Causes and pattern of eye diseases in children attending the paediatric eye unit of Ahmadu Bello University teaching hospital, Shika, Zaria

doi:10.21203/rs.3.rs-3332220/v1

Download PDF

Research Article

Causes and pattern of eye diseases in children attending the paediatric eye unit of Ahmadu Bello University teaching hospital, Shika, Zaria

https://doi.org/10.21203/rs.3.rs-3332220/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background

To determine the causes and pattern of eye diseases in children 0-15 years of age attending the Paediatric unit of the Department of Ophthalmology Ahmadu Bello University Teaching Hospital Shika, Zaria with a view of obtaining data for planning of children eye care in the hospital and in similar hospitals around the area.

This was a descriptive cross-sectional study. All children that met the inclusion criteria were recruited. Visual acuity assessments were done in verbal children using Snellen’s chart, Tumbling E-Chart and picture charts while preferential looking, fixation, objection to occlusion were used for preverbal patients. Anterior segment examination was done using a loupe or slit lamp biomicroscope as appropriate while posterior segment was examined by direct ophthalmoscopy. Manual refraction was done using streak retinoscope (cycloplegic refraction when required)

Result:

A total of 12,516 patients attended the Ophthalmology out-patient clinic of the hospital during the 30- month study period (May 2014- Oct. 2016); 1,760 (14.1%) were patients 0- 15 years of age (study population).A total of 448 children were recruited for the study. The male to female ratio M: F was 1.3:1. Allergic conjunctivitis 181 (40.4%), refractive error 42 (9.4%) and infective conjunctivitis 39 (8.7%) were the most common ocular disorders seen. The prevalence of visual impairment was 34.4%.Trauma was the most common cause of uniocular visual impairment. The proportion of blind eyes was 3.1% (n=12)

Conclusions:

The common ocular disorders seen among the children were treatable causes of visual impairment. Public health education is necessary to create awareness on the causes of blindness. However, there was no statistically significant difference in the ocular disorders with respect to age and gender of the children.

causes

children

eye diseases

Zaria

Good vision is very essential for the socio-psychological, educational and intellectual development of children¹.It aids their ability to communicate. Children who have poor vision seems to have poor performance in school or at work later in life¹.

About Seventy -five per cent of a child’s early learning come through vision and over one- third of the adult visual cortex responds to visual stimulations².Therefore, vision is not only very important for early development in infancy but also in adulthood.

About 13.5 million children worldwide had visual problems in 2009³. Furthermore, the World Health Organisation (WHO)⁴ reported an estimated 19 million children have visual impairment of whom 1.26 million are bilaterally blind. The economic burden of blindness in India was put at US$4.4 billion with childhood blindness accounting for 28.7% of that lifetime loss^5.Visual problems in children constitute a socio-economic problem The prevention and treatment of visual morbidities in children therefore enhance the economic productivity of families and the society at large.

There are regional variations in the causes of visual morbidities across the world as well as from countries to countries especially between developed and developing countries⁴.This may be due to differences in the social, ecological, and economic and health status from one region/ country to the other.

Biologically, childhood is defined as the period between birth and puberty.

There is debate on the definition of childhood by age. Legally, the term "child" may refer to anyone below the age of majority or some other age limit⁵. In Singapore, childhood is taken to be the period 14 years and below while in the United Kingdom the year of consent is set as 16 years⁵.The United Nations Convention on the Rights of the Child defines child as "a human being below the age of 18 years unless under the law applicable to the child in a particular country is attained earlier ⁶. Meanwhile, the United Nations International Emergency Fund (UNICEF) adopted the age of 15 years as the upper limit of childhood with respect to childhood abuse ⁷.

In Nigeria, children less than 15 years of age account for about 41.83% of the total population⁸. Nigerians health coverage is not optimal yet as the Universal Health Coverage (UHC) was to target 30 % of the population in 2015 according to the Federal Ministry of Health (FMoH). Nigeria was in the twelfth position in the rank of countries with highest under five mortality rates in the world with 143 children death per 1000 live births in 2010⁹. The high mortality rate is also underscored with the low immunization coverage in the country which remains lower than the global benchmark⁹. Thus, Nigerians still suffer from preventable and treatable diseases, ocular conditions inclusive. The Measles and Rubella vaccine are part of the triple Measles, Mumps and Rubella (MMR) vaccines of the national immunization programme. The measles vaccine can help in the prevention of corneal opacity resulting from Measles keratopathy and congenitally acquired cataract can be prevented with the administration of the Rubella vaccine.

