Estimated Prevalence of Monocular Blindness and Monocular Severe Visual Impairment in Children of Cross Rivers State, Nigeria

Aim: The aim was to report on the prevalence of monocular blindness/monocular severe visual impairment (MB/MSVI) in children found in Cross River State Nigeria, using the key informant method (KIM). Settings and Design: A cross‑sectional study using the KIM. Patients and Methodology: Key informants were trained to identify children with vision problems through recognition of pictures of disease conditions, observation of behavior of the child and discussion with villagers during house to house visits, school visits, church visits, or market visits. They were instructed to bring the children to a predetermined health center for examination by a pediatric ophthalmologist led team. The children were examined, and findings recorded on the World Health Organization/prevention of blindness and low vision recording form for children. Statistical Analysis Used: Data were entered into MS Excel, transferred and analyzed with STATA 11. Results: Among 994 children with suspected visual impairment, 21.5% were diagnosed as MB/MSVI, with a population prevalence of 0.18/1000 children in the state. Males accounted for 61%. The leading anatomical causes were the cornea in 41%, the whole globe in 20%, and lens‑related in 19%. Boys were 2.6 times (95% confidence interval: 1.4–4.7, P = 0.002) more likely to have trauma as an etiology compared with girls. Conclusions: Monocular blindness/monocular severe visual impairment children are essentially “one‑eyed” children at risk of becoming blind individuals. The prevalence of MB/MSVI is 2.25 times that of bilateral blindness and severe visual impairment in children in this population. The main anatomical causes, as well as ocular trauma, are largely avoidable. Trauma that is avoidable was a significant etiology in boys compared with girls. MB/MSVI adds to the burden for child eye care services.Keywords: Child eye care services, monocular blindness, monocular severe visual impairment, Nigeria, ocular traum

Key informant perceptions of vision loss in children and implications for their training

Background: The role of key informants (KIs) in identifying children with vision loss is expanding, yet there is a minimal understanding of KI perceptions of vision loss in children. The aim of the study was to understand the KI’s perception of childhood vision loss in order to design more effective training programmes.Materials and Methods: A population-based study on the prevalence and causes of childhood blindness and severe visual impairment was conducted using the KI method. KIs were selected by their communities and trained in advocacy, identifi cation and referral of children with visual impairment. Prior to the KI training, a pre-test was conducted, asking, “what is your perception of vision loss in children and how will you identify these children in your community?”.Result: The 742 KI provided 1,650 responses. There were three main methods suggested to identify children; observation of a child, vision assessment of a child, and recognition of isolation of a child.Conclusion: KI have a good understanding of the impact of vision loss on children. Training programmes should use existing knowledge of KI. Furthermore, training programmes should include the social impact of severe vision loss to help identify children needing the assessment.Keywords: Childhood blindness, key informant, Nigeria, perception, visio

Inequitable coverage of vitamin A supplementation in Nigeria and implications for childhood blindness.

BACKGROUND: Vitamin A deficiency (VAD) is of major public health significance; it is a risk factor for childhood deaths from diarrhoea and measles in low and middle-income countries and an important cause of preventable childhood blindness in low income countries. Vitamin A supplementation (VAS) is being implemented in many LMICs and high coverage reduces the prevalence of blinding corneal diseases in children. However, national estimates of coverage may not reveal any inequities in intra country coverage. The aim of this study is to assess factors influencing VAS coverage and also assess the relationship between VAS coverage and childhood corneal blindness in Nigeria. METHODS: Data were collected from the Nigeria Demographic and Health Survey (NDHS) 2013 and the published literature on population-based childhood blindness surveys in Nigeria. The main outcome measure was the proportion of eligible children who received VAS in the last 6 months preceding the survey. Study factors comprised a range of socioeconomic, and individual factors. Data were analysed using STATA V.12.1 (Statcorp, Texas). To explore the effects of the independent variables on VAS coverage, bivariate and multivariate regression was done. Variables with p < 0.05 in the final multivariable model were considered as independent factors. For the population-based childhood blindness surveys, aggregated and disaggregated data were used. Causes of blindness were stratified into corneal blindness and 'others'. Odds ratios were computed to determine the odds of developing corneal blindness in each geopolitical region. Tests of significance were set at the 95% level. RESULTS: The total VAS coverage in 2013 was 41.5%. VAS coverage was inequitable. Children with very educated mothers (OR 3.27 p < 0.001), from the south-south region (OR 2.38 p < 0.001) or in the highest wealth quintile (OR 2.81 p < 0.001) had higher odds of receiving VAS. The northwest zone had the lowest VAS coverage and the highest prevalence of corneal blindness. CONCLUSION: Regional and socioeconomic inequities in VAS exist in Nigeria and these may have grave implications for the causes of childhood blindness. The development and implementation of context specific and effective strategies are needed to reduce these inequities in VAS

The effect of visual support strategies on the quality of life of children with cerebral palsy and cerebral visual impairment/perceptual visual dysfunction in Nigeria: study protocol for a randomized controlled trial.

