Refractive error in school children in Agona Swedru, Ghana

S Afr Optom 2010 69(2) 86-92 Refractive error in school children in Agona Swedru, Ghana G O Ovenseri-Ogbomo* and R Assien† *Department of Optometry, University of Cape Coast, Ghana †Eye Unit, Regional Hospital, Koforidua, Ghana *<> Received 25 September 2009; revised version accepted 9 June 2010 Abstract Uncorrected refractive errors remains a public health problem among different population groups. Among schoolchildren, uncorrected refractive errors have a considerable impact on learning and academic achievement especially in underserved and under-resourced communities. A school based cross-sectional study was carried out to estimate the prevalence and distribution of refractive error among schoolchildren in the Agona Swedru municipality of Central Region of Ghana. 637 schoolchildren aged 11-18 years old were randomly selected for the study. Non-cycloplegic refraction was performed on each child who failed the reading test. Hyperopia was defined as spherical power of ≥ + 0.75 D, myopia as ≤ – 0.50 D and astigmatism as a cylindrical power of ≤ – 0.50 D. Of the children examined, only 13.3% had previously had an eye examination. Introduction Uncorrected refractive errors remains a public health problem among different population groups. Among schoolchildren, it has a considerable impact on learning and academic achievement especially in underserved and under-resourced communities. Uncorrected refractive errors in schoolchildren and its impact on academic achievement have only recently received attention. It became necessary therefore to Visual impairment (VA of 6/12 or worse in the better eye) was present in 4.5% of the children examined. Of those who failed the reading test, 85.9% had refractive error. The prevalence of hyperopia, myopia and astigmatism was 5.0%, 1.7% and 6.6% respectively. The study concludes that uncorrected refractive error is a common cause of visual impairment among schoolchildren in the municipality. A low uptake of eye care is also noted in the study. The study therefore recommends that the education authority in collaboration with the District Health Directorate institute appropriate measures to ensure compulsory eye examination for schoolchildren in the Agona Swedru district. (S Afr Optom 2010 69(2) 86-92) Key words: Refractive errors, ametropia in schoolchildren in Ghana, visual impairment. study the epidemiology of refractive errors among schoolchildren. A uniform protocol for this purpose has been developed1. Several studies have been conducted in different parts of the world using this protocol2-7. Refractive error is one of the most common causes of visual impairment and the second leading cause of blindness following cataract8. The significance of visual impairment due to uncompensated refractive Address for Correspondence: Dr GO Ovenseri-Ogbomo, Department of Optometry, University of Cape Coast, University PO, Ghana 86 The South African Optometrist ISSN 0378-9411 S Afr Optom 2010 69(2) 86-92 G O Ovenseri-Ogbomo and R Assien - Refractive Error in school children in Agona Swedru, Ghana error, especially in schoolchildren, derives from the fact that compared to cataract which is the leading cause of blindness, refractive error accounts for twice the number of blind-person-years as cataract9. There are an estimated 500 million people, mostly in developing countries including children that do not have access to eye examination and affordable correction. Many are not aware that there is a cure for their compromised vision, have no one to provide treatment, or cannot afford the appliance they need for correction10. Children with refractive error are less likely to opt for correction until they are significantly visually impaired that they have difficulty performing specific visual tasks. This is especially so in rural and urban poor regions where there are inadequate eye care services. Regular eye screening program in schools will help in early detection and correction of refractive errors. Schools with long established tradition of engaging in vision screening have proven to be effective in detecting previously undiagnosed conditions including refractive errors11. Impairment due to refractive error in any population suggests that eye care services are inadequate. This is because the treatment of refractive errors is perhaps the simplest and most cost effective healthcare interventions. Uncorrected refractive error in schoolchildren portends significant implications for a child’s academic achievement as well as social interactions12. In the latest global estimates of visual impairment due to refractive errors, 12.8 million children in the age group 5-15 years were visually impaired from uncorrected or inadequately corrected refractive error13. This represents a prevalence of 0.96% globally. The highest prevalence was reported in urban and highly developed areas of South-East Asia and China13. Refractive error was responsible for 88.5% of poor eye sight (defined as uncorrected unilateral or bilateral visual acuity of worse than 6/12 among secondary school children in Tanzania. This represented a prevalence of 6.1%. The children were aged between 11 and 27 years14. The majority of the children (91.6%) had myopia. Among 1707 secondary school students in Nigeria, refractive errors were found in 22.5%. It was further revealed that none of the students have had any form of eye examination in the past15. This paper presents the results of a study of refractive error among school children aged 11 - 18 years in The South African Optometrist Agona Swedru in the Central Region of Ghana. Methods Sampling Agona Swedru is the administrative capital of the Agona Swedru district of Central Region, Ghana. It has a total land area of 540 sq. km with a population of 40 000 and an annual growth rate of 2.55%16. Children aged below 15 years accounts for 47.7% of the total population16. As of the time the study was conducted, there were 24 public schools and 18 privately owned schools. Children from affluent homes attend the privately owned schools while the majority of the children attend public schools where fees are not charged. The study was a cross-sectional school based study. Of the 24 public and 18 privately owned schools registered in Agona Swedru, two public and two private schools were selected for the study taking into account the school enrolment figure for each school. We used a convenience sampling technique in selecting the schools. Each of the two schools selected had the highest enrolment figure in each case. All the schoolchildren aged 11-18 in the selected schools were enumerated for the study. Field operation Permission to conduct the study was obtained from the local education authority which assigned an officer to accompany the research team to the selected schools on the day of ea ch examination. Institutional approval was also obtained from the Department of Optometry, University of Cape Coast for the study. The heads (...truncated)