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ORIGINAL ARTICLE
Year : 2021 | Volume
: 10
| Issue : 3 | Page : 197-201
Ocular morbidity pattern among patients attending Red Cross Eye Unit in Sunyani, Ghana
Victor Opoku-Yamoah1, Ebenezer Afrifa-Yamoah2
1 Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
2 School of Science, Edith Cowan University, Joondalup, Australia
Correspondence Address:
Dr. Victor Opoku-Yamoah
Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, Durban
South Africa
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/ijhas.IJHAS_258_20
BACKGROUND: Visual health information is particularly important in planning appropriate interventions to combat preventable causes of blindness and visual impairment. Nonetheless, there is limited information on ocular health conditions in Ghana. The study set out to determine the pattern of ocular morbidity at the Red Cross Eye Unit in the Bono Region of Ghana.
SETTINGS AND DESIGN: The study was carried out at the Red Cross Eye Unit in the Bono Region of Ghana and used a hospital-based retrospective cross-sectional study design.
MATERIALS AND METHODS: A review of patient's ocular health records throughout the year 2018 was performed. Patients were conveniently sampled, and socio-economic details and diagnosis were analyzed.
STATISTICAL ANALYSIS USED: Analysis was carried out using Statistical Package for the Social Sciences (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY, USA).
RESULTS: A total of 2400 patients records were reviewed, comprising of 1012 males (42.2%) and 1388 females (57.8%) with a male to female ratio of 1:1.4. Each patient sampled was diagnosed with an ocular condition and the modal age group was found to be 41–60 years. The most common cause of ocular morbidity among the patients was refractive error (32.4%). This was followed by acute conjunctivitis (29.7%) and cataract (12.3%). Refractive error and acute conjunctivitis were found to be significantly higher among females (P < 0.05).
CONCLUSIONS: Refractive error, acute conjunctivitis, and cataract were common ocular morbidities found in this study. Interventions should target these ocular conditions to minimize the risk of preventable visual impairment and blindness in the Region.
Keywords: Ocular morbidity, physiological, preventable blindness, visual impairment
Vision is a complex physiological phenomenon that is important to all mankind. It is an essential human sense on which most life activities heavily depend. Vision loss is therefore detrimental to health and general well-being especially when it arises from preventable causes. The loss of sight renders enormous human suffering for the visually impaired and their families presenting a great public health concern for countries and the world as a whole. The global estimates of blindness and vision impairment (VI) are approximately 36.0 million and 217 million respectively according to 2015 World Health Organization data.[1] In developing countries where about 80% of the global estimate of vision loss occur, the situation is much worse.[2] Although the current trend of global estimate of VI is believed to change little with advancing age, the presence of many sight-threatening senile ocular conditions still put older population at higher risk.[3] The younger population are also faced with long blind years, enormous personal, social, and economic burden on communities as well as loss of employment and educational opportunities.[4]
Ocular morbidity encompasses all conditions that lead to VI as well as non-vision threatening conditions that has the potential of impacting the quality of life of the individual.[5] The essence of early intervention cannot be over-emphasized in the fight against preventable VI and blindness. Studies on the pattern of ocular morbidities can provide necessary information that would be helpful in formulating adequate policy measures to improve access to eye care services in developing countries such as Ghana. Thus, this study was set to determine the pattern of ocular conditions among patients attending the Red Cross Eye Unit in Sunyani, Ghana. This information will also provide baseline information essential for the planning of affordable primary eye care delivery in the Bono Region of Ghana.
MethodsStudy design
This was a hospital-based retrospective cross-sectional study. This was carried out by reviewing patients record information at the Red Cross Eye Unit during the study. A retrospective cross-sectional study measures and examines exposures to conditions or risks that have occurred in the past to establish relation to outcomes at a particular time.
Study area and population
This study was carried out at the Red Cross Health Services, a private eye facility in Sunyani, the capital of Bono Region of Ghana. The clinic serves the entire population of Sunyani and adjoining communities within the Municipal area. The Sunyani Municipality has a total land area of 1289 km2 and a population estimate of about 123,224 based on the recent population census.[6]
Sample size: A sample size of 2400 was considered.