The aim of this study was to determine the causes and pattern of eye diseases in children under 15 years of age who attended the paediatric unit of the Ophthalmology Department of Ahmadu Bello University Teaching Hospital, Shika, Zaria with the aim of getting data for planning of children eye care in the hospital and in similar hospitals around the area.

This was a descriptive cross sectional study conducted on all children under 15 years of age who were referred or presented to the paediatric Ophthalmology clinic ( which holds on Mondays) of ABUTH, Zaria from May 2014 to October 2016 (a 30 month period)

The study sample size was calculated using the Cochran’s formula¹⁰ where n = desired sample size, Z = standard normal deviate, set as 1.96 which corresponds to 95% confidence interval, P = prevalence taken as 50% (0.5), q = 1.0-p = 0.5, d = desired level of precision taken as 5% (0.05), thus n = 3.8416 x 0.5 x 0.5/0.0025 = 384. Attrition rate taken as 15% therefore, minimum sample size is 384+ 57 = 441.

Inclusion criteria

All children 15 years of age and below presenting to the paediatric Ophthalomology clinic with informed consent by the parents/guardians and who gave assent/willingness to participate.

Exclusion criteria

Children above 15 years of age, follow up cases and those who refused to participate were excluded from the study.

Ethical approval was obtained from the Health Research Ethics Committee (HREC) of Ahmadu Bello University Teaching Hospital Shika, Zaria. The informed consent of the parents’/guardians were obtained, as well as the assent of the children that participated in the study. The study was conducted in accordance with the tenets of Helsinki declaration.

Study definition

1. A diagnosis of congenital disease was made when the disease was present since birth and other diseases were diagnosed as acquired.

2. Refractive error: myopia was recorded if refractive error was worse than –0.5 DS (dioptre sphere). A diagnosis of hypermetropia was made if refractive error was worse than +0.5 DS. Similarly, astigmatism was recorded if refractive error was worse than +0.5 DC (dioptre cylinder)

3. Vernal conjunctivitis: redness and/or pigmentation with presence of conjunctival papillae on the upper tarsal conjunctiva and/or limbal infiltration/papillae with/without secretions¹¹.

4. Infective/ microbial conjunctivitis: conjunctival hyperemia, lacrimation, irritation, and discharge¹².

5. Visual impairment: mild or nil: vision equal to or better than 6/18, moderate: vision between 6/18-6/60, severe: vision 6/60-3/60, blindness: vision less than 3/60 or nil light perception⁴

5. Glaucoma: glaucoma was defined as fundus findings of vertical cup disc ratio of ≥ 0.50 or asymmetry of ≥0.2 between the two eyes with or without increased intraocular pressure, with associated visual field changes¹³.

Procedure

The biodata of all the selected children under 15 years who attended the Paediatric eye unit of Ophthalmology department ABUTH, Shika, Zaria were taken.
Visual acuity test with Snellen’s chart, or picture chart, tumbling E- chart (depending on their literacy level) for children > 5 years of age was done at six (6) meters. This was repeated with pin hole (and glasses where patient uses) for patient who could not read 6/6 unaided. For children less than 5 years old, fixation behaviours, preferential looking and occlusion etc were used to assess vision.
Ophthalmic examination

Extraocular movements, Hirschberg’s test, cover-uncover tests for detection of squints.
Gross examination of cornea, conjunctiva, anterior chamber, iris and pupil with a torch light.
Examination of anterior segment with slit lamp biomicroscope ( Haag Streit , BM 900, Germany)
Dilated fundoscopy with direct Ophthalmoscope ( Heine^R Beta 200, Germany)
Indirect ophthalmoscopy when needed

Those adjudged to have refractive errors (V.A < 6/12 with improvement of 2 or more lines with pin hole) had retinoscopy + subjective refraction (cycloplegic and non- cycloplegic) as required

The above data were collected in a proforma for each patient, stored and analysed by Statistical Package for Social Sciences version 20.0 (IBM SPSS statistics, Chicago, Illinois, USA)

A total of 12,516 patients attended the Ophthalmology out-patient clinic of the hospital during the 30- month study period (May 2014- Oct. 2016) 1,760(14.1%) were children less than 15 years of age (study population).

