Background characteristics of participants
Questionnaires were completed and returned by 79 of the 123 eligible pediatricians who were attending the conference, a response rate of 64.2%. The respondents comprised 45 males and 34 females. Their mean age was 37.8 years (SD=9.8 years), range 26−66 years, and their mean duration of medical practice was 8.2 years, range 1−33 years (table 1).
Table 1. Background characteristics of participants (n=79)
Characteristics
|
Variables
|
n (%)
|
Sex
|
Female
|
34 (43.0)
|
Male
|
45 (57.0)
|
Age (years)
|
21−30
|
27 (34.2)
|
31−40
|
24 (30.4)
|
41−50
|
26 (32.9)
|
51−60
|
2 (2.5)
|
Duration of practice (years)
|
1−10
|
54 (68.4)
|
11−20
|
20 (25.3)
|
21−30
|
1 (1.3)
|
>30
|
>4 (5.1)
|
Type of practice
|
Government
|
57 (72.2)
|
Private
|
17 (21.5)
|
Non-governmental organization (NGO)
|
5 (6.3)
|
Place of practice
|
Specialist hospital
|
56 (70.9)
|
General hospital
|
20 (25.3)
|
Primary hospital
|
3 (3.8)
|
Duration of undergraduate training in ophthalmology ⃰(weeks)
|
2
|
25 (31.6)
|
3
|
15 (19.0)
|
4
|
17 (21.5)
|
5
|
8 (10.0)
|
6
|
12 (15.2)
|
Not sure
|
2 (2.5)
|
Duration of postgraduate training in ophthalmology (weeks)
|
2
|
2 (2.5)
|
⃰ Undergraduate ophthalmology training at a medical school in Ethiopia.
Knowledge of childhood eye diseases
Knowledge of the 79 pediatricians about childhood diseases, as reflected by their responses on the questionnaire, is indicated in Table 2. As recorded in the table, the large majority 63; /79.3%) of respondents (Table 2) did not know signs of poor vision in children, and the rest had only poor knowledge of such signs, with ‘poor school performance’ being the one most frequently recognized. Only a few knew the definition of blindness according to the World Health Organization (WHO). There was good overall awareness of more than one ocular sign of vitamin A deficiency, the most frequently recognized signs being Bitot’s spots, xerosis, and keratomalacia.
As also shown in Table 2, all but 3 of the 79 pediatricians knew that refractive error is correctable. Most of those responded that it can be corrected by spectacles, with smaller numbers indicating that it can be corrected by the use of contact lenses or by surgery. There was a good knowledge of TORCH infection in children as a cause of cataract-associated systemic illness, but knowledge of the effects of other metabolic disorders was poor. All but 2 respondents knew about ROP, and most of them correctly said that the time to screen infants for ROP was at 4−6 weeks. Knowledge about the presenting features of congenital glaucoma was moderate to poor, as was recognition of conjunctivitis and/or nasolacrimal duct obstruction as causing tearing in infants.
Table 2 shows that in response to the question about presenting signs of retinoblastoma, more than half mentioned leukocoria, and a somewhat smaller number mentioned proptosis. For the treatment of retinoblastoma, 74 of the 79 of the respondents listed surgery and 70 listed chemotherapy.
All in all, the knowledge scores of the majority of respondents as shown in Table 2 were below 60%, indicating that the overall level of knowledge of this study population was poor.
Table 2. Knowledge of pediatricians about childhood eye diseases
Characteristic
|
Variable
|
n (%)
|
Do you know of any signs of poor vision in children?
|
No
|
63 (79.8)
|
Yes
|
16 (20.3)
|
Poor school performance
|
12 (15.2)
|
Nystagmus
|
2 (2.5)
|
Frequent eye rubbing or blinking
|
1 (1.3)
|
Head tilted to one side
|
1 (1.3)
|
Knowledge of WHO definition of blindness
|
VA<3/60
|
25 (31.6)
|
No light perception
|
20 (25.3)
|
Don’t know
|
22 (27.8)
|
VA<6/60, but ≥ 3/60
|
12 (15.2)
|
Knowledge of ocular signs of vitamin A deficiency
|
Bitot’s spots
|
66 (83.5)
|
Ocular xerosis
|
63 (79.7)
|
Keratomalacia
|
63 (79.7)
|
Night blindness
|
19 (24.1)
|
Knowledge of causes of leukocoria in children
|
Retinoblastoma
|
76 (96.2)
|
Cataract
|
57 (72.2)
|
Retinopathy of prematurity
|
40 (50.6)
|
Retinal detachment
|
17 (21.5)
|
When to refer a child with leukocoria?
|
Immediately
|
79 (100)
|
Is refractive error correctable?
|
Yes
|
76 (96.2)
|
Don’t know
|
3 (3.8)
|
Ways of refractive error correction
|
Spectacles
|
65 (82.3)
|
Surgery
|
39 (49.4)
|
Contact lens
|
38 (48.1)
|
Systemic illnesses in children associated with congenital cataracts
|
TORCH syndrome
|
74 (93.7)
|
Metabolic disorder
|
20 (25.3)
|
Don’t know
|
2 (2.5)
|
Do you know about retinopathy of prematurity?
