Transcript lily`s2 - University of Nairobi

PREVALENCE, KNOWLEDGE,
ATTITUDE AND PRACTICES IN
REFRACTIVE ERROR AMONG
HIGH SCHOOL STUDENTS IN
NAIROBI COUNTY
Dr. Margaret W Njuguna
Dr. Lucy Njambi Ombaba
Review of research literature
Uncorrected refractive error(RE)
• Global magnitude of uncorrected RE- leading
cause of visual impairment and blindness
• 43% of visual impairment due to Uncorrected RE
• 80% of visual impairment worldwide can be
avoided or cured
• In children it may hinder school performance and
lead to development of amblyopia.
1.Resnikoff S, Pascolini D, Mariotti SP, et al. Global Magnitude of visual impairment caused by uncorrected refractive errors in
2004. Bull world health Organ 2008; 86
2.WHO fact sheet on RE 2014
Review of research literature
Knowledge, attitude and practices(KAP) of
refractive error
• Lack of knowledge and stigmas plays a major role
in uptake of refractive services in different
continents
• the lack of knowledge and awareness of RE are
important risk factors for uncorrected RE
2,3,4
2.Congdon N., Z. m. (2008). prevalence and determinants of spectacle non-wear among rural Chinese secondary school children.
Arch Ophthalmol., 1717-1723.
3.Ebeigbe, J. (2013). attitude and beliefs of Nigerian undergraduates to spectacle wear. Ghana Medical Journal.
4.Rosman M, W. T. (2009). Knowledge and beliefs associated with refractive errors and undercorrection: the Singapore Malay Eye
Study. Br J Ophthalmol.
Study justification
• Uncorrected RE -public health concern.
• Uncorrected RE hampers performance at school,
reduces productivity and impairs quality of life.
• Lack of knowledge, stigma and erroneous beliefs
towards RE plays a major role in uptake of
refractive services .2,3,4
• Hardly any studies address KAP in refractive error
• Assessing KAP gaps will justify intervention
programmes
1.H.Nzuki. (2004). 2. Helen Significant refractive errors as seen in standard eight pupils attending public schools in langata Division,
Nairobi, K
2.Congdon N., Z. m. (2008). prevalence and determinants of spectacle non-wear among rural Chinese secondary school children.
Arch Ophthalmol., 1717-1723.
3.Ebeigbe, J. (2013). attitude and beliefs of Nigerian undergraduates to spectacle wear. Ghana Medical Journal.
4.Rosman M, W. T. (2009). Knowledge and beliefs associated with refractive errors and undercorrection: the Singapore Malay Eye
Study Objectives
Broad objective
• To determine the prevalence, knowledge, attitude and
practice in refractive errors among high school students in
Nairobi county.
Specific objectives
1. To determine the prevalence of refractive error among
high school students
2. To assess the knowledge of refractive error among high
school students
3. To determine the attitude of high school students towards
refractive errors
4. To determine the practice in refractive error of high school
students
Methodology
Study design
• Cross sectional school based study with a
qualitative component
Study population
• Form 3 high school students in public high
schools in Nairobi County
Study area
• Nairobi county-80 public high schools in 10
divisions
Methodology
• Sample size calculation and Sampling Method
Parameters
• Estimate of the expected proportion (p)
• Desired level of absolute precision (d)
• Estimated design effect (DEFF)
• Confidence limit (usually 95% and Z score
Methodology
• Sample size calculation and Sampling Method
• n = 1.962 x 0.1 x 0.9 (1.5)
0.022
• n = 1297
• To estimate the assumed prevalence of refractive
error 10% with 95% CI (8% - 12%) among high
school students, adjusting for the design effect of
1.5 and confidence limit (usually 95% and Z score
= 1.96), the final minimal sample size will be 1297
• Factor 10% to end up with 1500
• Total number 37580
Methodology
Sampling the Procedure
• Stratification/Categories of schools- National
schools, County schools and District schools
• Sub-stratified into boy, girl & mixed
• Schools from each category will be randomly
selected using spreadsheet program
• Participants will be form 3 students
• Participants will be allocated a study number
Study area- Nairobi County
westlands
dagoretti
starehe
Sampling frame of high school students in
Nairobi County
News letter of high school performance
1000-1500 in National schools, 300-900 in County schools and 200-400 in the District schools
Data collection procedure
Presenting VA-Log MAR chart 3m
VA better than
6/12 in better
eye. Record
VA
Plano/ 0.25
DS/DC
Spectacles-VA
sc&cc RE&LE
VA worse or equal to 6/12 in the better
eye
Power of
spectacle Lensometer
Objective refraction & subjective
refraction
RE ≥0.50
DS/DC
KAP FGD or
IDI
VA doesn’t
improve by 2 lines
VA improves 2
lines or more=RE
Anterior and
posterior segment
examinationrecordyytyffcnhhg
KAP=FGD or IDI
Data management
• Data analysis -SPSS 20.0. and Computer
Assisted/Aided Qualitative Data Analysis Software
(CAQDAS).
• Double data entry to ensure accuracy.
• Proportions will be used to estimate the
prevalence of R.E and proportion of students
knowledgeable in refractive errors.
• Responses to the KAP questions will be scored.
• Participants with RE will be assessed in terms of
KAP towards RE and access to ophthalmic
services.
• Results will be presented using ratio, proportion,
rates, tables and diagrams wherever appropriate.
Ethical considerations
1. Approval -Ethical Committee of University of
Nairobi – Kenyatta National Hospital.
2. Permission -Permanent Secretary, Ministry of
Education and Head teachers of schools
3. Assent- Participants.
4. Confidentially of participants records.
5. Spectacle prescription and follow up for
participants with RE.
6. Students with other ocular disease will be
referred to eye centers.
Tentative Timetable
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Ethical Approval by April 2014
Collection of data May- June 2014
Data Analysis July-August 31st 2014
Presentation of results September 2nd 2014
Hand in bound book by January 1st 2015