Most of the children that participated in the study were between the ages of 0–4 years 56.4% (n = 252) Majority were males 58.0% (n = 260) and were largely Hausa by ethnic group 79.5% (n = 356 ) Table 1.0

Table 1.0

Socio-demographics of 448 children 0–15 years of study population
Characteristics	Frequency (percentage) (n = 448)
Age
0–4	252 (56.3)
5–9	108(24.1)
10–15	88 (19.6)
Sex
Male	260 (58.0)
Female	188(42.0)
Ethnic distribution
Hausa	356 (79.5)
Yoruba	20(4.5)
Igbo	12(2.7)
Others	60(13.4)
Informants
Father	68(15.2)
Mother	356(79.5)
Siblings	16(3.6)
Relative	4(0.9)
Others	4(0.9)
Greater than half of the study population were children 4years and below. Almost 80% of the informants were the participants’ mothers

Allergic conjunctivitis 40.4% (n = 181) was the commonest disease observed followed by refractive error 9.4% (n = 42) and microbial conjunctivitis 8.7% (n = 39) (Tables 2.0, 3.0) An equal number of congenital cataract and congenital glaucoma was reported in this study as 6.3% (n = 28) and they constituted the most common congenital ocular abnormalities observed. Multiple congenital anomalies and retinoblastoma were 3.6% (n = 16) and 1.8% (n = 8) respectively. The causes of blindness in 12 eyes amongst verbal children 5–15 years were cortical visual disorders, congenital cataract, retinoblastoma and penetrating eye injuries (table 3)

Table 2.0

Diagnosis of eye disorders of 448 children of the study population
Diagnosis	Frequency	Percentage (%)
Allergic Conjunctivitis	181	40.4
Refractive error	42	9.4
Microbial conjunctivitis	39	8.7
Cong cataract	28	6.3
Cong glaucoma	28	6.3
Trauma	24	5.4
Strabismus	16	3.6
Foreign body	6	1.3
Corneal ulcer	4	0.9
Measles keratopathy	4	0.9
Glaucoma	8	1.8
Oculocutaneous albinism	4	0.9
Nasolacrimal duct obstruction	8	1.8
Stargardt disease	1	0.2
Multiple congenital anomalies	16	3.6
Sympathetic ophthalmitis	1	0.2
Sturge Weber	1	0.2
Tuberous sclerosis	1	0.2
Traumatic cataract	3	0.7
Blepharoconjunctivitis	8	1.8
Cerebral palsy with cortical blindness	5	1.5
Corneal opacity	4	0.9
Dermoid cyst	1	0.2
Lid retention cyst	1	0.2
Orbital cellulitis	1	0.2
Preseptal cellulitis	4	0.9
Toxoplasmosis	1	0.2
Retinoblastoma	8	1.8
Total	448	100
Allergic conjunctivitis, refractive errors and microbial conjunctivitis were the commonest diseases seen in the children

Table 3.0

Eye disorders in 448 children 0–15 years by age groups
Diagnosis	Age group ( Years)			Test of Stat
Diagnosis	0–4	5–9	10–15	X² df P value
Allergic Conjunctivitis	104	46	31	260 0.18
Refractive error	5	5	32
Microbial conjunctivitis	26	4	9
Trauma	4	20	0
Congenital cataract	18	6	4
Congenital glaucoma	28	0	0
Strabismus	12	4	0
Foreign body	0	4	2
Corneal ulcer	4	0	0
Measles keratopathy	4	0	0
Glaucoma	0	0	8
Oculocutaneous albinism	4	0	0
Nasolacrimal duct obstruction	4	4	0
Stargardt disease	0	0	1
Multiple congenital anomalies	16	0	0
Sympathetic ophthalmitis	0	1	0
Sturge Weber	1	0	0
Tuberous sclerosis	0	1	0
Traumatic cataract	2	0	1
Blepharoconjunctivitis	0	4	0
Cerebral palsy with visual disorders	2	3	0
Corneal opacity	4	0	0
Dermoid cyst	1	0	0
Lid retention cyst	1	0	0
Orbital cellulitis	1	0	0
Preseptal cellulitis	0	4	0
Toxoplasmosis	0	0	1
Retinoblastoma	5	3	0
Most of the children with allergic conjunctivitis were below age 5 years, while refractive error were more in the older children. (P value > 0.05). There is no significant statistical difference between eye disorders and age.