Sampling technique: Convenient sampling technique was used.
Study period: January 2018 to December 2018.
Study tools
Patients' records were reviewed, and secondary data collected from the eye unit's records for clients who visited the clinic during the study. Socio-demographic details and eye conditions diagnosed by Doctors (Ophthalmologists and/or Optometrists) were collected on pre-designed record sheets. Patients' distant visual acuity (VA) were measured using the Snellen's VA chart at 6 m and refractive error was defined in dioptric powers (as visual corrections ≥ ±0.25 DS for distance vision and ≥ ±1.50 DS for near correction). Participants were captured only once.
Inclusion criteria: All patients who attended the Red Cross Eye Unit in Sunyani.
Exclusion criteria: Patients who attended follow-up review at the Eye Unit.
Statistical analysis
Data were entered into Statistical Package for the Social Sciences (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY, USA). Data were then analyzed using descriptive statistics such as frequency, percentages, and cross tabulations to describe the study findings.
Ethical approval
The study was approved by the Ethics and Research committees of the Red Cross Health Services, Ghana. The study did not involve any interaction with clients who access the services of the Eye Unit. This study was carried out in accordance with the tenets of the declaration of Helsinki.
ResultsThere were 1012 males (42.2%) and 1388 females (57.8%) with a male to female ratio of 1:1.4. Out of the patients selected, 25.42% were 20 years or below, 25.83% of the patients were aged from 21 to 40 years, 26.41% of the patients were aged from 41 to 60 years, and 22.33% were above the age of 60 years [Table 1].
The most common ocular condition diagnosed among the patients was refractive error (32.4%) followed closely by acute conjunctivitis (29.7%). The acute conjunctivitis consisted of forms such as allergic conjunctivitis, vernal conjunctivitis, and acute hemorrhagic conjunctivitis. Cataract and dry eye syndrome followed up with 12.3% and 8.1% respectively while glaucoma recorded 7.1%, corneal ulcer 2.1%, uveitis 1.9%, retinopathies 0.5%, and other 6.0%, comprising of conditions such as blepharitis, staphyloma, nystagmus, retinal scars, toxoplasmosis, foreign body, ptosis, and phthisis bulbi[Table 2] and [Table 3]. Refractive error and acute conjunctivitis were significantly higher among females than males (P < 0.05); although females were found to record higher frequencies for other conditions such as cataract, glaucoma, and dry eye syndrome [Table 4]. However, these differences were not significant (P > 0.05).
The pattern of ocular condition by the ages of the patients showed that acute conjunctivitis was greater among age groups 0–20 years and 21–40 years. Above the age of 40 years, refractive error becomes the most dominant condition which is followed by the age group 21–40 years. Other conditions worth noting among the patients >40 years include cataract and refractive error which recorded 244 (10.2%) and 118 (4.9%) respectively among the age group of above 60 years [Table 3].
With the exception of corneal ulcers and uveitis, the other ocular conditions were dominated by a greater number of female patients [Figure 1]. Even though, there was a greater female preponderance among the study population, it does not ultimately translate into females recording higher number of cases. Ocular conditions such as acute conjunctivitis, cataract, glaucoma, and dry eye syndrome were diagnosed among more females than males [Table 4].
The pattern of attendance to the eye unit was particularly high in certain periods of the year. The month with the higher patient's attendance was August, followed by September, then November. A similar trend was seen with regards to the diagnosis of refractive error within these months [Table 5]. Patients within the age group of 41–60 years attended the eye unit most frequently followed by the age group of 21–40 years then the age group of 0–20 years.