BACKGROUND: Cerebral visual impairment (CVI), including perceptual visual dysfunction (PVD), is common in children with cerebral palsy (CP). Inventories of questions relating to practical aspects of visual perception in everyday life, in particular the closed-ended Insight Questions Inventory (IQI), can be used to assess CVI/PVD. Studies linking responses to the inventory with specific visual support strategies, aimed at modifying the child's environment and/or behaviour to minimize the impact of the CVI/PVD, have been piloted. The IQI and tailored strategies have not been used in an African population, nor have they been tested in a controlled trial. This trial will compare the effectiveness of the IQI and linked visual support strategies versus general supportive treatments on the quality of life of children with CVI/PVD and CP through a randomized controlled trial. METHODS/DESIGN: This is a prospective, double-blind, parallel-arm, randomized controlled trial. The primary outcome is change in quality of life scores between the two arms of the trial at 6 weeks, assessed using the Paediatric Quality of Life Inventory (PedsQL) generic 4.0 and CP 3.0 module. All children will undergo baseline assessment including the Open Questions Inventory, IQI, PedsQL 3.0, PedsQL 4.0 generic, and the Strengths and Difficulties Questionnaire (SDQ). Eligible children with CP aged 4 years to < 16 years will be stratified and blocked by the age groups 4-9 and 10 to < 16 years and by Gross Motor Function Classification System (GMFCS) levels 1-3 and 4-5. Families in the intervention arm will receive tailored insight visual support strategies and telephone calls during the 6-week trial period. The control arm will receive standard treatment and the intervention after the 6-week trial period. Follow-up interviews will be performed in both arms at 6 weeks with a repeat administration of the PedsQL CP 4.0 and 3.0, the IQI and the SDQ. Secondary outcomes include a change in functional vision. DISCUSSION: This randomized controlled trial will provide evidence of the effectiveness of this intervention for children with CP in a resource-poor setting. TRIAL REGISTRATION: Pan African Clinical Trials Registration, PACTR201612001886396 . Registered on 3 December 2016

Evaluation of Competence of Medical Students in Performing Direct Ophthalmoscopy

Aim: The aim was to determine the competence of medical students in performing direct ophthalmoscopy. Materials and Methods: It was a cross‑sectional study whereby year 5 medical students were assessed during Objective Structure Clinical Examination (OSCE) at the end of 4 weeks clinical rotation in ophthalmology. Every student had 5 min in each OSCE station, including the station for direct ophthalmoscopy. The correctness or otherwise of students’ quantitative assessment of cup‑disc ratio (CDR) was analyzed using Statistical Package of Social Sciences (SPSS, USA) version 20.0. Result: A total of 96 students were assessed in 6 groups over a 6 months period; age range was 20–33 years and a mean age of 24.8 ± 3.2. There were 57 males and 39 females (M:F = 1:0.25). Seventy‑eight (81.3%) were satisfied with teachings and tutorials on direct ophthalmoscopy. Eighty‑nine (92.7%) admitted visualizing the disc in the course of tutelage while 7 (7.3%) had never seen the disc with the direct ophthalmoscope. The retinal vessels were seen with the ophthalmoscope by 93 (96.9%). Direct Ophthalmoscopy was not considered to be difficult by 87(90.6%). Forty‑six (47.9%) got CDR correct on the right eyes while 50 (52.1%) got it correct on the left eyes. There was statistically significant relationship between the group students belonged and performance with 2 = &lt;0.001. Conclusion: Based on the CDR benchmark, students’ performance was not satisfactory.Keywords: Direct ophthalmoscopy, medical curricula, medical students, ophthalmic educatio

Pattern of comorbidities in school-aged children with cerebral palsy in Cross River State, Nigeria.

BACKGROUND: To describe the pattern of comorbidities in school-aged children with cerebral palsy (CP) and to identify which, if any, were associated with poor school attendance. A cross-sectional study, using the key informant methodology, between December 2017 and July 2018 was conducted in Cross River State, Nigeria. Assessments, confirmation of CP and identification of systemic comorbidities using standard tools and questionnaires were performed. Children confirmed to have CP between the ages 4 to 15 years were included. RESULTS: Three hundred and eighty-eight children were confirmed to have CP, 59% males. The mean age was 9.2 years ± SD 4.0; 28% were non-ambulatory (gross motor function classification system (GMFCS) level IV-V) and spastic CP was seen in 70%. Comorbidities included Speech impairment 85%, feeding difficulties 86%, and swallowing difficulties 77%, learning difficulties 88%, abnormal behaviour 62%, visual acuity impairment 54%, objective perceptual visual disorders 46%, communication difficulties 45%, epilepsy 35%, hearing impairment 12% and malnutrition 51%. Learning difficulties (OR 10.1, p < 0.001; CI: 3.6-28.1), visual acuity impairment (OR 2.8, p = 0.002; CI: 1.5-5.3), epilepsy (OR 2.3, p = 0.009; CI:1.2-4.3) manual ability classification scale 4-5 (OR 4.7,p = 0.049; CI:1.0-22.2) and CP severity (GMFCS V-VI) OR 6.9 p = 0.002, CI: 2.0-24.0.) were seen as increasing the likelihood of poor school attendance. CONCLUSION: Comorbidities were common, and some were associated with limited school attendance. A multidisciplinary tailored approach to care, with application of available therapeutic interventions for comorbidities is suggested. This may be useful in reducing barriers to school attendance

