Editorial: Conducting Evidence-based Research: Interventions and Observational Analytic Studies

No Abstract

Comparative Analysis of Satisfaction with the Use of Ready-Made Spectacles and Custom-Made Spectacles among School Children in Nigeria: A Randomised Controlled Trial

Refractive error is an important cause of visual impairment in Cross River State (CRS), Nigeria. Optical services and spectacles are not readily available to school children for the treatment. The aim of this study was to compare satisfaction with the use of ready-made spectacles and custom-made spectacles in the treatment of refractive error for school eye health programme. A one month double-blinded randomised controlled trial was used to evaluate satisfaction, symptoms, vision and planned continued use of ready-made and custom-made spectacles in school children 6 -17 years with ≥ 1 diopter of uncorrected refractive error. The sample size for each arm was 63. This research was funded by African Vision Research Institute (AVRI). Full ethical approval was obtained from the ethics committee CRS Ministry of Health, Nigeria. Data was analysed using SPSS and EPI info. Out of the 2110 children refracted with non-cycloplegic method, 243 (11.5%) has significant refractive error and only 104(82.5% response rate) met the inclusion criteria for the intervention study. There was no difference (p >0.05) in satisfaction (96.2% vs 96.2%) and  symptoms ( headache 5.8% vs7.7%; eye strain 3.8% vs 1.9%  ) in the use of ready-made vs custom-made spectacles to the 1 month follow up. Ready-made spectacles are recommended for eye health programmes in schools because it is a cost effective strategy for treatment of refractive errors. The ready-made spectacles should be available in different frame pupillary distance for various powers to reduce discomfort associated with frame induced prismatic effect. Keywords: Eye health, vision care, school-aged children, ready-made spectacles, custom-made spectacle

The voices of children and young people during COVID-19: A critical review of methods

Aim: Critically review research methods used to elicit children and young people's views and experiences in the first year of COVID-19, using an ethical and child rights lens.Methods: A systematic search of peer- reviewed literature on children and young peo-ple's perspectives and experiences of COVID-19. LEGEND (Let Evidence Guide Every New Decision) tools were applied to assess the quality of included studies. The critical review methodology addressed four ethical parameters: (1) Duty of care; (2) Children and young people's consent; (3) Communication of findings; and (4) Reflexivity.Results: Two phases of searches identified 8131 studies; 27 studies were included for final analysis, representing 43,877 children and young people's views. Most studies were from high-income countries. Three major themes emerged: (a) Whose voices are heard; (b) How are children and young people heard; and (c) How do research-ers engage in reflexivity and ethical practice? Online surveys of children and young people from middle-class backgrounds dominated the research during COVID-19. Three studies actively involved children and young people in the research process; two documented a rights- based framework. There was limited attention paid to some ethical issues, particularly the lack of inclusion of children and young people in re-search processes.Conclusion: There are equity gaps in accessing the experiences of children and young people from disadvantaged settings. Most children and young people were not in-volved in shaping research methods by soliciting their voicesThe Icelandic Research Fund, grant no. 217579-051Pre-print (óritrýnt handrit

Prevalence of Presbyopia, Spectacle Correction Coverage and Unmet Need, among Adults in Cross River State, Nigeria.

Purpose: To determine the prevalence of presbyopia, spectacle correction coverage and its unmet needs among adults 35 years and above in the study area.Methods: This cross-sectional descriptive study design used multistage cluster random sampling procedure to select the 616 adults. Data was collected using an interviewer administered semi-structured questionnaire. Visual acuity at distance and near was tested with Snellen’s chart at 6m and 40cm respectively. This was followed by eye examination. Presbyopia was defined as near visual acuity of N8 or worse. Relationship between variables were determined using chi square and multivariate analysis at 5% significant level.Results: The average age of participants was 48.1 years ± 10.4 (range, 35-88 years) and 330 (53.6 %) were males. The prevalence of presbyopia was 73.2% (95% Confidence interval [CI]: 69.5, 76.7). Multiple regression analysis showed that, female sex (Adjusted odds ratio [AOR] =1.58 (95% CI: 1.02, 2.38), older age (AOR =3.29 (95% CI: 1.02, 13.6), unemployment (β = 0.47, p = 0.016, AOR =1.59 (95% CI: 1.26, 4.55), lack of formal education (β = -3.67, p < 0.001, AOR =0.03 (95% CI: 0.007, 0.09) were significantly associated with presbyopia. The spectacle correction coverage and unmet presbyopic need were 40.8%, and 59.2% respectively.Conclusion: The Prevalence of presbyopia and unmet presbyopic correction were high among the participants. This can be addressed through awareness creation and provision of accessible and affordable primary eye care services in the communities

International research collaboration during the pandemic: Team formation, challenges, strategies and achievements of the African Translational Research Group

