Retinal Microvasculopathy Is Common in HIV/AIDS Patients: A Cross-Sectional Study at the Cape Coast Teaching Hospital, Ghana

properly cited. Purpose. The purpose of this study was to evaluate the ocular disorders in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. Methods. A cross-sectional study using systematic random sampling was conducted on 295 HIV positive patients. Data collection consisted of semistructured questionnaires, laboratory investigation, medical profile, and ophthalmic examination. Statistical association tests including 2 , independent -test, and ANOVA were done. A value ≤ 0.05 was considered statistically significant. Results. Of the 295 participants, 205 (69.5%) were on antiretroviral therapy while 90 (30.3%) were not on therapy. Majority of the participants (162, 54.9%) were in clinical stage two, followed by stages three (68, 23.1%), one (62, 21%), and four (3, 1%), respectively. The overall prevalence of ocular disorders was 5.8%. The most common HIV related ocular disorder was HIV retinal microvasculopathy (58.8%), followed by herpes zoster ophthalmicus and Toxoplasma retinochoroiditis, both representing 11.8% of ocular disorders seen. Cytomegalovirus retinitis, Bell's palsy, and optic neuritis were the least common (5.9%). CMV retinitis recorded the highest viral load of 1,474,676 copies/mL and mean CD4 count of 136 cells/mm 3 . The mean CD4 count for participants with HIV related ocular disorders was significantly lower compared to participants without disorders ( = 2.5, = 0.012). Participants with ocular disorders also recorded significantly higher mean viral loads than those who did not have ocular disorders ( = 2.8, = 0.006). Conclusion. Lower CD4 counts and high viral load copies were associated with the manifestation of HIV related ocular disorders. Background Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV) which affects all body organs either directly or by opportunistic infections, and the eye is not spared. AIDS indicates advanced HIV disease in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive There is a huge dearth of information in Ghana on ocular related findings in HIV patients. Reports from other societies have always considered the associations between HIV related ocular manifestations and CD4 counts but not viral loads. The purpose of this study was to evaluate the associations between presenting ocular disorders and CD4 counts/viral load copies in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. Methods Study Site. The study was carried out at the Antiretroviral Therapy (ART) Specialist Clinic of the Cape Coast Teaching Hospital in Ghana. The Cape Coast Teaching Hospital, one of the five teaching hospitals in Ghana, provides health services to people in the central and western regions and parts of Ashanti and eastern regions. It also has the mandate of training doctors and other medical staff. Study Design and Participants. The study employed a descriptive cross-sectional design. Sample size was determined based on the expression , where is the minimum sample size, is the standard normal deviation, usually set at 1.96 which corresponds to the 95% confidence interval, is the proportion in the target population estimated to have the infection (1.4% for the central region), and is the degree of accuracy desired, usually set at 5%. Consequently, a sample size of 30 was calculated. This was adjusted to 200 participants to account for attrition rate and inefficiencies associated with the sampling method. A systematic sampling method was used to recruit clinically diagnosed HIV patients, who attended the ART Specialist Clinic between January and May 2016. Based on the average daily attendance at the clinic and a determined sampling interval of three (3), the first participant was chosen by randomly selecting a number between one and three. Every third patient from the first participant was then recruited into the study. In all, 320 patients were examined within the period. Out of them, 295 patients had complete medical data and they were included in the analysis. Patients who had comorbidities such as diabetes, hypertension, and sickle cell disease were excluded from the study. Ethical Considerations. The study was conducted in accordance with the Helsinki Declaration on Research Regarding Human Subjects. Ethical clearance (ID number UCCIRB/CHAS/2015/090) was obtained from the Institutional Review Board of the University of Cape Coast. The rationale of the study was comprehensively explained to all participants after which consent forms were issued to them to sign, including local language versions which were read out to illiterate subjects who consented with a thumbprint prior to investigation. For participants below 18 years of age whose assent was sought, their parents/guardians signed the consent forms on their behalf. The participants were