% (96/106) of those trained on ICT use Internet for education/learning compared to 88.4% (107/121) of those without ICT training (p = 0.76). Google™ search tool had the highest rating in terms of familiarity and utility for education/learning (mean rating 4.3 on a scale of 5.0), while Skype™ had the least rating (mean 2.0). Overall, 89% of respondents (mean rating 4.5 on a scale of 5.0) indicated that Internet tools could be effectively applied in surgical education specifically in areas of lectures, assignments, real-time procedure demonstration, case discussion, and interaction with surgical experts. The key benefits are utility as a regular self-assessment tool (mean rating = 4.6) and offer of flexible learning schedule (mean rating = 4.0). Fifty-two percent (118/227) strongly agree that combination of the use of Internet tools with the traditional teaching may give better learning outcome (mean rating 4.44). The major challenges were cost of accessing Internet (n = 126; 55.5%), lack of facility with the technology (n = 115; 50.7%), and network availability (n = 96; 42.3%). Availability of affordable Internet (n = 205; 90.3%), improvement of training on ICT (n = 135; 59.5%), and encouragement of the use of these tools by faculty (n = 107; 47.1%) were the major suggestions to address the challenges. CONCLUSION: In our setting, a substantial number of undergraduate medical students are familiar with and use Internet tools for learning and believe that the tools may have utility in surgical education. However, to further consolidate and enhance learning experience, it may be useful to integrate this learning modality with the traditional mode of teaching through a well thought out curriculum modification.

Prevalence and severity of pterygium among commercial motorcycle riders in south eastern Nigeria.

BACKGROUND: Pterygium is common among outdoor workers who are daily exposed to sunlight and dust due to repeated conjunctival /corneal drying and micro-trauma especially in the tropics. Commercial motorcyclists in Nigeria are outdoor workers who spend the greater part of the day outdoors under the intense heat and dust characteristic of this part of the world and would therefore be largely predisposed to developing this conjunctival disorder. OBJECTIVE: The aim of this study is to determine the prevalence and severity of pterygium among these workers and relate these findings to their duration of work. METHODS: A cross sectional study with a multi stage random sampling design was used to choose the 615 subjects enrolled in the study. RESULTS: The prevalence for pterygium was 19.3% (206 eyes) with stage 1 occurring mostly (52%) followed by stage 2(46%). Pterygium was common among riders who had been riding for 5 years or less. The relationship between duration of riding and pterygium severity was significant (p=0.009). This prevalence was unaffected by the use of regular sun glasses (p=0.188). CONCLUSION: A strong relationship exists between commercial motorcycle riding and development of pterygium not affected by using regular sunglasses. We recommend that helmets with full face shields and/or proper UV protected riding goggles where the helmets have no face shield be enforced by the regulation bodies so as to reduce the prevalence of these disorders.

Prevalence and severity of pterygium among commercial motorcycle riders in south eastern Nigeria

Background: Pterygium is common among outdoor workers who are daily exposed to sunlight and dust due to repeated conjunctival /corneal drying and microtrauma especially in the tropics. Commercial motorcyclists in Nigeria are outdoor workers who spend the greater part of the day outdoors under the intense heat and dust characteristic of this part of the world and would therefore be largely predisposed to developing this conjunctival disorder. Objective: The aim of this study is to determine the prevalence and severity of pterygium among these workers and relate these findings to their duration of work. Methods: A cross sectional study with a multi stage random sampling design was used to choose the 615 subjects enrolled in the study. Results: The prevalence for pterygium was 19.3 (206 eyes) with stage 1 occurring mostly (52) followed by stage 2(46). Pterygium was common among riders who had been riding for 5 years or less. The relationship between duration of riding and pterygium severity was significant (p=0.009). This prevalence was unaffected by the use of regular sun glasses (p=0.188). Conclusion: A strong relationship exists between commercial motorcycle riding and development of pterygium not affected by using regular sunglasses. We recommend that helmets with full face shields and/or proper UV protected riding goggles where the helmets have no face shield be enforced by the regulation bodies so as to reduce the prevalence of these disorders

Factors That Affect Medical Students' Performance in Anatomy in the University Of Nigeria

Background: Much attention has been drawn to the area of medical education in contemporary times with the aim of developing effective teaching strategies in our medical schools. Objectives: To identify the problems encountered by students in the study of Anatomy and suggest ways of enhancing their performance in the subject.Materials and Methods: Three hundred structured; pretested self administered questionnaires were applied to medical students of the Faculty of Medical Sciences; University of Nigeria Enugu Campus (UNEC); who had spent at least two years in the medical school. Data analysis was by SPSS version 15.Results: Of the 300questionnaires; 201(67.0) were correctly filled and analysed. One hundred and three (51.2) of the respondents were females; 163 (81.1) were aged 21 to 30 years and 105(52.3) had spent more than two years in the medical school. One hundred and eleven (55.2) believed that dissection followed by audio-visual aids 101(50.3) offered students adequate exposure to the learning of anatomy. One hundred and eleven; (55.2) also implicated overcrowding as a major cause of students' aversion for dissection leading to inadequate exposure to the subject and the resultant poor performance. One hundred and seven (53.2) believed that the preparatory period for 2nd MBBS exams should be extended so as to offer students adequate exposure to laboratory specimens.Conclusion: Over-population causes inadequate exposure of students to anatomical specimens and thus affects their performance negatively

