PREVALENCE, KNOWLEDGE, ATTITUDE AND PRACTICES IN REFRACTIVE ERROR AMONG HIGH SCHOOL STUDENTS IN

NAIROBI COUNTYDr. Margaret W NjugunaDr. Lucy Njambi Ombaba

Review of research literatureUncorrected 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; 862.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. Br J Ophthalmol enya 2004

Study ObjectivesBroad objective • To determine the prevalence, knowledge, attitude and

practice in refractive errors among high school students in Nairobi county.

Specific objectives• To determine the prevalence of refractive error among

high school students • To assess the knowledge of refractive error among high

school students • To determine the attitude of high school students towards

refractive errors • To determine the practice in refractive error of high school

students

MethodologyStudy design•Cross sectional school based study with a qualitative componentStudy population •Form 3 high school students in public high schools in Nairobi CountyStudy area•Nairobi county-80 public high schools in 10 divisions

Methodology• Sample size calculation and Sampling

MethodParameters • 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

MethodologySampling 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 Countystarehe

dagoretti

westlands

Sampling frame of high school students in Nairobi County

News letter of high school performance1000-1500 in National schools, 300-900 in County schools and 200-400 in the District schools

Data collection procedurePresenting VA-Log MAR chart 3m

VA better than 6/12 in better eye. Record

VA

VA worse or equal to 6/12 in the better eye

RE ≥0.50 DS/DC

Power of spectacle -

LensometerObjective refraction & subjective

refraction

Plano/ 0.25 DS/DC

VA doesn’t improve by 2 lines

VA improves 2 lines or more=RE

KAP=FGD or IDI Anterior and

posterior segment examination-

recordyytyffcnhhg

Spectacles-VA sc&cc RE&LE

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 considerations1. 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

• 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