assured of confidentiality and safety at all times. They were also reminded of the voluntary nature of the study which granted them the right to withdraw at any point. Data Collection. The method of data collection consisted of semistructured questionnaires, laboratory investigation, medical profiles, and ophthalmic examination. Every consenting patient was assigned a specific study code. A trained investigator interviewed and filled the questionnaires for all the participants. Information obtained from the questionnaires included age, gender, occupation, religion, marital status, level of education, and duration of infection from the time of diagnosis. The patient's HIV related medical information such as the World Health Organization (WHO) clinical stage of the disease, whether the participant was on ART or not, and duration of ART usage was recorded. Blood Sample Collection and Analysis . About 3 mL of venous blood was collected from each participant and HIV biomarkers CD4 counts and viral loads were determined. Two CD4 counts were obtained for this study: nadir CD4 counts (the lowest CD4 count ever recorded) and the current CD4 counts (CD4 counts at the time of the study). It was important to evaluate both the nadir and the current CD4 counts in this study to appreciate the effect of antiretroviral therapy on CD4 and to ascertain the stage at which some HIV related ocular disorders actually occurred. Ophthalmic Examination. Ophthalmic examination was conducted by experienced eye care personnel. Presenting Distance Visual Acuity (PDVA) measurements followed by slit lamp biomicroscopy and dilated funduscopy were performed on all participants. Pinhole acuity was performed to rule out refractive error as the cause of reduced vision. Dilated fundus examination was performed with 2.5% phenylephrine ophthalmic solution. Two drops of the phenylephrine were administered at an interval of 5 minutes followed by one hour of waiting to ensure maximum papillary dilation. Journal of Ophthalmology 3 Ophthalmoscopy was then performed on each participant. Ophthalmic examination forms were correspondingly labeled for each participant. Categories of visual impairment (VI) were determined based on the International Classification of Diseases, where "low vision" is defined as presenting visual acuity < 6/18 in the better eye Statistical Analysis. The data collected were entered into SPSS for Windows, version 21.0.1. The analysis involved the use of frequency distribution tables. Chi-square ( 2 ) test was used to determine the associations between categorical variables. Fisher's exact test was used where counts were less than 5. Independent -test and analysis of variance (ANOVA) were performed to compare the mean values of HIV biomarkers (CD4 counts and viral loads) between participants who had HIV related visual disorders and those who did not. A value ≤ 0.05 was considered statistically significant. Results A total of 320 patients were examined within the period, out of whom 295 had complete medical data and were included in the analysis. They comprised 78 (26.4%) males and 217 (73.6%) females. Their ages ranged from 10 to 83 years with mean age of 45.3 years (SD: ±11.6). According to the WHO criteria on HIV classification, majority of the participants (162, 54.9%) were in clinical stage two, followed by stages three, one, and four that had 68 (23.1%), 62 (21%), and 3 (1%) participants, respectively. Two hundred and five (69.5%) of the participants were on antiretroviral therapy while the remaining 90 (30.5%) were not on therapy. The mean age of participants on ART was 45.9 (SD: ±11.64) years while those not on ART had a mean age of 43.8 (SD: ±11.46) years. There was no statistically significant difference between the mean ages of participants on ART and those without therapy ( = 1.4, = 0.14). The mean current CD4 count of participants on ART was lower (786.5 cells/mm 3 ) than of participants not on ART (863.8 cells/mm 3 ). This difference was, however, not significant ( = 1.3, = 0.20). Similarly, there was no significant difference between the mean viral load counts for participants on ART and those not on ART ( = 1.1, = 0.28). Majority of the participants (150, 50.8%) had normal vision of VA 6/6. One hundred and sixteen (39.3%) had mild visual impairment (VA 6/9-6/18). Twenty-nine (9.8%) of the participants had low vision (VA < 6/18) out of whom 19 (65.5%) were on antiretroviral therapy. Five (17.2%) of the 29 participants were in the first clinical stage of the disease whereas 19 (65.5%) and 5 (17.2%) were in stages two and three, respectively. Low vision occurrence was lower in the ART group (9.8%) than in the non-ART group (11.1%). However, there was no significant association between low vision and ART status ( 2 = 0.24, = 0.62). Out of the 295 participants who took part in the study, 17 (5.8%) had HIV related