DiscussionThe results showed a significantly higher ratio of females, 57.8% than males among the study participants (P < 0.05). This may be associated to the role of many women in the family as caregivers who cater for children and the elderly. These women take the opportunity as caregivers to seek eye care for themselves. This result is similar to reports from other studies within the country and the subregion.[7],[8]
Patients aged from 41 to 60 years recorded the highest attendance accounting for 26.4% followed by patients aged from 21 to 40 years whose attendance represented 25.8%. This may be due to increase knowledge in eye care among the middle-aged adult group. This age group falls within the presbyopic age who experience symptomatic blurry vision at near especially when reading which might have compelled them to attend the eye clinic for correction. The least attendance was recorded among patients above the age of 60 years, 22.3%. People above age 60 may have recorded least attendance due to naturally depreciating energy levels among this group which pose a difficulty in accessing eye care as frequently as the younger population.
The most common ocular condition recorded was refractive error which was diagnosed among 777 (32.4%) patients followed by acute conjunctivitis seen among 712 (29.7%) patients and then cataract 295 (12.3%). Other studies from different geographical locations have reported much less proportions of refractive error but occurring as the most common condition 3.5%,[9]13.8%[10] and 20.0%.[11] However, similar prevalences of refractive error has been reported from earlier studies which found refractive error as the most common ocular morbidity accounting for 26.3%,[8] 25.1%,[12] and 25.6%,[13] respectively. Allergic conjunctivitis like as reported in this study, has also been identified as the second-most common ocular condition accounting for 17.3% in a study in Ghana.[8] The disparities in prevalence rates could be attributed to differences in the study populations being compared who may have different characteristics.
Acute conjunctivitis recorded highest number among patient aged below 20 years. As earlier described, this condition consists of forms such as allergic conjunctivitis, vernal conjunctivitis, and acute hemorrhagic conjunctivitis. This could be attributed to high allergic response among this age group. Earlier studies suggested the presence of high concentrations of allergens such as dust from school children playgrounds and dusty roads.[8],[14] Ajaiyeoba et al. also noted vernal or allergic conjunctivitis to be high among this age group.[7] Refractive error was highest among the patients aged 41–60 years (12.7%) followed by 21–40 years (8.5%). One obvious reason could be attributed to the classification of presbyopia as refractive error in the study. Presbyopia is predominant among these age groups because the crystalline lens naturally loses the ability to accommodate with advancing age, hence difficulties in performing near work.[15] These age groups also represents quite an experienced workforce of the country who may have acquired knowledge on eye care due to their education and improved eye care knowledge across the nation due to the increased numbers of eye care workers including optometrists, ophthalmologists, optical technicians within the public and private sectors of the economy.
The number of female patients diagnosed with refractive error and acute conjunctivitis was significantly higher than males. This could be due to the greater percentage of females among the study population. Second, more females are placed in an advantaged position to access eye care in the country than males due to their pioneering role in caring for children in the family. The greater number of males diagnosed with ocular conditions such as corneal ulcers could possibly explain the kind of risky ventures males engage in during work and leisure.
The pattern of patient's attendance was much higher in the months of August and September and this may be due to the fact that these months are mostly for commencement of school in Ghana. Most senior high schools and tertiary institutions include eye examinations as part of their admission process. Hence, patients may have engaged the services of the eye unit in the bid to secure and complete their admissions to these secondary and tertiary institutions. Moreover, these months come along with major seasonal changes and as a result could have sparked allergic reactions in the eyes of several people.[8],[14]
ConclusionsThe most common causes of ocular morbidity among patients attending the Red Cross Eye Unit was refractive error (32.4%) followed by acute conjunctivitis (29.7%) and then cataract (12.3%). Attendance to the eye clinic and ocular morbidity was greater among females than males and again, highest among the age group of 41–60 years (26.4%) followed by 21–40 years (28.8%). The results observed in this study are similar to findings from other parts of the subregion. It is recommended that increasing community awareness and sensitization campaigns could be relevant to reduce the occurrences of avoidable blindness. This can improve the early identification of conditions that are potential causes of blindness in the country. The information from this study would be relevant to provide guidance for the Ministry of Health toward the formulation of policies and programs to enhance eye care accessibility in the country.
Acknowledgment
I would like to acknowledge the management and workers of the Red Cross Eye Unit, Sunyani, Ghana for their support and contribution toward making this work a success.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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