Letters to the Editor: Delay in surgical uptake for cataract services in a pediatric population in Cross River State, Nigeria

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The Effect of Insight Questions Inventory and Visual Support Strategies on Carer-Reported Quality of Life for Children With Cerebral Palsy and Perceptual Visual Dysfunction in Nigeria: A Randomized Controlled Trial.

Structured clinical history question inventories have previously been used to try and elicit symptoms of perceptual visual dysfunction (PVD) in children with cerebral palsy (CP) in different settings. Earlier studies have suggested that PVD may affect quality of life and specific habilitational strategies, linked to inventory responses, may improve quality of life. Through an RCT, based on a community based sample of children with CP in Cross River State, Nigeria, we aimed to determine if a structured history inventory such as the Insight question inventory (IQI) and associated tailored visual support strategies (IQI VSS) for the management of those children who have PVD, can improve quality of life and is superior to standard therapy. Children with CP were recruited by the key informant method and confirmed by clinical examination. The parent reported IQI was used to identify children with PVD. Primary outcome measures were both Pediatric Quality of Life 4.0 Generic (PedsQL 4.0 Generic) and Pediatric Quality of Life 3.0 Cerebral Palsy (PedsQL 3.0 CP) scale scores. Children were enrolled with a parallel arm allocation to either IQI and IQI VSS or to standard therapy for CP. Children were followed up for 6 weeks with weekly phone call session and the questionnaires repeated at the end of the 6 weeks' period. Results show that the children in the treatment group (n = 191) showed no significantly different change between baseline and follow up in quality of life (PedsQL 4.0 Generic p = 0.943: and PedsQL-CP 3.0 p = 0.287), compared to the control group. There was suggestion of a better improvement (p = 0.035) in the PedsQL 3.0 CP subscale of speech and communication for the intervention group. The use of IQI VSS for the treatment of PVD in children with CP in this population does not show any superiority over current standard CP management in terms of overall quality of life. However, there was some evidence of improvement in quality of life in the area of speech and communication. Further research and refinement of these management method is required. Clinical Trial Registration: www.ClinicalTrials.gov, identifier [PACTR20161200188] 6396

Histopathologic risk factors for metastasis in retinoblastoma seen in a tertiary eye center in South, South Nigeria

Purpose: To analyze the frequency of histopathological high-risk factors (HRF) for systemic metastasis in retinoblastoma (RB) in our patient population. Materials and Methods: This is a retrospective case series, with review of clinical data and histopathologic, immunocytochemistry slides, from a particular laboratory, of eyes enucleated for RB between 2006 and 2012. Results: A total of 28 eyes with histopathologic reports confirming RB from a particular laboratory were seen between 2006 and 2012. The mean age at presentation was 33.68 +/- 12.27 months (range: 6-55 months). 15 (53.60%) of the patients were males, and 13 (46.40%) were females. Approximately 12 (43%) of these patients presented with leucocoria, while the least frequent presentation was strabismus 2 (7%). The mean duration of symptoms at presentation was 7.07 +/- 4.29 months. Grade e intraocular classification for RB was seen in 27 (96.40%) of cases. International staging classification of stages included Stage 1 (1 patient, 3.57%), Stage 2 (2, 7.14%), Stage 3A (4, 14.30%), Stage 3B: (6, 21.40%) Stage 4A (2, 7.14%) and Stage 4B (13, 46%). HRF that were predictive of metastasis were choroidal infiltration (20 patients, 71.40%), retrolaminar optic nerve (ON) invasion (17, 60.70%), invasion of the ON to transection 1 (6, 78.60%), scleral infiltration (23, 82.10%) and extra-scleral extension (13, 46.40%). Conclusion: There is a high frequency of histopathological risk factors present in the patients with eyes enucleated for RB in this population. This finding is in agreement with suggestions of poor prognosis and high-mortality in this region, especially from the central nervous system metastasis. [Arch Clin Exp Surg 2015; 4(2.000): 83-88