Transcript sagina proposal ppt_Kimani comments_25.5.15

A REVIEW OF SEVERE OCULAR
TRAUMA IN CHILDREN ADMITTED IN
SABATIA EYE HOSPITAL
Principal investigator:
Dr Esevwe Sylvia Sagina
Supervisors:
Dr Kahaki Kimani
Dr Sheila Marco
Dr Sarah Sitati
INTRODUCTION
• Ocular trauma is injury to the eyeball, adnexa,
orbital and/or periorbital tissues
• Most injuries occur when supervision is minimal
LITERATURE REVIEW
Background
• Ocular trauma is an important, preventable, worldwide
public health problem1
• Estimated 18 million people worldwide with uniocular
blindness from traumatic injury2
• 1/4 million children present with serious ocular trauma
every year, majority of which is preventable2
1. Whitcher JP, Srinivasan M, Upadhyay MP: Corneal blindness: a global perspective. Bulletin of the World Health Organization, 2001, 79: 214–
221.
2. Abbott, J., Shah, P. The epidemiology and etiology of paediatric ocular trauma. Surv Ophthal. 2013;58:476–485.
Background
• Cause of significant morbidity in young
children 3
• Murithi found that in a series of 182 children
in KNH, amblyopia therapy was done in 18%
of the children while refraction in only 1.6%4
3. Shoja , Miratashi AM. Pediatric ocular trauma. Aeta Medica Iranica 2006. 2006; 44(2):125-30.
4. Murithi, I., Gichuhi, S., Njuguna, M.W. Ocular injuries in children. East African Medical Journal. 2008; 85(1) 39-45
Epidemiology
• Accounted for 9% in KNH Kenya5, 13.3% in
Nigeria6, 11.8% in Ethiopia of childhood ocular
morbidity7
• In KNH, Murithi found 47.8% were blind while
5.5% were severely visually impaired in one
eye4
5. Echelu, C. Traumatic eye injuries in children. M.Med Dissertation, Department of Ophthalmology, University of Nairobi, 1990.
6. Isawunmi MA: Ocular disorders amongst school children in Ilesa east Local Government area. Osun State, Nigeria: National
Postgraduate Medical College of Nigeria; Dissertation; 2003.
7. Mehari: Pattern of childhood ocular morbidity in rural eye hospital, Central Ethiopia. BMC Ophthalmology 2014 14:50.
4. Murithi, I., Gichuhi, S., Njuguna, M.W. Ocular injuries in children. East African Medical Journal. 2008; 85(1) 39-45
Classification
Adapted from Kuhn F, Morris R, Witherspoon CD: Birmingham eye trauma terminology (BETT):
Terminology and classification of mechanical eye injuries. Ophthalmol Clin North
Am 2002, 15(2):139–43.
JUSTIFICATION
• Management is challenging in children
• Large numbers of children with ocular trauma in
Sabatia
• Scanty literature in Kenya rural setting
STUDY OBJECTIVES
Broad objective
To review the pattern and outcome of ocular
trauma in children hospitalized in Sabatia Eye
Hospital between 1st January 2012 and 31st
December 2014
Specific objectives
i. To determine the etiology and presentation of
childhood ocular trauma in Sabatia Eye Hospital
ii. To determine treatment of childhood ocular
trauma
iii. To determine the visual outcome and
complications post ocular trauma
iv. To identify risk factors associated with ocular
trauma
MATERIALS & METHODS
Study design
• Retrospective,
hospital-based case
series
Study area
• Sabatia Eye Hospital
-tertiary/ referral
eye hospital
Study setting
• Catchment area of 15
million people; > 30,000
patients/year
• Estimated no. of children
managed for ocular trauma
is 100 - 200 /yr over the
past 3 yrs, estimate 350 over
study period
Study period
• Sept 2014 to May 2016
Study population/case
• All children below 16 years of age admitted
with eye injuries at Sabatia Eye Hospital from
1st Jan. 2012 to 31st Dec. 2014
Sample size
• Sample size calculation was done using the
following sample size formula for finite (small)
population14
• For statistical power purposes, an estimated
93 patients would form the minimum sample
size
14. Wanga SK, Lemeshow S. Sample size determination in health studies. A practical manual. Ginebra: World
Health Organization, 1991.
Outcome measures
• Primary outcome measure - visual acuity at
last follow up period
• Secondary outcomes will include
complications post trauma & globe
preservation
Data collection tool
• Questionnaire
Inclusion criteria
• All children below 16 years admitted & treated
for ocular trauma at Sabatia Eye Hospital
within the study period
Exclusion criteria
• Children below 16 years admitted for
treatment of long–standing complications
related to trauma sustained before Jan 2012
• Missing or incomplete data
Data collection procedure
• The name, age, in-patient no. & date of admission
will be obtained from theatre and in-patient
registers
• Files will then be retrieved from records
department
• Questionnaire will be used to collect data
• WHO classification of VA & BETT classification of
ocular trauma will be used
Data management
• Each questionnaire will have a unique
identification code
• It will be coded, cleaned, validated and stored
& into a computer prior to analysis
• Back up will be created in an external hard
disk
Data analysis
• Data analysis will be done with the help of a
biostatistician using SPSS version 20.0.
• Descriptive analysis will be done to determine the
frequencies and proportions of causes,
epidemiology & treatment outcomes
• Chi-square (χ2) test / logistical regression will be
used for comparison of proportions
Data analysis
• Statistically significant differences and
associations will be based on a p-value less than
0.05
• Results will be presented in form of tables, charts
graphs
ETHICAL CONSIDERATIONS
• Ethical approval will be obtained from the KNH/UON
Ethical and Research Committee before undertaking the
study
• Patients and clinicians confidentiality will be observed
• Safe keeping of files & raw data
• Raw data will be discarded once all publications have
been made