Rural eye care practice-survey of ophthalmology resident doctors in Nigeria

AIM:To determine the factors affecting the uptake of rural practice by trainee ophthalmologists in Nigeria.METHODS: This cross sectional survey was conducted among Nigerian Ophthalmology resident doctors attending an annual Neuro-ophthalmology course jointly organized by the West African College of Surgeons and the Ophthalmological Society of Nigeria Southeast-South south zone(OSN SESS), preparatory to the part 1 and 2 fellowship examination from 15th to 21st June 2015. A pre-tested closed-ended questionnaire adapted and modified for this study was self-administered at the end of the course to all consenting participants. Data on respondent's socio-demographics and views about rural eye care services were collected. In addition, information was collected on the respondents' perception of rural practice, willingness to practice in the rural area, benefits and barriers to working in the rural area. Data were analyzed using the statistical package for social sciences(SPSS), version 19(SPSS Inc., Chicago, Illinois, USA). Descriptive analysis yielded measures of central tendency while comparative statistical tests for significance of observed inter-group differences was performed using Chi-square. In all comparisons, the P- value for statistical significance was set at PRESULTS: The total number of respondents was 44 aged 32.9±0.56y, comprising of 24(54.5%)males and 20 females with a male to female ratio of 1:0.8. All the respondents viewed the current state of rural service in Nigeria as unsatisfactory. Majority(75.0%)of the respondents were unwilling to practice Ophthalmology in rural areas. More females than males indicated willingness to work in the rural area. The commonest potential benefit of working in a rural area mentioned by the respondents was “health services for the poor/serving the country”(37; 84%)while all the respondents(44; 100%), noted absence of infrastructure/facilities as drawback to rural ophthalmic practice.CONCLUSION: All the respondents in our survey had an unsatisfactory perception of Nigeria's rural eye-care service and majority were unwilling to work in a rural area

Strengthening retinopathy of prematurity screening and treatment services in Nigeria: a case study of activities, challenges and outcomes 2017-2020.

OBJECTIVES: Retinopathy of prematurity (ROP) will become a major cause of blindness in Nigerian children unless screening and treatment services expand. This article aims to describe the collaborative activities undertaken to improve services for ROP between 2017 and 2020 as well as the outcome of these activities in Nigeria. DESIGN: Descriptive case study. SETTING: Neonatal intensive care units in Nigeria. PARTICIPANTS: Staff providing services for ROP, and 723 preterm infants screened for ROP who fulfilled screening criteria (gestational age <34 weeks or birth weight ≤2000 g, or sickness criteria). METHODS AND ANALYSIS: A WhatsApp group was initiated for Nigerian ophthalmologists and neonatologists in 2018. Members participated in a range of capacity-building, national and international collaborative activities between 2017 and 2018. A national protocol for ROP was developed for Nigeria and adopted in 2018; 1 year screening outcome data were collected and analysed. In 2019, an esurvey was used to collect service data from WhatsApp group members for 2017-2018 and to assess challenges in service provision. RESULTS: In 2017 only six of the 84 public neonatal units in Nigeria provided ROP services; this number had increased to 20 by 2018. Of the 723 babies screened in 10 units over a year, 127 (17.6%) developed any ROP; and 29 (22.8%) developed type 1 ROP. Only 13 (44.8%) babies were treated, most by intravitreal bevacizumab. The screening criteria were revised in 2020. Challenges included lack of equipment to regulate oxygen and to document and treat ROP, and lack of data systems. CONCLUSION: ROP screening coverage and quality improved after national and international collaborative efforts. To scale up and improve services, equipment for neonatal care and ROP treatment is urgently needed, as well as systems to monitor data. Ongoing advocacy is also essential

Microbial Keratitis—A Review of Epidemiology, Pathogenesis, Ocular Manifestations, and Management

Purpose: To review updated knowledge on the epidemiology, pathogenesis, clinical features, and treatment of microbial keratitis (MK).Source of Data: International and local journals containing current literature on MK were sourced through the Internet.Study Selection: Findings consistent with our objectives were compiled and reviewed. Data Extraction: Data were extracted using endnotes. Results: MKis a sight-threatening ocular infection caused by bacteria, fungi, and protist pathogens. The pathogenesis comprises molecular mechanismsdescribing microbial activities which involve virulence and host factors  responsible for ocular tissue damage and progression in keratitis. Clinical features include redness, pain, tearing, blurred vision, and inflammation, but symptoms vary depending on the causative agent. The primary treatment goal is the elimination of causative organism in addition to neutralization of virulence factors and healing of damaged host tissue. A timely review of our current understanding of MK with the recent advances in its treatment will ensure improved management outcomes. Conclusion: Optimal outcome from management of MK will require an  updated knowledge of its pathogenesis, clinical features, and treatment protocols, especially in sub-Saharan Africa where its prevalence is on the increase.Keywords: Epidemiology, management, microbial keratitis, ocular manifestations, pathogenesi

Clinical outcomes of surgical management of paranasal sinus mucocoeles in South-East Nigeria

Paranasal sinus mucocoeles are uncommon, benign clinical entities. They result from obstruction of the sinus drainage ostium with accumulation of secretions within the cavity and slow progressive expansion, resulting in adjacent tissue displacement. The clinical features demonstrated are therefore dependent on the prominent direction of its expansion. Treatment is by surgical intervention to drain the mucocoele with or without extirpation of the sinus mucosa to prevent re-accumulation. Complications result from tissue damage following delay in surgical intervention. We present four cases with sinonasal mucocoeles who underwent surgical drainage and mucosal extirpation in two tertiary eye centres in South-East Nigeria. The first had lost vision prior to surgery from exposure keratopathy and globe perforation. Two had no impairment of vision. Proptosis, diplopia, chronic discharging sinus and cosmetic blemish were the prominent presenting complaints. All complaints were fully resolved following surgery. There has been no report of recurrence of symptoms during the limited follow-up period