Ocular Morbidity Among Children With Protein Energy Malnutrition in Northwest Nigeria.

Background: Protein energy malnutrition (PEM) remains a major health challenge in Nigeria, especially Northern Nigeria. Its association with ocular morbidity and irreversible blindness has been previously documented. There are however limited recent literature on these ocular manifestations, which may have evolved over the years. This study is thus relevant to establish a current baseline for the ocular manifestations associated with PEM in Northern Nigeria. Materials and Methods: This was a comparative, cross-sectional study. The sample size was 400 children; 200 with PEM, and 200 without PEM. Consenting parents with children between 6 - 59 months of age diagnosed with PEM, and those without PEM were recruited. Sociodemographic characteristics, general and ocular history were documented. A detailed ocular examination which included visual acuity assessment, examination of ocular adnexae, as well as the anterior and posterior segment of the eyes were done. Data was collected in a structured proforma, and analysed with the SPSS version 21, and Windows WinPepi softwares. Results: Abnormal ocular findings were significantly higher in the PEM group compared to the non-malnourished group [46.5% vs 24%, OR = 2.910 (1.891, 4.477), p = < 0.001]. The predominant ocular examination findings in the PEM and non-malnourished groups were infective conjunctivitis (35.5% vs 17%), lid oedema (11% vs 0%), signs of xerophthalmia (6% vs 0%) and visual impairment (3% vs 0%). Conclusion: PEM is still complicated by varying severity of ocular morbidity, with the potential of progression to irreversible blindness.

Ease and Willingness to Use Smartphone Applications for Visual Acuity Assessment Among Patients in Ahmadu Bello University Teaching Hospital, Zaria.

Background: Smartphone applications (apps) are increasingly becoming more popular for medical use. Aim: The aim of this article is to determine the willingness and ease of using smartphone apps for visual assessment among adult patients attending the general outpatient ophthalmology clinic of Ahmadu Bello University Teaching Hospital, Zaria in Nigeria. Design: The study was a hospital-based descriptive cross-sectional design. Materials and Methods: New and old adult patients who presented at the clinic and consented to the study were selected. Visual acuity assessment was done using a 6-m Snellen chart and three selected Smartphone visual acuity applications sequentially. A semi-structured questionnaire was used for data collection and then analysed using SPSS version 23. Results: A total of 287 patients were studied. Majority (96%) of the patients found the Smartphone apps to be easy to use. A good proportion (76%) of the patients also believed that Smartphone charts were easier to use than the conventional Snellen chart and expressed willingness to use the app again. Conclusion: Smartphone visual acuity apps could offer a convenient, easy-to-learn, and easy-to-use means of visual acuity assessment. This coupled with the demonstrated patient's willingness to embrace this technology could be used to encourage the use of clinically validated apps for the early detection as well as monitoring of any impairment of vision, especially in out-of-clinic situations.

Outcome of cataract surgery in rural areas of Kaduna State, Nigeria.

AIM: To evaluate the visual outcome of all patients who had cataract surgery with intraocular lens implant in five Local Government Areas (LGAs) of Kaduna State and to identify reasons for poor outcome and to proffer suggestions to improve outcome. MATERIALS AND METHODS: A prospective study using the WHO cataract surgery record form to collect data from consecutively screened and operated cataract patients over a period of 18 months (January 2006-June 2007). Data was analysed using Monitoring Catarct Surgery Outcome V2.3 software by the WHO. RESULTS: A total of 690 eyes of 644 patients were operated, ECCE+PCIOL implantation was achieved in 664 (96.2%) while 26(3.8%) had anterior chamber lens implant. The age range was 40 - 99 years and male to female ratio was 1: 0.9. Good outcome was obtained in 239 (34.6%) and 370(53.6%) of patients at 2 and 8 weeks respectively in the postoperative period. Surgical complications like striate keratopathy/corneal oedema (18.3%), cortical reminant (4.2%) and posterior capsular rupture (2.9%), and uncorrected refractive error were identified as reasons for poor outcome. CONCLUSION: A good outcome of greater than 80% at 8 weeks postoperative period was not achieved. Provision of postoperative correction of residual ametropia in the rural community, as well as improved surgical techniques of surgeons, will go a long way to improve the visual outcome and cataract surgery uptake.

Corneal ulcers in a tertiary hospital in Northern Nigeria.

