Correction of Severe Traditional Medication-induced Lower Lid Ectropion: A case report

Introduction: The medical and surgical management of lower lid ectropion induced by the instillation of traditional eye medication in a middle-aged Nigerian woman is described . The patient was blind in both eyes as a result of severe panophthalmitis and phthisis bulbi; a floppy ectropion in the left eye required autograft correction. The medical and surgical management is described. Type of study: Case report. Setting: The correction of the lower lid tarsal ectropion was carried out at the Rachel Eye Center in Abuja, Nigeria. Result: After conservative intervention failed, a free pre-auricular skin graft of the floppy ectropion, led to a stable correction. Conclusions: Harmful traditional eye medication continues to be a problem in the Nigerian society. More public health education is needed to avoid complications such as the one described in this communication.Keywords: public health education, harmful traditional eye medication, ectropion surger

Impact of Cataract Surgery on Quality of Life in Plateau State, Nigeria

Aim: To evaluate the outcome of cataract surgery subjectively byassessing functional vision in terms of quality of life(QOL),activities of daily living (ADL), and patient’s satisfaction.Methodology: This was an observational and multicenteredstudy in which patients with age-related cataract who hadsurgery in Plateau State from 1st October 2002 – 31st March2003 constituted the population. The study instrument wasthe standardized Visual Function (VF-14) and Quality of Life(QOL) questionnaires developed by the Cataract PatientOutcome Research Team (PORT), and designed to measurethe impact of impaired vision on patient’s ability to performdaily activities. Patient’s satisfaction was assessed in relationto the hospital environment, friendliness of staff, nature ofsurgery and visual restoration.Result: Two hundred patients were recruited. One hundred andninety-nine (59.5%) of them were male and 81(40.5%) werefemale. About 34.5% of the study population were farmers, 97(48.5%) of them were blind and 183 (83.6%) eyes were blindpreoperatively. The mean preoperative visual function (VF)and quality of life (QOL) scores of the ninety-seven blindpatients were 15.2 (SD 3.9) and 22.4 (SD 4.5) respectively.There was a positive correlation between visual acuity (VA)and subjective visual function ( r = 0.92), and between VAand QOL ( r = 0.83). Functional vision improved aftercataract surgery; it was more remarkable among blindpatients with mean VF and QOL scores of 58.3 and 60.5respectively. One hundred and twenty-one (80.1%) patientsexpressed satisfaction with the outcome of surgery.Conclusion: Visual impairment from cataract has a wideimplication on health and the quality of life of patients.Cataract surgery in our environment leads to an increase inthe quality of life for many cataract-blind patient

Red-dot card test of the paracentral field as a screening test for optic nerve disease in onchocerciasis.

A new screening test for optic nerve pathology is described, consisting of a series of four red targets presented at an angle of 12 degrees in the paracentral field above and below the horizontal meridian. Nonperception and desaturation of the targets are recorded. Inter-observer variability studies found a kappa value = 0.8. A total of 6831 individuals aged > or = 5 years in communities that were mesoendemic for savanna onchocerciasis in Kaduna State, northern Nigeria, were screened using the test. Of the participants 22% were unable to complete the test; almost two-thirds of these (62%) were aged 5-8 years. After exclusion of those visually impaired or blind according to WHO criteria and those unable to complete the test, the test showed a sensitivity of 40% and a specificity of 98% for optic nerve disease when inability to visualize one or more targets was used as the definition of test failure. The sensitivity increased to 54% with a specificity of 96% when the criterion for failure included desaturation of one or more targets. These values compare favourably with those for other available screening methods. The test took 1-2 minutes to perform and was readily accepted by patients and nurses

Levels of awareness and concentrations of heavy metals in the blood of electronic waste scavengers in Nigeria

Background - Electronic waste (e-waste) contains both valuable and hazardous materials. E-waste scavengers specialize in the collection and crude recycling of waste electronics to retrieve valuable metals, which are then sold. These activities provide an income for scavengers, but also expose them to toxic heavy metals such as lead (Pb) and copper (Cu). Objectives - The aim of the present study was to investigate the level of awareness and concentrations of heavy metals (Pb, Cu, zinc (Zn) and manganese (Mn)) in the blood levels of e-waste scavengers at Jakande dumpsite, Alaba International Market, Lagos, Nigeria. Methods - Material and data were collected by empirical survey with the use of a questionnaire to obtain information from e-waste scavengers. Blood samples of the scavengers in the present study (30 adult males exposed to recycling processes) were collected and concentrations of heavy metals were determined through acid digestion and the use of an atomic absorption spectrophotometer (AGILENT 55B AA, 2010). Results - The geometric means of blood levels of Pb, Cu, Zn and Mn were 11.0, 33.85, 126.15 and 19.38 µg / dL, respectively. High concentrations of Pb and Mn (11.0 and 19.38 µg / dL) were found in the blood samples, while Zn and Cu (126.15 and 33.85 µg / dL) showed low concentrations. The maximum blood level of lead (BPb) (24.0 µg / dL) was extremely high compared to the maximum BPb of occupationally exposed males. Statistical analysis of the questionnaires showed that all of the respondents were male, and more than half (56.7%) were between 21-30 years of age and had been involved in recycling of e-waste for 1-5 years. The results showed that 83% of the respondents were aware that hazardous fractions in e-waste require special treatment, while 76.7% were aware of the possible negative impact on their health. Conclusions - Lack of education, poverty and lack of effective enforcement of e-waste management and regulations are the major contributors to the current situation and thus scavengers carry on with their activities unhindered. The authors recommend the use of protective clothing, sensitization visits and awareness campaigns on the safe disposal of hazardous components

Impact of annual dosing with ivermectin on progression of onchocercal visual field loss.