ocular disorders of whom three were bilateral cases (making 20 eyes in all). Of these 17 participants, 4 (23.5%) were males and the remaining 13 (76.5%) were females. There was no significant association between manifestation of ocular disorders and sociodemographic factors such as gender ( = 1.00), age ( = 0.60), occupation ( = 0.38), and duration of infection from the time of diagnosis ( = 0.81). There was also no significant difference between the mean ages of patients who manifested ocular disorders and those who did not ( = 0.2, = 0.80). The most prevalent HIV related ocular disorder in this study was retinal microvasculopathy (10, 58.8%). The mean CD4 count for participants with this disorder was 142 cells/mm 3 with a mean viral load of 20,308 copies/mL. Herpes zoster ophthalmicus and Toxoplasma retinochoroiditis each accounted for 2 (11.8%) of the ocular disorders found. Participants who had HZO recorded a mean CD4 count of 269 cells/mm 3 and mean viral load of 38,090 copies/mL. Cytomegalovirus retinitis was responsible for only 1 (5.9%) case and it occurred in a participant with a CD4 count of 136 cells/mm 3 and the highest viral load count of 1,474,676 copies/mL. Neuroophthalmic disorders found were Bell's (hemifacial) palsy and optic neuritis, each accounting for (1, 5.9%) of the cases. Participants who had HIV related ocular disorders had significantly lower mean values of nadir CD4 counts (172 cells/mm 3 ) when compared to those who did not have ocular disorders (309 cells/mm 3 ) ( = 0.012). This mean CD4 count (172 cells/mm 3 ) indicates that the patients who manifested HIV related ocular disorders had severe immune suppression (i.e., CD4 < 250 cells/mm 3 ). Also, patients who manifested HIV related ocular disorders recorded significantly higher mean values of viral load copies as compared to their counterparts who did not manifest ocular disorders ( = 0.006). However, no significant association was found between ocular disorders and current CD4 counts ( = 0.10). Non-HIV related ocular conditions such as nonneurological blepharoptosis, pingueculae, pterygia, conjunctivitis, cataract, and glaucoma suspects were also found in the study population. Majority (11, 64.7%) of the participants who had 4 Journal of Ophthalmology HIV related ocular disorders were at stage two of the disease while 4 and 2 were at stages one and three, respectively. There was, however, no association between ocular manifestation and clinical stage of the disease ( 2 = 1.213, = 0.724). Again, no association was found between ART usage and ocular manifestation ( 2 = 0.110, = 1.000). Discussion Previous studies have always considered the associations between HIV related ocular manifestations and CD4 counts but not viral loads. The current study sought to evaluate the associations between presenting ocular disorders and CD4 counts/viral load copies in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. The 5.8% prevalence of HIV related ocular disorders in the present study was lower than in a recently published study from the Ashanti region of Ghana where the authors reported ocular complications in 48% The finding of 9.8% low vision in this study was higher than the 3.1% reported by Abokyi et al. [20] also in the Cape Coast Metropolis in Ghana. HIV retinal microvasculopathy being the most common HIV related ocular manifestation is consistent with the recent report from the Ashanti region, Ghana Herpes zoster ophthalmicus as the second most common ocular disorder was comparable with reported cases from Nigeria and Cameroon The finding on CMV retinitis is consistent with that in Ethiopia Conclusion Consistent with other findings, our study suggests that ocular manifestations in HIV patients are heightened by reduced CD4 counts and corresponding higher viral load copies. Particularly, CMV retinitis was associated with extremely high viral load copies though it was very rare. Ethical Approval Ethical clearance with certificate ID UCCIRB/CHAS/2015/ 090 was obtained from the Institutional Review Board of the University of Cape Coast. Consent Participants and guardians provided informed consent by thumbprinting or signatures after freely agreeing to participate. Competing Interests The authors declare that they have no competing interests. Authors' Contributions Emmanuel Kwasi Abu, Samuel Abokyi, Richard Kobina Dadzie Ephraim, and Daniel Afedo conceived the study idea and participated in its design and data analysis and in the manuscript preparation. Emmanuel Kwasi Abu, Samuel Abokyi, Dorcas Obiri-Yeboah, Daniel Afedo, and Samuel Bert Boadi-Kusi participated in the clinical examination of patients and in the data analysis and were also involved in reviewing the manuscript. Richard Kobina Dadzie Ephraim and Lawrence Duah Agyeman conducted the laboratory analysis of the samples. All authors read and approved the final manuscript

The impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-Saharan Africa

Background Vaccination remains the most powerful weapon against the emergence of new variants of coronavirus (COVID-19). However, false information about COVID-19 vaccines through various platforms including social media remains a major threat to global public health. This study examined the impact of information sources on COVID-19 vaccine hesitancy and resistance in sub-Saharan Africa (SSA). Methods A validated web-based cross-sectional study was conducted from 14 March to 16 May 2021, and was administered in both French and English to 2572 participants aged 18 years and over. Data on sociodemographic characteristics, medical and vaccination history, and the information sources (mainstream media and social media) used by the participants during the pandemic were obtained. There were three main outcomes: The vaccinated group were those who responded in the affirmation (Yes) to the question of whether they have been vaccinated against COVID-19. Those who responded ‘not sure’ or ‘no’ to the question were then asked if they were willing to be vaccinated when the vaccine became available in their home countries. The responses to this follow-up question were used to derive the second and third outcome variables of ‘vaccine hesitancy’ and ‘vaccine resistance’, respectively. A series of logistic regression analyses were used to examine the impact of information sources on the three main outcomes. Results The prevalence of COVID-19 vaccine hesitancy among the participants was lowest among newspaper readers (42%) and highest among TV (72%) and social media users (73%). The prevalence of COVID-19 vaccine-resistance was also lowest among newspaper readers (37%) but highest among social media users (87%). Multivariate analyses revealed that compared to those who did not use these information sources, SSA participants who relied on the radio (aOR 0.83, 95%CI = 0.70, 0.99), TV (aOR 0.80, 95%CI = 0.65, 0.97) and social media (aOR 0.79, 95%CI = 0.65, 0.97) for information during the pandemic were less likely to be hesitant towards taking the vaccines. However, social media users (aOR 2.13, 95%CI = 1.62, 2.80), those who watched TV (aOR 1.40, 95%CI =1.08, 1.80), relied on healthcare workers (HCWs: aOR 1.32, 95%CI = 1.07, 1.63) and families/friends (aOR 1.31, 95%CI = 1.06, 1.61) for COVID-19 related information during the pandemic were more likely to resist taking the COVID vaccines in this study. Participants who relied on the newspaper for information during the pandemic were less likely to resist the vaccines (aOR 0.77, 95%CI = 0.62, 0.95) compared to non-readers of a newspaper. Conclusion We found that all six information sources except radio were strong predictors of the resistance towards COVID-19 vaccination. Further research on how these channels can be used to improve the availability of reliable healthcare information is needed. Investments in these resources will protect people and empower them to make appropriate choices about their health

Acceptance of COVID-19 vaccine among sub-Saharan Africans (SSA): a comparative study of residents and diasporan dwellers

Background: The COVID-19 vaccines are being rolled out across all the sub-Saharan Africa (SSA) countries, with countries setting targets for achieving full vaccination rates. The aim of this study was to compare the uptake of, resistance and hesitancy to the COVID-19 vaccine between SSA locally residents and in the diasporan dwellers. Methods: This was a cross-sectional study conducted using a web and paper-based questionnaire to obtain relevant information on COVID-19 vaccine acceptance. The survey items included questions on demography, uptake and planned acceptance or non-acceptance of the COVID-19 vaccines among SSAs. Multinomial logistic regression was used to determine probabilities of outcomes for factors associated with COVID-19 vaccination resistance and hesitancy among SSA respondents residing within and outside Africa. Results: Uptake of COVID-19 vaccines varied among the local (14.2%) and diasporan (25.3%) dwellers. There were more locals (68.1%) who were resistant to COVID-19 vaccine. Participants’ sex [adjusted relative risk (ARR) = 0.73, 95% CI: 0.58 – 0.93], education [primary/less: ARR = 0.22, CI:0.12 – 0.40, and bachelor’s degree: ARR = 0.58, CI: 0.43 – 0.77]), occupation [ARR = 0.32, CI: 0.25—0.40] and working status [ARR = 1.40, CI: 1.06—1.84] were associated with COVID-19 vaccine resistance among locals. Similar proportion of local and diasporan dwellers (~ 18% each) were hesitant to COVID-19 vaccine, and this was higher among health care workers [ARR = 0.25, CI: 0.10 – 0.62 and ARR = 0.24, CI:0.18—0.32, diaspora and locals respectively]. After adjusting for the potential confounders, local residents aged 29–38 years [ARR = 1.89, CI: 1.26—2.84] and lived in East Africa [ARR = 4.64, CI: 1.84—11.70] were more likely to report vaccine hesitancy. Knowledge of COVID vaccines was associated with hesitancy among local and diasporan dwellers, but perception was associated with vaccine resistance [ARR = 0.86,CI: 0.82 – 0.90] and hesitancy [ARR = 0.85, CI: 0.80 – 0.90], only among the local residents. Conclusions: Differences exist in the factors that influence COVID-19 vaccine acceptance between local SSA residents and thediasporan dwellers. Knowledge about COVID-19 vaccines affects the uptake, resistance, and hesitancy to the COVID-19 vaccine. Information campaigns focusing on the efficacy and safety of vaccines could lead to improved acceptance of COVID-19 vaccines