Ocular Features Seen in Children with Hydrocephalus at University of Nigeria Teaching Hospital Enugu: A Case Series

Background:Hydrocephalus has been known since antiquity. It has been defined as an increase in size of the ventricular system of the brain; resulting from raised cerebrospinal fluid volume. Objective: The purpose of this study is to determine the various ocular disorders that may be associated with hydrocephalus in children seen in the University of Nigeria Teaching Hospital (UNTH) Enugu.Patients and Methods: This study was carried out on 15 patients attending the neurosurgical outpatient clinic of the University of Nigeria Teaching Hospital Enugu. All patients who met the criteria for inclusion in the study of hydrocephalus; aged less than two years and attended the neurosurgical outpatient clinic between January and December 1998 were included. The diagnosis of hydrocephalus was made based on the history; clinical examination and brain ultrasonography. The data was analysed with a scientific calculator Casio FX-82 Lb and Epi info version 6 software.Results: Fifteen children with un-operated hydrocephalus confirmed by transfontanelle ultrasonography were examined at presentation for ocular complications of hydrocephalus. The mean age at presentation was 29.8 weeks. The peak age group of presentation was 11-20 weeks. The male/female ratio was 1:1. Ocular complications of hydrocephalus included setting sun appearance; nystagmus; optic disc palor and hyperaemia. Conclusion: The Ophthalmologist has a well established role to play in assisting the paediatric neurosurgeon in the long term management of children with hydrocephalus if the risk of blindness is not to be added to their other physical disabilities

Prevalence of Asthenopia among Computer Users in Enugu; Southeast Nigeria

A cross-sectional survey of 560 computer users in Enugu urban; Enugu State was conducted between August and December 2002.The prevalence of asthenopic symptoms and risk factors to the occurrence of asthenopia were determined. Method: Interview was done using structured; pre-tested; interviewer- administered questionnaire. Subjects were examined with Snellen's chart to measure distance visual acuity; jaegers reading chart for near acuity; pen torch for anterior segment examination; direct ophthalmoscope for fundoscopy; streak retinoscope for refraction and metre tape for distance between the screen and the subject. Result: Out of 560 subjects interviewed and examined 401 (71.6) had asthenopic symptoms. Headache was the most common symptom occurring in 35of the subjects. Tearing was seen in 27.1; ocular discomfort or pains accounted for 26.6. Some subjects had more than one symptom. Presence of ametropia was found to be significantly related to the occurrence of asthenopia (P=0.0); as also the female gender compared to the males; P=0.0000007. Distance of operators to their monitors; age of operators and the use of screen filters did not seem to significantly influence occurrence of asthenopia (P= 0.71; P=0.55 and P=0.39 respectively). Majority of the subjects (96) had good vision (VA of 6/6- 6/18). Conclusion: Presence of ametropia is related to occurrence of asthenopia. Correction of existing ametropia would contribute to visual comfort of computer (vdt) users. Pre- employment and regular ocular examination should be made accessible to those who make regular and long use of computers

Performance of students in anatomy in the 2nd MBSS examinations in some Nigerian universities

Aim: The aim of our study was to compare the pass rates of medical students in anatomy with those of medical biochemistry and physiology. Method: The 2nd MBBS (Part I MBBS) examination results of some medical schools in Eastern Nigeria over a variable period of 3-5 years were obtained. The schools were those of Abia State University (ABSU); Nnamdi Azikiwe University (NAU); University of Port Harcourt (UNIPORT) and University of Nigeria; Enugu Campus (UNEC). The performance of students in anatomy; medical biochemistry and physiology were compared. Result: ABSU and NAU had relatively smaller populations of students than UNIPORT and UNEC The percentage passes in anatomy in ABSU; NAU; UNIPORT and UNEC were 78.31; 79.3; 41.24and 54.7respectively. The performance of students in schools with small populations was better in anatomy than in either medical biochemistry or physiology. The reverse was the case in schools with large populations of students. Conclusion: Class size plays an important role in the performance of students in anatomy. The lower the population of students; the greater the chances of adequate exposure of students to the study materials; and consequently the better the performance

Age and sex distribution of blindness in Ahoada East Local Government Area; Rivers State; Nigeria