Reported are the results of a randomized, double-masked, placebo-controlled trial of annual ivermectin dosing in 34 rural communities, Kaduna State, northern Nigeria, where guinea savanna onchocerciasis is mesoendemic. A total of 939 individuals underwent Friedmann field analysis at the first examination and saw at least 19 spots in at least one eye. Of these, 636 (68%) completed a subsequent Friedmann field analysis 2-3 years later. The adjusted incidence rate ratio for the ivermectin group versus the placebo group was 0.64 (95% confidence interval (CI): 0.42-0.98). There was some evidence that the impact of ivermectin was greatest among those who had received one dose of ivermectin. The majority of the deteriorations occurred in eyes that gave evidence of optic atrophy at the first examination. An analysis restricted to individuals with optic atrophy at baseline indicated a reduction of 45% in the incidence of visual field deterioration in the ivermectin group (95% CI: 8-67%). Previous findings have shown that ivermectin has an impact on the incidence of optic atrophy. Our results indicate, for the first time, that ivermectin has a substantial impact on the progression of visual field loss among those with pre-existing optic atrophy

The need to promote behaviour change at the cultural level: one factor explaining the limited impact of the MEMA kwa Vijana adolescent sexual health intervention in rural Tanzania. A process evaluation

Background - Few of the many behavioral sexual health interventions in Africa have been rigorously evaluated. Where biological outcomes have been measured, improvements have rarely been found. One of the most rigorous trials was of the multi-component MEMA kwa Vijana adolescent sexual health programme, which showed improvements in knowledge and reported attitudes and behaviour, but none in biological outcomes. This paper attempts to explain these outcomes by reviewing the process evaluation findings, particularly in terms of contextual factors. Methods - A large-scale, primarily qualitative process evaluation based mainly on participant observation identified the principal contextual barriers and facilitators of behavioural change. Results - The contextual barriers involved four interrelated socio-structural factors: culture (i.e. shared practices and systems of belief), economic circumstances, social status, and gender. At an individual level they appeared to operate through the constructs of the theories underlying MEMA kwa Vijana - Social Cognitive Theory and the Theory of Reasoned Action – but the intervention was unable to substantially modify these individual-level constructs, apart from knowledge. Conclusion - The process evaluation suggests that one important reason for this failure is that the intervention did not operate sufficiently at a structural level, particularly in regard to culture. Recently most structural interventions have focused on gender or/and economics. Complementing these with a cultural approach could address the belief systems that justify and perpetuate gender and economic inequalities, as well as other barriers to behaviour change

Onchocerciasis: The Pre-control Association between Prevalence of Palpable Nodules and Skin Microfilariae

*Background*: The prospect of eliminating onchocerciasis from Africa by mass treatment with ivermectin has been rejuvenated following recent successes in foci in Mali, Nigeria and Senegal. Elimination prospects depend strongly on local transmission conditions and therefore on pre-control infection levels. Pre-control infection levels in Africa have been mapped largely by means of nodule palpation of adult males, a relatively crude method for detecting infection. We investigated how informative pre-control nodule prevalence data are for estimating the pre-control prevalence of

The outcome of trachomatous trichiasis surgery in Ethiopia: risk factors for recurrence.

BACKGROUND: Over 1.2 million people are blind from trachomatous trichiasis (TT). Lid rotation surgery is the mainstay of treatment, but recurrence rates can be high. We investigated the outcomes (recurrence rates and other complications) of posterior lamellar tarsal rotation (PLTR) surgery, one of the two most widely practised TT procedures in endemic settings. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a two-year follow-up study of 1300 participants who had PLTR surgery, conducted by one of five TT nurse surgeons. None had previously undergone TT surgery. All participants received a detailed trachoma eye examination at baseline and 6, 12, 18 and 24 months post-operatively. The study investigated the recurrence rates, other complications and factors associated with recurrence. Recurrence occurred in 207/635 (32.6%) and 108/641 (16.9%) of participants with pre-operative major (>5 trichiatic lashes) and minor (5 lashes (major recurrence). Recurrence was greatest in the first six months after surgery: 172 cases (55%) occurring in this period. Recurrence was associated with major TT pre-operatively (OR 2.39, 95% CI 1.83-3.11), pre-operative entropic lashes compared to misdirected/metaplastic lashes (OR 1.99, 95% CI 1.23-3.20), age over 40 years (OR 1.59, 95% CI 1.14-2.20) and specific surgeons (surgeon recurrence risk range: 18%-53%). Granuloma occurred in 69 (5.7%) and notching in 156 (13.0%). CONCLUSIONS/SIGNIFICANCE: Risk of recurrence is high despite high volume, highly trained surgeons. However, the vast majority are minor recurrences, which may not have significant corneal or visual consequences. Inter-surgeon variation in recurrence is concerning; surgical technique, training and immediate post-operative lid position require further investigation