Eye diseases differ with age, gender and geographical locations from one region of the world to the other as reported in many works.^{14, 15}. In children, eye diseases can cause visual impairment as well as potentially cause blindness if not treated early¹⁶.The family serves as a primary unit in health and medical care. Women report to health facilities more than men¹⁷.Sick role is culturally more compatible with women and this include the traditional role of care for their household especially children¹⁷. In this work, majority of the informants were mothers (79.5%). This underscores the role of mothers in child care and in seeking health for a vulnerable population that cannot seek health for themselves.

Allergic or vernal conjunctivitis more often occurs in warm, dry, climates with a decrease in inflammation and symptoms in the winter¹⁸. Zaria, the location of the study area, has a tropical wet and dry climate with warm weather all year-round- a wet season lasting from April to September and a drier season from October to March ¹⁹. Onset of the symptoms of allergic conjunctivitis especially vernal conjunctivitis begin from childhood and peaks in early teen around age 13 years¹⁸. This study also agrees with the description of early onset of allergic/ vernal eye disease which peaked around the age of 11 years (table 4) although there was no statistically significant association between age and disease P value > 0.05

Earlier works by researchers have shown that in Nigeria, refractive error is one of the common presentations to the eye clinic ^{20, 21}. In this study, a total of 42 children (9.4%) were diagnosed to have refractive error, mainly hypermetropic-astigmatism (40.0%) followed by hypermetropia (26.2%). More female (73.8%) patients were observed to have refractive error compared to the males (26.2%) (P value > 0.05) this was similar with the findings of Isawumi et al²¹ in which males constituted 33.9%-although myopia was reported more in their study. Living in a rural area is associated with a higher risk of hypermetropia. The study area is located in an environment where it serves a predominantly rural population and this may explain the fact that hypermetropia was more common in the study. Children in a rural setting are also more likely to be engaged more in outdoor games and less of indoor games which may be a reason for lower percentage of children having myopia as noted. Most of the children with refractive error were between the ages of 10–15 years. The finding of more refractive error in older children compared to children of younger age reported in this study is similar to the report by Sandra²² in Germany as well as another study by Jaya et al in West Bengal, India²³. The relatively higher percentage of the number of patients in the age range 10–15 years with refractive error may probably be due to the fact that it is around this age range that there is increased need for near vision because of school activities and children may be able to articulate their complaints better than younger children.

In a primary eye care clinic microbial conjunctivitis constitute about 1% of all consultations by general practitioner and could be as high as 40% of cases seen in paediatric eye care^{24, 25}. The estimates of children with bacterial conjunctivitis vary with age. In this study 8.7%of the patients had microbial conjunctivitis (Table 2.0). Out of these the age group of 0–4 years range had the highest number of cases 66.7%, 5–9 age 10.3% and 10–15 years 23.7% respectively. In the United States²⁶ it was estimated that bacterial conjunctivitis was 23% in the 0–2 year age range, 28% occurred in the 3–9 year range and 13% in the 10–19 year range. Furthermore, factors that have been associated with bacterial infection include age less than 6 years, onset of symptoms between December and March, and the absence of watery eyes²⁶.The fact above is also supported by the bulk of the patients with infective conjunctivitis which were in children less than 6 years of age reported in this study. Besides, the study period also transited through the period of December and March which are characteristically dry and has low humidity. In the 1980s trachoma was an important cause of blindness and accounted for 12% of world blindness²⁷. However, a downward trend to 3% has been recorded by the World Health Organization²⁸. No case of trachoma was recorded in this study. The concerted efforts of the government and Non-Governmental Organization (NGOs) in the provision of portable water as part of the components of the SAFE strategy plus behavioural change may as well explain this development. Although a previous study²⁹ opined that trachoma was more of a population- based problem rather than hospital based.Studies^{30, 31} in Calabar South-South Nigeria and Benin –City recorded ophthalmia neonatorum (neonatal conjunctivitis) as 1.1% and 1.7% respectively. No case of ophthalmia neonatorum was however, recorded in this study. Improved maternal education, antenatal and obstetric care and socioeconomic status may be responsible for this observation.

