PREVALENCE KNOWLEDGE ATTITUDE AND PRACTICES IN REFRACTIVE ERROR

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 3 m VA better than 6/12 in better eye. Record VA Spectacles-VA sc&cc RE&LE Power of spectacle Lensometer Plano/ 0. 25 DS/DC VA worse or equal to 6/12 in the better eye 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 • • • Ethical Approval by April 2014 Collection of data May- June 2014 Data Analysis July-August 31 st 2014 Presentation of results September 2 nd 2014 Hand in bound book by January 1 st 2015