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Year : 2017  |  Volume : 6  |  Issue : 2  |  Page : 127-131

Ocular morbidity among Senior high school students in the Kumasi metropolis, Ghana

Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

Date of Web Publication18-May-2017

Correspondence Address:
David Ben Kumah
Department of Optometry and Visual Science, B8, COS Building, Kwame Nkrumah University of Science and Technology, PMB Kumasi, 0023 Ghana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijhas.IJHAS_61_16

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BACKGROUND: Studies have suggested that the majority of nonblinding eye diseases may be of significant burden to the population and health system of developing countries. This study was conducted to determine the prevalence of ocular morbidities among senior high school students and their association with age and sex in public senior high schools in the Kumasi metropolis.
METHODS: The study was a descriptive cross-sectional survey. Six hundred and sixty-two students, with ages ranging from 14 to 20 years, from 12 randomly selected schools were examined and included in the study. The detailed examination included visual acuity measurement, external examination with a pen torch, ophthalmoscopy, +1 blur test, cover test, and subjective refraction.
RESULTS: Out of 662 students examined, 90% suffered at least one ocular condition. The most common morbidity was allergy (31.1%), followed by allergic conjunctivitis (22.2%), refractive error (10.0%), dry eye (6.9%), suspicious disc (3.6%), bacterial conjunctivitis (2.9%), foreign body (2.7%), glaucoma suspect (1.4%), and papillitis (0.5%). More females suffered ocular problems than males.
CONCLUSION: The prevalence of ocular morbidity among senior high school students in the metropolis is high, with allergies being the most common. Eye health education, regular eye examination, and adequate classroom illumination should be implemented in senior high schools.

Keywords: Cross sectional survey, conjunctivitis, ocular morbidity, refractive error, senior high school

How to cite this article:
Kumah DB, Abdul-Kabir M, Ablordeppey RK, Adu-Gyamfi K, Bonsu K, Asare-Bediako B, Kyei EN. Ocular morbidity among Senior high school students in the Kumasi metropolis, Ghana. Int J Health Allied Sci 2017;6:127-31

How to cite this URL:
Kumah DB, Abdul-Kabir M, Ablordeppey RK, Adu-Gyamfi K, Bonsu K, Asare-Bediako B, Kyei EN. Ocular morbidity among Senior high school students in the Kumasi metropolis, Ghana. Int J Health Allied Sci [serial online] 2017 [cited 2023 Mar 28];6:127-31. Available from: https://www.ijhas.in/text.asp?2017/6/2/127/206427

  Introduction Top

Common ocular disorders in many countries, especially the United Kingdom and United States were shown to be congenital or hereditary. In India, it is known that one out of every four persons in the country suffers from an eye problem at some point in time.[1] Many studies on ocular morbidity have shown that blindness and vision impairment remain major public health problems that need to be addressed globally.[2],[3],[4] Blinding eye diseases such as cataract, trachoma, glaucoma, and retinal disease have been prioritized by the Word Health Organization in Vision 2020.[5] However, other eye conditions that may affect people's functionality and quality of life causing them to seek care but do not necessarily lead to blindness are mostly disregarded.[6] As such, the epidemiology of nonblinding diseases such as allergic and infective conjunctivitis, dry eye syndrome, and others which are also very common in the population, especially that of developing countries have not been sufficiently investigated.

Information concerning the prevalence of ocular morbidity, particularly among senior high school students, in developing countries such as Ghana, is limited. A few studies conducted suggest that the majority of nonblinding eye diseases maybe significant burdens to the population and health system of developing countries.[7] In Ghana, most studies focus on refractive errors and have revealed the high levels of their prevalence among school-going children with low uptake of refractive services among the same group.[8] Most of these studies have focused on children because certain eye conditions are sight-threatening and these sight-threatening ocular morbidities can be prevented and treated on early diagnoses in their early stages in children. Consequently, periodic screening of school children is very important to improve eyesight quality. This study was conducted with the aim of determining the prevalence of ocular morbidity among senior high school students in the Kumasi metropolis. The results of this study will provide data that will inform the magnitude of ocular problems these students harbor that have been overlooked and the need for certain eye care schemes for the said group.

  Methods Top


This descriptive cross-sectional study was carried out from March 2014 to March 2015 in 12 randomly selected senior high schools in the Kumasi metropolis, Ghana. The study participants were students in the age group of 14–20 years. There were five mixed schools, three boys schools, and four girls schools involved in this study. The principals of these selected schools were contacted and informed consent obtained after a detailed explanation of the purpose, content, and benefits of the study. All government senior high schools in the Kumasi metropolis were listed as eligible for the study. A list of the various classes available in each school were written on sheets of paper and put in a box. After mixing them up, one piece of paper was picked, and the class on it then became the particular class of concern to us. Students in these selected classes were examined for the study. As part of the plan to sharpen the clinical skills of the team members, a pilot project was conducted in one senior high school on February 13, 2014. The pro forma was then adjusted after the pilot study revealed shortcomings in it.