This paper discusses multidisciplinary international research collaboration team formation during the COVID-19 pandemic, challenges faced, strategies adopted, achievements and dynamics in the implementation of research on Coronavirus disease-2019 (COVID-19), by the African Translational Research Group (ATReG). The paper also discusses the lessons learnt and future opportunities for global collaborative research. In-depth virtual interviews were conducted with consenting members of ATReG. Questions were designed to provide rich, deep, and insightful opinions, lived experiences and perspectives of ATReG group members on group formation, challenges, strategies and achievements. Interview data was transcribed and analysed thematically, and the results were presented with important quotations presented. The ATReG consisted of English (n = 13) and French (n = 1) speaking sub-Saharan African (SSA) researchers who specialise in public health, epidemiology, optometry, information technology, supply chain management, psychiatry, community health, general medical practice, nutrition and biostatistics. Most members of the group reported an informal but well-coordinated structure of the group. Formed during the pandemic, all group meetings were held online, and many members are yet to meet each other in person. The group collected data from Africans and published 10 peer reviewed journal articles on COVID-19 within two years. It presented in international conferences, engaged with the media and the public and was awarded a national competitive funding in Nigeria all of which which contributed to career progression and academic promotion of some members. There have been challenges in sustaining the research collaboration and maintaining productivity. Challenges include difficulties meeting deadlines and obtaining funding for research activities. However, these challenges have been addressed through a collaborative problem-solving approach. The study found the need for operational and methodological flexibility, centralised coordination, and established funding sources as being essential for long term sustainability and performance of the group. The ATReG’s objective of providing useful data on COVID-19 and generating useful knowledge about COVID-19 in SSA has been achieved. In such a multi-disciplinary international collaborative team relaiant on the online medium to operate, the experiences and challenges can be a model for learning for researchers intending to form international multidisciplinary collaborative groups. Nonetheless, there are still many important areas of research which ATReG will continue to pursue

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

Clinical Investigations and Management of Refractive Changes in Pregnancy: A Case Report

Pregnancy also presents with ocular changes, just as it affects other non - reproductive systems of the female. It has been reported to be associated with development of new health conditions or can exacerbate pre- existing health conditions. This paper reviews the management of Mrs AA, a 41 year old pregnant woman (primigravida) with refractive changes from myopia in the first trimester, to hyperopia in the second and third trimesters of her pregnancy. A comprehensive ocular examination was performed including fundus photograph and Optical Coherent Tomography. The results revealed signs of Central Serous Chorioretinopathy in both eyes which may have been due to various hormonal changes in pregnancy with resultant changes in refractive error. These ocular changes associated with pregnancy are, most often transient in nature, though occasionally permanent. This condition therefore requires clinical observation and monitoring until the resolution of the serous detachment is complete, and vision returned back to normal. Other ocular changes that are pregnancy related were reviewed.Keywords: Primigravida, central serous chorioretinopathy, ocular changes, transient, optical coherent tomograph

Visual status and prevalence of eye disorders among school-age children in southern Nigeria

Aim: This study assessed the types and prevalence of eye problems among school-age children in Cross River State (CRS), Nigeria. Method: The study design was a cross-sectional analytic survey of 2418 school children aged 6–17 years from seven public and three private schools in CRS, selected using the multistage random sampling technique. Ethical approval was obtained from the Ethical Committee, CRS Ministry of Health, Nigeria. The following tests were carried out on all children enrolled in the study: researcher-administered semi-structured questionnaires, LogMAR visual acuity measurements, external and internal eye examinations, non-cycloplegic auto-refractions, retinoscopy and subjective refractions. Quality assurance was carried out to validate the data collected, and data were analysed using SPSS and EPI info. Results: A total of 2418 school children were enumerated, and 2110 (87.3%) were examined; 1117 (52.9%) were girls, and 1250 (59.2%) were 6–11 years old, while 860 (40.8%) were 12–17 years old, and 77% attended public schools. The majority, 1895 (89.9%) of the children examined, had never had an eye examination. The prevalence of eye diseases among the school children was 32.1%, and the major causes were conjunctivitis 397 (18.8%; confidence interval [CI] 19.2–13.0), refractive error 243 (11.5%; CI 10.2–13.0), glaucoma suspects 52 (2.5%; CI 1.9–3.2), amblyopia 7 (0.3%; CI 0.0–0.7) and corneal opacity 4 (0.2%; CI 0.1–0.5). Analysis using chi-square tests and logistic regression shows a positive higher association of refractive error in private (16.7%) than public schools (9.9%) (crude odds ratio [COR] 1.8150; adjusted odds ratio [AOR] 1.9129, p < 0.001), higher socio-economic status of parents (COR 2.3402, AOR 1.9819, p < 0.001), older age group (COR 1.7258, AOR 1.8202, p < 0.001) and girls (13.1%) versus boys (9.8%) (COR 0.7200, AOR 0.7144, p < 0.001). Conclusion: Physical and eye health examination of children before school entry is strongly recommended. The application of 2 D lens for children who fail a standard visual acuity test should be routine during vision screening to ensure that significant refractive errors are not missed

[In Press] A systematic review of diabetes risk assessment tools in sub-Saharan Africa

Objectives: To systematically review all current studies on diabetes risk assessment tools used in SSA to diagnose diabetes in symptomatic and asymptomatic patients. Methods: Tools were identified through a systematic search of PubMed, Ovid, Google Scholar, and the Cochrane Library for articles published from January 2010 to January 2020. The search included articles reporting the use of diabetes risk assessment tool to detect individuals with type 2 diabetes in SSA. A standardized protocol was used for data extraction (registry #177726). Results: Of the 825 articles identified, 39 articles met the inclusion criteria, and three articles reported tools used in SSA population but developed for the Western population. None was validated in SSA population. All but three articles were observational studies (136 and 58,657 study participants aged between the ages of 15 and 85 years). The Finnish Medical Association risk tool, World Health Organization (WHO) STEPS instrument, General Practice Physical Activity Questionnaire (GPPAQ), Rapid Eating and Activity Assessment for Patients (REAP), and an anthropometric tool were the most frequently used non-invasive tools in SSA. The accuracy of the tools was measured using sensitivity, specificity, or area under the receiver operating curve. The anthropometric predictor variables identified included age, body mass index, waist circumference, positive family of diabetes, and activity levels. Conclusions: This systematic review demonstrated a paucity of validated diabetes risk assessment tools for SSA. There remains a need for the development and validation of a tool for the rapid identification of diabetes for targeted interventions