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Refractive error correction among urban and rural school children using two self-adjustable spectacles

Objective Self-refracting spectacles (SRSs) have different optical and mechanical designs, which may affect the refractive outcome, depending on the experience of the end user. This study compared the performance of two SRS among children in Ghana.Methods and analysis A cross-sectional study of two Alvarez variable-focus SRS designs was conducted. A total of 167 children (mean age 13.6±1.6 years) identified as having refractive error were recruited from 2465 students who underwent screening. Subjects completed self-refraction using FocusSpecs, and Adlens, autorefraction and cycloplegic subjective refraction (CSR) (gold standard). Wilcoxon signed-rank test was used to compare visual outcomes and accuracy of refraction and graphically illustrated using Bland-Altman plots.Results Eighty (47.9%) urban and 87 (52.1%) rural children were analysed and only about one-quarter 40 (24.0%) wore spectacles. The proportion who achieved visual acuity of ≥6/7.5 with FocusSpec, Adlens, autorefraction and CSR among urban schools were 92.6%, 92.4%, 60% and 92.6%, while those in rural schools were 81.6%, 86.2%, 54.0% and 95.4%, respectively. The mean±SD spherical equivalent errors for urban and rural schools using FocusSpec, Adlens and CSR were −1.05±0.61 D, –0.97±0.58 D and −0.78±0.53 D; and −0.47±0.51 D, –0.55±0.43 D and −0.27±0.11 D, respectively. The mean differences between the two self-refraction spectacles for urban and rural schools were not statistically different (p&gt;0.00) but differed significantly when both were compared with the gold standard (CSR) (p&lt;0.05).Conclusion Background and refraction experience of school children did not significantly affect self-refraction

Knowledge, attitude and practices of Ghanaian midwives regarding the use of ophthalmic medications among pregnant women

Background: Midwives are the primary healthcare attendants of pregnant women and have per their mandate among others to detect and manage minor ailments presented by pregnant women including ocular disorders. This study was, therefore aimed at assessing the knowledge, attitude, and practices (KAP) of Midwives regarding the use of topical ophthalmic medications in managing common ocular diseases in pregnancy. Methods: Simple proportionate sampling was used to recruit midwives across the ten regions of Ghana. Participants completed a semi-structured questionnaire. KAP scores were computed as frequencies and percentages. Data were analyzed using Cross tabulations and Spearman’s non-parametric correlation to determine associations. Results: A total of 273 registered midwives aged between 20 and 68 years participated in the study. The results indicated that 56.8% of midwives had low knowledge on ophthalmic medication use and 60.4% scored below average on their practice regarding ophthalmic medication use among pregnant women. This reflected the “dispassionate attitude” (78.6%) of the midwives towards the use of ophthalmic medications. Red eyes (58.2%) were the most reported ocular symptom with bacterial conjunctivitis being the most (55.7%) diagnosed ocular disease by the participants. Most referrals made by the midwives were to ophthalmologists (59.9%) and ophthalmic nurses (38.8%). Conclusion: The study revealed that midwives had low knowledge on ophthalmic medications and for that matter their practice of ophthalmic medication use in pregnancy was unsatisfactory. This had influenced their laissez-faire attitude towards the administration of ophthalmic medications despite they receiving complaints of ocular symptoms and subsequent diagnosis. Keywords: Pregnancy, Knowledge, Attitude, Practice, Midwives, Trimeste

Dry eye symptom questionnaires show adequate measurement precision and psychometric validity for clinical assessment of vision-related quality of life in glaucoma patients.