Congenital cataract was one of the most common congenital ocular abnormality - recorded with a proportion of 28 (6.3%). Studies^32–34 done in Kaduna, Lagos and Ogun States also indicated that congenital cataract was a common ocular congenital anomaly operated /reported. One hundred and eighty one of 204 eyes (88.0%) had cataract surgery in Kaduna, n = 27 (39.1%) and n = 50 (47.6%) of congenital cataracts in Lagos and Ogun respectively. A similar pattern of congenital cataract as a common ocular congenital condition observed was also noted in Kolkota, India n = 16 (16.49%)³⁵ and the United Kingdom n = 160 ( 66%)³⁶.

Furthermore, the patients who had congenital glaucoma were 28(6.3%), lower than what was recorded in Ogun State³⁴ Nigeria (14.3%) and in Lagos, Nigeria (8.7%)³³ but higher than the report from a suburban region of Edo state³⁷(1.7%) .In this study all the patients with congenital glaucoma presented within the first four (4) years of life. This is similar to the time presentation pattern reported in Edo³⁷ of between 2 to 5 months and 12.31 (± 17.13) months in Ibadan³⁸

Parents of children with birth defects have anxieties socially, emotionally, financially on how to manage a child with defect³⁹. In this work, the patients who had multiple congenital anomalies n = 16 (3.6%) mainly had cleft lips and palates, microphthalmos, lids coloboma, microcephaly and polydactyly. Most of the cases of congenital anomalies reported between the ranges of 0–4 years of age. The concern and eagerness to find answers to the question of care for these children may explain the reason majority of the cases of congenital eye diseases were diagnosed at a younger age group –less than 4 years old.

Retinoblastoma was the only orbito-ocular tumour reported in this work n = 8 (1.8%) of all children less than four years of age. Over four decades ago in Kaduna, Nigeria Abiose et al⁴⁰ reported retinoblastoma as n = 63 (60.5%) of all orbito-ocular tumours. Fifteen years later in the neighbouring town of Zaria, retinoblastoma recorded a lower percentage n = 50 (40.3%) amongst orbito-ocular tumours⁴¹. The relatively low percentage recorded in this work compared to the above perhaps may be due to the fact that their studies^40,41 were solely on orbito-ocular tumours relative to retinoblastoma. Additionally, the fact that there are more tertiary health facilities now around the study area compared to the time when those studies were carried out may have reduced the concentration of patients only to the study area. Besides, the culture of consanguineous marriage, which is a risk factor for genetic diseases including retinoblastoma is likely to have reduced now due to civilization.

The proportion of blindness observed in in verbal children in the study population was 12 (3.1%) as shown in Table 4.0. Adegbehingbe⁴²recorded a lower prevalence of blindness (1.4%) and so did Kemmanu⁴³ et al (0.08%). In this study the leading causes of blindness were cortical visual impairment and congenital cataract (33.3% each n = 4). Although childhood cataract and cortical blindness were also reported as the leading causes of blindness by Adegbehingbe⁴², 17.9% of blindness was due to childhood cataract and 12.0% from cortical blindness, these proportions reported were dissimilar to this study. The different timelines between this study and Adegbehingbe’s⁴²and the difference in the study area may explain the reason for the varying results.

Table 4.0

Type of refractive errors in 42 children by age groups
Type of error	Age group (Years)
Type of error	0–4	5–9	10–15	Total
Myopia	0	2	3	5
Hypermetropia	0	0	11	11
Myopic-astigmatism	0	2	3	5
Hypermetropic-astigmatism	5	1	11	17
Mixed astigmatism	0	0	4	4
Total	5	5	32	42
Simple hypermetropia and hypermetropic-astigmatism were the commonest refractive error and were observed to be more in the age group 10–15 years

Table 4.0

Causes of blindness in 12 eyes of verbal patients aged 5–15 years
Causes	Frequency	Percentage (%)
Cortical Visual disorder	4	33.3
Congenital cataract	4	33.3
Orbito-ocular tumour (Retinoblastoma)	2	16.7
Penetrating globe Injury	2	16.7
Total	12	100
Bilateral cortical blindness and congenital cataracts were the most common causes of blindness in the patients, retinoblastoma and globe injury were unilateral

