Uncorrected refractive error and associated factors among primary school children in Debre Markos District, Northwest Ethiopia

BMC Ophthalmology Uncorrected refractive error and associated factors among primary school children in Debre Markos District, Northwest Ethiopia Sintayehu Aweke Sewunet 2 Kassahun Ketema Aredo 0 Molla Gedefew 1 0 Department of Public Health, Debre Markos University, College of Medicine and Health Sciences , PO Box: 269, Debre Markos , Ethiopia 1 Department of medicine, Gamby College of Medical Sciences , Bahir Dar , Ethiopia 2 Debre Markos referral hospital , East Gojjam Zone, Amhara Regional State, Debre Markos , Ethiopia Background: Uncorrected Refractive Error is one of the leading cause amblyopia that exposes children to poor school performance. It refrain them from productive working lives resulting in severe economic and social loses in their latter adulthood lives. The objective of the study was to assess the prevalence of uncorrected refractive error and its associated factors among school children in Debre Markos District. Method: A cross section study design was employed. Four hundred thirty two students were randomly selected using a multistage stratified sampling technique. The data were collected by trained ophthalmic nurses through interview, structured questionnaires and physical examinations. Snellens visual acuity measurement chart was used to identify the visual acuity of students. Students with visual acuity less than 6/12 had undergone further examination using auto refractor and cross-checked using spherical and cylindrical lenses. The data were entered into epi data statistical software version 3.1 and analyzed by SPSS version 20. The statistical significance was set at 0.05. Descriptive, bivariate and multivariate analyses were done using odds ratios with 95% confidence interval. Result: Out of 432 students selected for the study, 420 (97.2%) were in the age group 7-15 years. The mean age was 12 2.1SD. Overall prevalence of refractive error was 43 (10.2%). Myopia was found among the most dominant 5.47% followed by astigmatism 1.9% and hyperopia 1.4% in both sexes. Female sex (AOR: 3.96, 95% CI: 1.55-10.09), higher grade level (AOR: 4.82, 95% CI: 1.98-11.47) and using computers regularly (AOR: 4.53, 95% CI: 1.58-12.96) were significantly associated with refractive error. Conclusion: The burden of uncorrected refractive errors is high among primary schools children. Myopia was common in both sexes. The potential risk factors were sex, regular use of computers and higher grade level of students. Hence, school health programs should work on health information dissemination and eye health care services provision. Refractive error; Myopia; Students; School; Children - Background Refractive error is a state in which optical system of the eye fails to adjust to bring parallel rays of light to focus on proper place (fovea). It is obvious that without appropriate optical correction, millions of children are losing educational opportunities and adults are excluded from productive working lives, facing severe economic and social consequences. Individuals and families are pushed into a cycle of deepening poverty because of this health problem [1,2]. Uncorrected refractive error is the leading cause of eye problem worldwide and the second cause of blindness [3]. Worldwide, there are about 2.3 billion people have refractive error. Out of these peoples, only 1.8 billion have access to eye health care services which are affordable correction. Children are more vulnerable group, because uncorrected refractive error can result in to a dramatic impact on learning process and educational capacity [4]. Most of the children with such diseases are apparent and hence screening helps in early detections and correction [5]. This eye problem is a reason for a number of blind for years by a person than most other causes if not corrected early. The blindness due to refractive error can be resulted in an average of 30 years which 5 years in case of untreated cataract [6]. Special attention has to be given to school age because it is the age at which refractive error begins. The prevalence of myopia is less than 2% before 7 or 8 years but increases with age and reaches 20% at 15 year. The potential risk factors for myopia were family history and near work during childhood, and time spent outdoors [6,7]. Most refractive errors can be managed by early refractive correction. If it cannot treated in childhood may come up with amblyopia, resulting in blindness. The correction can be done by spectacles, contact lenses, or refractive surgery. The most commonly used correction method is spectacles. Hence, spectacles are treatment for refractive error in developing countries [8]. The situation is worse in Sub-Saharan Africa, including Ethiopia. The level of refractive error in Debre Markos, Ethiopia has not been previously addressed. Lack of awareness of the students towards refractive error in addition to the painless and progressive nature of this disease is believed to be among the causes which let the problem remain undetected or uncorrected. Unavailability of and/or inaccessibility to eye care services are also serious problems in Ethiopian. Paucity of sufficient information in Ethiopia is another problem which restrains the decision makers at various levels from taking preventive as well as corrective measures. It was with these backgrounds that the researcher determined to investigate the prevalence of uncorrected refractive error of school children in Debre Markos district and identify modifiable risk factors that have paramount importance for the improvement of programs aimed at prevention and control. Methods Study design School based cross sectional study was conducted in Debre Markos district, Northwest Ethiopia in March 2013. The district is located about 300 kilo meters from the capital city, Addis Ababa [9]. According to the 2012 East Gojjam Zone administrative office report, the district has a total population of 86,786 within seven kebeles of which children below 15 years, at primary school level, account 18,345, boys 8,325 (45.4%) and girls 10,020 (55.6%). The district has one public referral hospital which serves East Gojjam zone and other nearby zones; and two private eye clinics institution giving eye care service. There are 23 primary schools excluding the school for the blind. They comprise a total of 11,842 students. Out of these 23 primary schools, 4 are found in rural areas. Eight of them are private owned whereas 15 are public schools (unpublished district education office record). The source populations of the study were school children with the age of 516 years living in the district. Public and private schools of the district were randomly selected. Then children, who met the inclusion criteria from the target, were selected as the subjects of the study. The study excluded children with eye injury and with other serious sickness. Sampling methods The sample size was calculated using single population proportion formula by taking int (...truncated)