Data collection procedures

Students in the selected classes were examined for the study. Ocular examinations began by taking history (age, sex, previous eye examinations, and ocular symptoms) and measuring distant visual acuity using the Snellen chart at 6 m away from the participants. Children with visual acuity < 6/9 underwent a pinhole visual acuity to differentiate refractive errors from pathological conditions. The unavailability of full cycloplegic refraction was overcome by fogging the vision of participants with high plus lenses while they fixated at distance for subjective refraction. Refractive error was diagnosed based on visual acuity of 6/9 or worse that improved with pinhole test. Examination of the eyelid margins, conjunctiva, cornea, and anterior segment was done with the aid of a pen torch and a magnifying ophthalmic loupe. Cover-uncover test was also carried out to diagnose strabismus and latent squint. The posterior segment of the eyes of each participant was examined in a darkened room using the direct ophthalmoscope. Those study participants with visual acuity 6/18 or less requiring further management or having some ocular disorder were referred to nearby hospitals for further investigation and management. A short talk on eye health education was given to the children after examination.

A diagnosis of myopia was made, if refractive error was more than −0.50 DS. Similarly, hyperopia was recorded, if it was +1.00 DS or greater after refraction. Astigmatism was recorded, if it was more than 0.50 DC. A diagnosis of amblyopia was made for visual acuities <6/9 that did not improve with refraction and no ocular pathology was observed after a careful eye examination including fundoscopy. Strabismus was diagnosed by recording corneal light reflex combined with cover tests. Participants with a history of intraocular surgery and systemic vascular disorders were excluded from the study.

The study participants also gave responses to a short questionnaire regarding sitting position and ability to see comfortably from the board. Students who preferred to sit 3m or less from the board were considered sitting in front, those who sat between 3m and 6m from the board were considered sitting in the middle and those who sat 6m and beyond from the board were considered sitting at the back. After the data were collected, it was thoroughly examined to check for completeness of answers, accuracy, and consistency.

Data analysis

The Statistical Package for Social Scientists version 16.0 (SPSS Inc., Chicago, IL, USA) was used to analyze the data. Continuous variables were expressed as mean ± standard deviation. Descriptive statistics and Chi-square test were employed to find significant differences between comparable categorical groups. Statistical significance was set at P > 0.05.

Ethical consideration

After ethical approval was obtained, written approval was sought from the Head of the District Education Directorate and the heads of the selected schools. Consent forms were given to guardians of the selected students to sign for their approval before their wards took part in the study. The study was carried out in accordance with the tenets of the Declaration of Helsinki.

  Results Top

A total of 662 students were screened in the 12 schools visited. The age and sex distribution of the study population are shown in [Table 1]. There were 344 males (52.1%) and 318 females (47.9%) with an overall male-to-female ratio of 1:1. The mean age (±SD) was 16.8 (±1.13) years (range = 6, 14 - 20 years).
Table 1: Age and sex distribution of study subjects

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Of the 662 students screened, 305 of them reported, they had had an eye disorder before that made up 46.1% of the total population. Three hundred and fifty-seven of the students had never had an eye examination of any kind before. This represents 53.9% of the sample population. There were more female students with ocular disorders than male (88.8% of boys and 90.85% of the girls in the study population were suffering from at least one ocular disease), and this was found to be statistically significant (P = 0.04).

The most prevalent eye disorder among the students was allergy (31.1%). Allergic conjunctivitis was next, affecting 148 students making up 22.2% of the population. Uncorrected refractive error was found in 66 students (9.97%). Suspicious discs were seen in 24 (3.6%) of the students. Sickle cell retinopathy and exophoria were seen in 9 (1.4%) students, respectively. Other morbidities were bacterial conjunctivitis (2.9%), dry eye (6.9%), foreign body (FB) on the eye (2.7%), and papillitis (0.5%). Distribution of ocular conditions among the students examined are shown in [Table 2]. Allergy was found to be significantly associated with females (P < 0.01), whereas allergic conjunctivitis was significantly associated with males (P < 0.05). All the other conditions were approximately equally prevalent among the boys and girls, but this was not statistically significant (P = 0.49).
Table 2: Distribution of ocular conditions among students examined