Background: Differences exist in the impact of blindness by age and sex; the overall risk of death being higher for blind males than females. Aim: To describe the age and sex differences among the blind in Ahoada-East Local Government Area (LGA) of Rivers State; Nigeria. Methods: Age and sex data were analyzed for 24 blind persons seen during a cross-sectional; community-based study of blindness in Ahoada East LGA. A total of 866 subjects were studied and ocular examination included visual acuity; pen torch examination; fundoscopy and applanation tonometry. Ages were estimated from historic events or verified using hospital/immunization cards. Results: Of the 866 subjects examined; there were 400 males and 466 females. Children and adolescents (0-19 years) formed 44.1while those = 60 years old were 16. Of the 24 blind persons; 21 (87.5) were over 60 years while 3 (12.5) were less than 50 years old; the difference in age among the blind was statistically significant (P 0.05). The age-specific prevalence of blindness in the study population increased from 0.6in adolescence to 38.3in those =90 years. The sex specific prevalence of blindness was 4.5for males and 1.3for females. Males were more likely to be blind than females (Relative Risk=3.49; 95CI=1.40-8.72). Conclusion: This study found blindness to be commoner in the older age groups; and the male gender appeared to be an important risk factor. Eye health education must target such vulnerable groups. Males especially should be enlightened on social habits and environmental factors that increase their risk

Causes of childhood blindness: results from schools for the blind in south eastern Nigeria.

AIM: This cross sectional study was undertaken to identify the major causes of childhood severe visual impairment/blindness (SVI/BL) among students in schools for the blind in south eastern Nigeria with a view to offering treatment to those with remediable blindness. METHODS: 142 students attending three schools for the blind in the study area were interviewed and examined using the World Health Organization programme for prevention of blindness (WHO/PBL) childhood blindness proforma. RESULTS: By anatomical classification, the major causes of SVI/BL identified in the children (aged 15 years or less) were lesions of the lens (30.4%), corneal lesions (21.7%), whole globe lesions (mainly phthisis bulbi) (17.4%), and glaucoma/buphthalmos (10.9%). For the young adults (more than 15 years) these lesions accounted for 31.9%, 21.3%, 23.4%, and 8.5% of SVI/BL, respectively. For all the students, the commonest single diagnoses were cataract (23.5%) and corneal scarring (21.4%), of which 86.7% were caused by measles. By aetiological classification, childhood factors (38.6%) constituted the major cause of blindness: 37.0% in the children and 39.4% in the young adults. In 74.5% of all the students, blindness was considered avoidable. CONCLUSIONS: A high proportion of childhood blindness in schools for the blind in south eastern Nigeria is avoidable. Development of paediatric ophthalmology in Nigeria to manage childhood cataract and glaucoma is advocated.

Magnitude and causes of blindness and low vision in Anambra State of Nigeria (results of 1992 point prevalence survey).

A survey to determine the prevalence and causes of blindness in Anambra State of Nigeria was conducted. The aim was to provide baseline data for the planning, implementation and evaluation of both the state's and the National Programme for Prevention of Blindness. A multistage cluster random sampling technique was used. The World Health Organization/Prevention of Blindness (WHO/PBL) Eye Examination Record Form was used. The WHOs definitions of blindness and low vision were adopted for the analysis. The prevalence of blindness in the state is estimated to be 0.33% +/- 0.27%. Visual acuity of from 3/60 to less than 6/60 has a prevalence of 0.41% +/- 0.30% while visual acuity of from 6/60 to less than 6/18 has a prevalence of 0.67% +/- 0.39. There are equal numbers of blind males as females, although the prevalence among males is 0.44% +/- 0.26% while among females it is 0.24% +/- 0.15%. Most of the blind are above 50 y of age with prevalence of blindness in this age group being 2.62% +/- 1.31% (3.27% +/- 2.1% for males and 2.02% +/- 1.58% for females). Cataract caused most of the blindness (70.59%), followed by glaucoma (17.65%). Macular degeneration is becoming important (5.88%) while obvious infective causes are rare. Errors of refraction are important public eye health care problems. Methods of tackling the cataract problem (both backlog and incident), and other eye health needs within the primary eye/health care are recommended. The need to extend refraction services to the rural areas is emphasized.

PIP: To provide baseline data for the planning, implementation, and evaluation of the National Program for Prevention of Blindness, a survey was conducted in Nigeria's Anambra State. A multistage cluster random sampling technique was used to enroll 1752 adults. Blindness was defined, according to World Health Organization criteria, as visual acuity in the better eye of less than 3/60 with spectacle correction or pinhole. Low vision was defined as visual acuity less than 6/18 to not better than 6/60 (category 1) or less than 6/60 to not better than 3/60 (category 2) in the better eye with best correction or pinhole. The estimated prevalence of blindness in the sample was 0.97% (1.54% among men and 0.64% among women). When adjusted to the age and sex structure of the Nnewi North Local Government Area, this prevalence became 0.33% (0.44% for men and 0.24% for women). For those above 50 years of age, the prevalence of blindness was 2.62% (3.27% for men and 2.02% for women). Cataract was the primary cause of blindness (70.57%), followed by glaucoma (17.65%). The prevalence of category 1 low vision was 0.67%, while that of category 2 low vision was 0.41%. Finally, the prevalence of monocular visual impairment was 1.20%. In this area, blindness associated with measles and other infectious causes has decreased substantially. At present, most visual impairment is due to progressive lesions associated with aging. These findings suggest that the priority needs in Anambra State are sight restorative surgery for the cataract blind, early diagnosis and treatment of glaucoma, and provision of low-cost spectacles for the correction of ametropia. A community outreach eye care service, integrated into primary health care, is recommended.