PurposeTo ascertain the presence of Dry Eye Syndrome (DES) in patients being treated for glaucoma, using subjective and objective methods and to examine DES impact on their quality of life (QOL).MethodA cross-sectional study was conducted by employing 156 glaucoma patients recruited from treatment centers in the Cape Coast Metropolis in Ghana. All the participants underwent dry eye examination and completed the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ), the Dry Eye-related Quality of Life Score (DEQS) and the Ocular Surface Disease Index (OSDI). Comparisons of the clinical tests, NEI VFQ-25 subscale item and composite scores and scores of DEQS and OSDI were made among subgroups divided according to the presence of dry eye symptoms or signs. Multivariate logistic regression analysis was performed to investigate the factors that influence DES related-QOL among the patients.ResultsThe study involved 156 subjects with a mean age of 47.88 ± 16.0 years and made up of 81 (51.9%) females and 75 (48.1%) males. A One-Way ANOVA was conducted, and the F-statistic (F) indicated that there was a significant difference in the mean scores of the groups. There were significantly lower Tear break-up time (TBUT) values found in the group with definite dry compared with the group without DES and the group that was symptomatic with no signs DES in both eyes, [(F(3,151) = 13.703, pConclusionThe study established a high presence of DES and consequently low DES related-QOL in glaucoma patients. Dry eye questionnaires are able to discriminate those who have definite dry eye from the other groups, showing its appropriateness for clinical use in glaucoma patients. Ocular surface evaluation should be conducted among glaucoma patients on topical anti-glaucoma therapy to ensure the timely detection and treatment of signs and symptoms of DES and improvement of dry-eye related QOL

Association between Poor Ergophthalmologic Practices and Computer Vision Syndrome among University Administrative Staff in Ghana

Aim. The aim of this study was to assess the prevalence of computer vision syndrome (CVS) and its associated ergonomic factors among university administrative staff in Ghana. Methods. A cross-sectional survey was conducted among 200 administrative staff of the University of Cape Coast. The procedure included a self-administered questionnaire, comprehensive ocular health examination, and assessment of computer workstation and lighting conditions. The prevalence of CVS among the subjects and the association between CVS and ergonomic practices were determined. Results. The mean age of the study sample was 31.0 ± 4.7 years, and the majority were males (56.0%). The prevalence of CVS was among 103 (51.5%)participants. Over a third of the respondents used computers for 6 or more hours daily. Significant association was found between CVS and poor ergonomic practices (χ = 15.175, p=0.001). Conclusion. In addition to poor ergonomic office setup, university administrative staff spend several hours behind computer screens leading to the development of CVS. Increased awareness of CVS and adherence to recommended ergonomic practices are necessary to reduce the prevalence of CVS and ultimately enhance work satisfaction and productivity

Occupational hazards correlates of ocular disorders in Ghanaian fisheries

The study examined the ocular health of agricultural workers in the fisheries sub sector with the aim of establishing a possible correlation between the work place hazards and their ocular health. A multi-stage random sampling (involving 683 subjects, 358 fishmongers and 325 fishers) was employed. Ocular hazards encountered at the work place included seawater, sand or dust, heat, sunrays and smoke. Exposure to these hazards were found to be associated with ocular irritation (P&lt;0.001), tearing (P&lt;0.001), red eye (P&lt;0.001), gritty sensation (P&lt;0.001), blurred distant vision (P=0.001) and blurred near vision (P=0.001). The development of pterygium was associated with the exposure to sunrays (P=0.042) and heat (P=0.001) among fishmongers. Further analysis using multivariate logistic regression indicated exposure to heat as the most important predictive factor for pterygium (OR=1.951, P=0.003). Exposure to seawater was found to be associated with the development of cataract (P=0.022) among fishermen/fishers. Cataract among fishmongers was rather associated with exposure to heat (P=0.005), sunrays (P=0.035) and sand/dust (P=0.002). Exposure to work place hazards is associated with ocular disorders in the fishing industry of Ghana