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Since crisp vision is needed for a better view of the board, students were questioned about their sitting position in the class. As shown in [Table 3], 224 students (33.8%) said they sat in front. A total of 189 students (28.5%) sat in the middle and 249 students (37.6%) at the back. Five hundred and six students (76.4%) said their sitting position made no significant change to the way they saw from the board, whereas 156 students (23.6%) indicated that where they sat in class played a major role in how clearly they could see from the board.
Table 3: Sitting position and unaided visual acuity

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The symptoms that were presented by the students in the sample population are summarized in [Table 4]. The symptom that was experienced by most of the students was headaches (17%). This was followed by itching (16%), redness (14%), tearing (12%), photophobia (11%), and FB sensation (9%). Other symptoms such as gritty sensation (7%), burning sensation (4%), discharge (3%), blurred vision (3%), and double vision (3%) followed in that order. Stinging sensation (1%) was the least reported.
Table 4: Symptoms reported by students

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As shown in [Table 4], almost half of the students who experienced at least one ocular symptom did so in the afternoons (54%). The next most common time that the students experienced symptoms was in the evenings (18%).

  Discussion Top

School screening for uncorrected refractive errors and other eye conditions causing visual impairment has been the subject of many studies during the past few years as it is considered an effective way to identify unreported visual problems in children who may require intervention.[9] This study was conducted to detect visual disorders and other morbidities that may predispose students to poor educational performance and potential blindness.

This study showed a high prevalence (53.9%) of ocular morbidity among the students. Similar studies have reported much lower prevalence such as in the USA where it was estimated to be between 5% and 10% and 10% in Nigeria.[10] The high prevalence in this study is likely to be due to differences in environmental conditions, as most of the selected schools had dusty environments that predisposed students to large amounts of allergens and disease-causing organisms. This could also be due to the finding that approximately half of the students had not had any eye examination before the study, and in such a developing country, one of countries where health-care seeking behavior is reported to be poor due to lack of funding,[11] it is likely that most of these students harbored the untreated ocular ailments that did not significantly reduce their vision to warrant “expensive” eye care, and only responded when they had access to free eye care services – an issue which might not have occurred among those studied in the developed countries. It is therefore important that more public health interventions are directed toward providing remedies for nonblinding conditions such as uncomplicated ocular allergies that these students suffer to allow for comfortable studies in this and similar developing countries.

This study also showed the most prevalent refractive error was myopia (6.8%), followed by hyperopia (2.7%) and astigmatism (0.5%). Other studies have reported similar low trends, such as in Baltimore and Tanzania.[12],[13] However, only 66 out of 156 students who reported that their sitting positions (distance from the board) were influenced by their vision from the board were diagnosed of refractive error. This could be due to other factors affecting the visual acuity of the students from the board such as poor room illumination of the classrooms. It has been established that visual functions are degraded under low luminance.[14] Improving room illumination, such as fitting light bulbs in classrooms with inadequate illumination and fixing broken bulbs, could go a long way to enhance visual acuity in classrooms.

Allergic conjunctivitis was the second most common ocular morbidity (22.2%) in this study. This is in agreement with the findings of Okosa.[10] However, some studies have reported refractive error being the most common ocular problem among students.[15],[16],[17],[18] This was found to occupy the fourth place in this study (10.0%). This is likely to be due to the fact that allergic causes of ocular morbidity were more burdensome to students due to their constant exposure to the allergens, thereby bloating the prevalence of allergic conditions in this study. Furthermore, similarly, low prevalence (3.5%) of refractive error has been reported in private schools in Ghana.[19]

Twenty-four (3.6%) of students were found to have suspicious optic discs, a worrying outcome which shows that such students are at risk of glaucomatous damage in the eyes. Given the high prevalence of primary open-angle glaucoma among Africans, which has been found to be higher among Ghanaians than other Africans,[20] it is imperative that such students are monitored on a regular basis to identify and arrest any vision loss that may result.

Due to limited resources available, the study sample was limited to only senior high schools in the Kumasi metropolis and did not consider those of other district and municipal assemblies. As such, the findings in this study cannot be generalized for the entire senior high school population of the country. It would be worthwhile if further studies included students from the remaining municipalities.

  Conclusion Top

The high prevalence of ocular morbidity among this population suggests the need for a regular school eye screening/health education programs in senior high schools, particularly, in developing countries where poor environmental sanitation and malnutrition predisposes students to a number of ocular disorders. It is important that these screening programs are not only limited to conditions that cause visual impairment or blindness, as has been the case so far, but also other “less serious” morbidities that prevent the comfortable use of the eyes, which could also affect academic performance. It would be appropriate for such countries to have a national survey to evaluate the extent of such morbidities to serve as a source of information for planning of health care services for students.

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Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4]


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