BACKGROUND/OBJECTIVE: To highlight the pattern of corneal ulcers at the Guinness Ophthalmic Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. MATERIALS AND METHODS: A retrospective review of case notes of patients who presented with corneal ulcer at the Guinness Ophthalmic Unit, Ahmadu Bello University Teaching Hospital between January 1995 and December 2005. Information obtained include demographic data, presenting complaints, predisposing factors, microbiological diagnosis, use of orthodox or traditional medications before presentation, duration before presentation and, presenting and final visual acuity. RESULTS: A total of 228 cases presented within the 10 years study period. There were 129 (56.6%) males and 99 (43.4%) females. The age range was 15 months to 66 years. The commonest presenting complaints was poor vision 109 (47.8%) followed by lacrimation 97 (42.5%) and ocular pains 96 (42.1%). The common predisposing factors were trauma 117 (51.3%), use of traditional eye medications 39 (17.1%), self medication with topical steroids 13 (5.7%) and measles 9 (4.0%). The presenting visual acuity was <6/60 in 49.8% of the patients, <6/18-6/60 in 23.4%, and 6/6-6/18 in 25.5% of the patients. At discharge, 45.6% had a visual acuity of 6/6-6/18, 27.2% had borderline vision (<6/18-6/60), 18.0% had severe visual impairment (<6/60), while 6.6% had no light perception. The commonest organisms isolated were Staphylococcus aureus in 19.7%, fungal hyphae in 15.8% and Streptococcus pneumoniae in 4.8%. CONCLUSION: In this study most patients with corneal ulcer presented with poor vision and excessive lacrimation. Trauma was the commonest predisposing factor with bacterial organisms as the commonest isolate.

Corneal Ulcers in a Tertiary Hospital in Northern Nigeria

Background/Objective: To highlight the pattern of corneal ulcers at the Guinness Ophthalmic Unit; Ahmadu Bello University Teaching Hospital; Kaduna; Nigeria.Materials and Methods: A retrospective review of case notes of patients who presented with corneal ulcer at the Guinness Ophthalmic Unit; Ahmadu Bello University Teaching Hospital between January 1995 and December 2005. Information obtained include demographic data; presenting complaints; predisposing factors; microbiological diagnosis; use of orthodox or traditional medications before presentation; duration before presentation and; presenting and final visual acuity.Results: A total of 228 cases presented within the 10 years study period. There were 129 (56.6) males and 99 (43.4) females. The age range was 15 months to 66 years. The commonest presenting complaints was poor vision 109 (47.8) followed by lacrimation 97 (42.5) and ocular pains 96 (42.1). The common predisposing factors were trauma 117 (51.3); use of traditional eye medications 39 (17.1); self medication with topical steroids 13 (5.7) and measles 9 (4.0). The presenting visual acuity was 6/60 in 49.8 of the patients; 6/18-6/60 in 23.4; and 6/6-6/18 in 25.5 of the patients. At discharge; 45.6 had a visual acuity of 6/6-6/18; 27.2 had borderline vision (6/18-6/60); 18.0 had severe visual impairment (6/60); while 6.6 had no light perception. The commonest organisms isolated were Staphylococcus aureus in 19.7; fungal hyphae in 15.8and Streptococcus pneumoniae in 4.8.Conclusion: In this study most patients with corneal ulcer presented with poor vision and excessive lacrimation. Trauma was the commonest predisposing factor with bacterial organisms as the commonest isolate

Survey of the attitudes of nigerian ophthalmologists to and resources for ophthalmic research.

AIM: To study the views of ophthalmologists on their attitude to and the resources for ophthalmic health research in Nigeria and draw appropriate policy implications. MATERIALS AND METHODS: Structured questionnaires were distributed to 120 ophthalmologists and ophthalmic residents who were attending an annual congress in Nigeria. Data were collected on background information, importance attributed to research, motivation for conducting research, funding, ethical oversight, literature search, and statistical support. The coded responses were statistically analyzed. P < 0.05 was statistically significant. RESULTS: Eighty-nine of the 120 questionnaires were returned giving a response rate of 74.2%. Research function was rated a distant last by 49.5% of the respondents after clinical service (93.2%), teaching (63.1%), and community service (62.8%). Advancement of knowledge was the strongest motivating factor for conducting research (78.2 %). Securing funding (91.8%) and finding time (78.8%) were the major constraints. The ethical review committees were considered suboptimal by the respondents. Literature searches for research were conducted on the internet (79.3%) and was independent of age (P = 0.465). Research data were stored and analyzed on commonly available statistical software. CONCLUSIONS: Although study respondents regarded research highly, they were severely constrained in conducting research due to lack of access to funds and finding time away from the clinical workload. We recommend periodic (re)training on conducting good research including preparation of successful applications for research grants and allotting protected research time for ophthalmologists in Nigeria.

Ophthalmic research priorities and practices in Nigeria: an assessment of the views of nigerian ophthalmologists.

PURPOSE: To study the views of ophthalmologists on research priorities and outcomes in Nigeria. MATERIALS AND METHODS: A structured questionnaire was distributed to 120 ophthalmologists and ophthalmic residents who were attending an annual congress in Nigeria. The participants' background information, relative research priorities, frequency of publications, research types, publication media, challenges faced in publishing and impact on health practice or policy were collected. RESULTS: Eighty-nine (74.2%) of the 120 questionnaires were returned. Childhood blindness was given the highest priority for ophthalmic research by 42.9% of the respondents, and genetic studies had the least priority (19.8%). About two-thirds of the respondents had either never been involved or only involved occasionally in any type of ophthalmic research. Clinical trials (13.1%) and basic science studies (12%) were the least-performed types of research. About 51% of the respondents indicated that they had never published in journals nor did so "occasionally"; only 9% quarterly and 43% published less than once a year. They also indicated that their research very rarely resulted in change of clinical practice or health policy (20%). CONCLUSIONS: Research works conducted by respondents were largely simple low-budget ones that rarely had significant impacts and outcomes, including publication. There is a need to retrain and emphasize the importance of research during undergraduate and postgraduate medical education. Adequate resources and research infrastructure should be provided for ophthalmic research in Nigeria.