|
Yes
|
77 (97.5)
|
No
|
2 (2.5)
|
What is the age to screen for retinopathy of prematurity?
|
4−6 weeks
|
67 (84.8)
|
Don’t know
|
7 (8.9)
|
6−12 months
|
5 (6.3)
|
Knowledge about presentation of congenital glaucoma
|
Skipped the question
|
55 (69.6)
|
Buphthalmos(enlarged eye)
|
14 (17.7)
|
Lacrimation
|
13 (16.5)
|
Fear of light
|
5 (6.3)
|
Knowledge about complication of squint in children
|
Loss of depth perception
|
76 (96.2)
|
Lazy eye
|
72 (91.1)
|
Social stigma
|
46 (58.2)
|
Knowledge of causes of tearing in infant
|
Conjunctivitis
|
55 (69.6)
|
Nasolacrimal duct obstruction
|
46 (58.3)
|
Congenital glaucoma
|
27 (34.2)
|
Skipped the question
|
6 (7.6)
|
Foreign body
|
1 (1.3)
|
Knowledge about presenting signs of retinoblastoma
|
Leukocoria
|
56 (70.9)
|
Proptosis
|
45 (57.0)
|
Skipped the question
|
8 (10.1)
|
Squint
|
3 (3.8)
|
Treatment of retinoblastoma
|
Surgery
|
74 (93.7)
|
Chemotherapy
|
70 (88.6)
|
Radiation therapy
|
28 (35.4)
|
Not treatable
|
2 (2.5)
|
VA, visual acuity
Treatment practice and referral of eye disease cases
Practices of the 79 pediatricians regarding treatment and referral of eye diseases in children are recorded in Table 3. To summarize those results, 68 responded that they do perform such eye examinations, but only 29 reported performing them routinely. More than half (59/79) perform a pupillary examination, and among those who do not, the most frequently cited reason was inadequate training. For children with red eyes, 5 reported an immediate referral for eye care. All the rest said that they prescribe eye drops; among these 74 responders, almost half said that failing improvement they refer the child for eye care, while a small number (6/74) said that following eye-drop administration they refer the child immediately. In the case of squint, the response of the large majority of responders was an immediate referral, while 5 said that they refer if the squint fails to resolve after follow-up. In the case of suspected retinoblastoma, most respondents listed immediate referral, while the remaining 20 reported ordering an imaging examination. For children with congenital cataracts or suspected congenital glaucoma, referral to eye-care workers was the response of nearly all of the pediatricians.
Table 3. Practices of treatment and referral of various eye disease cases in children
Question
|
Respondent’s answer(s)
|
n (%)
|
Do you do eye examinations on children? (n=79)
|
Yes
|
68 (86.1)
|
No
|
11 (13.9)
|
How frequently do you perform eye examinations? (n=68)
|
Every visit
|
29 (36.7)
|
When I see an eye problem
|
21 (26.6)
|
When caregiver complains
|
18 (22.8)
|
Which test do you usually do? (n=68)
|
Pupillary response
|
59 (74.7)
|
Ocular motility
|
39 (49.4)
|
Visual acuity
|
31 (39.2)
|
Fundus examination
|
1 (1.3)
|
What is/are reasons not to do eye examination ?(n=11)
|
Not adequately trained
|
5 (6.3)
|
Not my responsibility
|
1 (1.3)
|
Time-consuming
|
1 (1.3)
|
Difficult (i.e. children uncooperative)
|
2 (2.5)
|
I do not know how to examine
|
2 (2.5)
|
How do you manage children with red-eye (n=79)
|
Give eye drops and refer if no improvement
|
39 (49.4)
|
Give eye drops
|
29 (36.7)
|
Give eye drops and refer immediately
|
6 (7.6)
|
Refer immediately
|
5 (6.3)
|
What do you do for a child who squints? (n=79)
|
Refer immediately to eye-care worker
|
74 (93.7)
|
Follow up and refer if it fails to resolve
|
5 (6.3)
|
What do you do for a child in whom you suspect retinoblastoma? (n=79)
|
Immediately refer to eye-care center
|
59 (74.7)
|
Order CT-scan
|
17 (21.5)
|
Order B-scan ultrasonography
|
3 (3.8)
|
What do you do for a child with a congenital cataract? (n=79)
|
Immediately refer to eye-care worker
|
79 (100.0)
|
What do you do for a child you might suspect of having congenital glaucoma? (n=79)
|
Refer to eye-care worker immediately
|
77 (97.5)
|
Give eye drops and follow up
|
2 (2.5)
|
What do you do for a child with congenital tearing? (n=79)
|
Immediately refer to eye-care worker
|
47 (59.5)
|
Maintain observation
|
23 (29.1)
|
Reassure the family
|
6 (7.6)
|
Give eye drops and send home
|
3 (3.8)
|
Attitude of participants
Table 4 shows that nearly all of the 79 responding pediatricians had a positive attitude to providing care in children with eye diseases.
Table 4. category of attitude on the Likert Scale (n=79)
Category
|
n (%)
|
Positive attitude
Neutral attitude
Total
|
75 (94.9%
4 (5/1%)
79
|