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 64.7% of 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, 20% and 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.

Perceptions of Nigerian medical specialists on research.

The current research aimed at collating the views of medical specialists on disease priorities, class and outcomes of health research in Nigeria, and draw appropriate policy implications. Structured questionnaires were distributed to consent 90 randomly selected medical specialists practising in six Nigerian tertiary health institutions. Participants' background information, relative disease priority, research types and class, type and class of publication media, frequency of publications, challenges faced in publishing research, impact of their research on health practice or policy, and inventions made were probed. Fifty-one out of the 90 questionnaires distributed were returned giving a response rate of 63.3%. Sixty-four point six percent indicated that the highest priority should be given to non communicable diseases while still recognizing that considerations should be giving to the others. They were largely "always" involved in simple low budget retrospective studies or cross-sectional and medical education studies (67.8%) and over a third (37.5%) had never been involved in clinical trials. They largely preferred to "always" publish in PubMed indexed journals that are foreign-based (65.0%). They also indicated that their research works very rarely resulted in inventions (4%) and change (4%) in clinical practice or health policy. Our study respondents indicated that they were largely involved in simple low budget research works that rarely had significant impacts and outcomes. We recommend that adequate resources and research infrastructures particularly funding be made available to medical specialists in Nigeria. Both undergraduate and postgraduate medical education in Nigeria should emphasize research training in their curricula.

Efficacy of Garcinia kola 0.5% Aqueous Eye Drops in Patients with Primary Open-Angle Glaucoma or Ocular Hypertension.

PURPOSE: To evaluate the intraocular pressure (IOP) lowering efficacy of Garcinia kola 0.5% aqueous solution eye drops in patients with newly diagnosed primary open-angle glaucoma or ocular hypertension (POAG/OH). MATERIALS AND METHODS: A randomized, double-masked, multicenter, active-controlled prospective study. Patients who met the inclusion criteria were randomly assigned in equal numbers to receive Timolol 0.5% eye drops as a control medication (A = Group 1 eyes) or Garcinia kola 0.5% eye drops as the study medication (B = Group 2 eyes). All drops were instilled at 6 am and 6 pm daily. Goldman applanation tonometry was performed at 9 am, 12 pm and 3 pm at baseline, week-6, week-12 and week-24 visits. Voluntary and actively elicited reports of adverse events were documented. The mean change in IOP over 24 weeks was the primary outcome measure. Both groups were compared for statistically significant differences at all visits. A P < 0.05 was considered statistically significant. RESULTS: A total of 178 patients were randomly assigned to G. kola and Timolol groups. At baseline there were no differences in mean IOP between groups, based on age, sex, or diagnosis. At the end of the study period (24(th) week), the mean (+/- SD) reduction in IOP was 12.93 +/- 2.3 mmHg (47.8% +/- 0.8% reduction) in G. Kola group and 13.09 +/- 2.8 mm Hg (48.2% +/- 1.03% reduction) in the Timolol group (P > 0.05). Adverse events were mild in nature with no statistically significant differences between groups (P > 0.05). CONCLUSIONS: Garcinia kola ophthalmic solution significantly reduces IOP as compared to baseline. The IOP lowering effect of both treatments was equivalent.

Perceptions of Nigerian Medical Specialists on Research

"The current research aimed at collating the views of medical specialists on disease priorities; class and outcomes of health research in Nigeria; and draw appropriate policy implications. Structured questionnaires were distributed to consent 90 randomly selected medical specialists practising in six Nigerian tertiary health institutions. Participants' background information; relative disease priority; research types and class; type and class of publication media; frequency of publications; challenges faced in publishing research; impact of their research on health practice or policy; and inventions made were probed. Fifty-one out of the 90 questionnaires distributed were returned giving a response rate of 63.3. Sixty-four point six percent indicated that the highest priority should be given to non communicable diseases while still recognizing that considerations should be giving to the others. They were largely ""always"" involved in simple low budget retrospective studies or cross-sectional and medical education studies (67.8) and over a third (37.5) had never been involved in clinical trials. They largely preferred to ""always"" publish in PubMed indexed journals that are foreign-based (65.0). They also indicated that their research works very rarely resulted in inventions (4) and change (4) in clinical practice or health policy. Our study respondents indicated that they were largely involved in simple low budget research works that rarely had significant impacts and outcomes. We recommend that adequate resources and research infrastructures particularly funding be made available to medical specialists in Nigeria. Both undergraduate and postgraduate medical education in Nigeria should emphasize research training in their curricula."