Avoidable and preventable (treatable) eye diseases constituted the bulk of the cases seen in the patients that attended the Paediatric unit, Department of Ophthalmology, ABUTH, Zaria, Kaduna State, Nigeria. We hereby recommend that adequate provision should be made in the optical unit to enhance children access and uptake of corrective eye glasses, target education for mothers in the community on ocular health, training and retraining of Ophthalmologists in paediatric ophthalmology and procurement of technology/ equipment to build more functional Paediatric surgical units of the department of Ophthalmology across the region.

Limitation of the study

The technicality and materials for examining the visual acuity of preverbal children and children under 4 years of age. In preverbal children, often vision is assessed to actually find out if the child can see at all and not usually to be able to quantify the degree to which they can see by way of visual acuity assessment. Specialised instruments like electrophysiological tests, electronic picture charts containing pictures of modern day (for instance mobile phones instead of analogue telephone) are some of the materials required for the adequate assessment of vision in children.

WHO: World Health Organisation

UNICEF: United Nations international emergency Fund

UHC: Universal Health Coverage

FMoH: Federal Ministry of Health

ABUTH: Ahmadu Bello University Teaching Hospital

HREC: Health Research Ethics and Committee

VA: Visual acuity

NGOs: Non- Governmental Organisations

Ethics of approval and consent to participate

Consent for Publication

Nil restriction to publication

Availability of data and material

Materials available in the Ophthalmology department were made available for use in carrying out the research.

Competing Interests

Nil

Funding

Self- funded

Author’s Contribution:

Dr Orugun Ayodele Jacob : Research conceptualization, data collection, writing, editing

Prof Oladigbolu KK: supervision, editing

Prof Pam V: supervision, editing.

Acknowledgements

I wish to acknowledge my supervisors for the guidance provided in the course of this work.

Chandna A, Gilbert C. When Your Eye Patient is a Child. Comm Eye Health 2010; 23 (72):1-20
Seeman S, Vashti B, Meenakshi MG. Magnitude of Refractive Errors among School Children in a Rural Block of Haryana Internet J Epidemiol 2008;6 :21-24.
Ferebee A. Childhood Vision Public Challenges and opportunities: New York School of Public Health and health Services the George Washington University Medical Centre; 2004.p.1-24
Visual Impairment and Blindness, Geneva. World Health Organisation, 2013,p24
Children and Young Persons Act- Singapore Statues Online- retrieved 30/5/2018)
Convention on the Rights of the Child"New York, The Policy Press, Office of the United Nations High Commission for Human rights, 1996,p4-11
Childhood. UNICEF https://www.unicef.org accessed 13/6/2018
Wikipedia. Demographics of Nigeria. Wikipedia The free encyclopedia. 2009 last accessed 06/12/17
Universal Health Coverage, Federal Ministry of Health; www.fmh.gov.ngaccessed 12-10-2016.
Barlett JE, Kotrlik JW. Organizational research: determining appropriate sample size in survey research. Information Technology, learning and performance journal 2001;19(1):43-50
Kanski JJ, Bowling B. Clinical Ophthalmology a systematic approach 6^th edition. China. Elsevier Saunders 2007 p 229
Kanski JJ, Bowling B. Clinical Ophthalmology a systematic approach 6^th edition. China. Elsevier Saunders 2007 p 219
Kanski JJ, Bowling B. Clinical Ophthalmology a systematic approach 6^th edition. China. Elsevier Saunders 2007 p 376-377
Canavan YM, O'Flaherty MJ, Archer DB. A Ten -year Survey of Eye – Injuries in Northern Ireland. Br J Ophthalmol. 1980; 64: 618-25.
Ajayeoba AI, Scott SCO. Risk factors associated with eye disease in Ibadan, Nigeria. Afr J Biomed Res. 2002; 5: 1-3.
Simon JW, Kaw P. Albany Medical College, Albany, New York Am Fam Physician, 2001; 64: 623-9.
Constance AN Illness and the feminine role: a theoretical review Soc Sci Med 1975; (9,2):57-62.
Bonini S, Coassin M, Aronni S, Lambiase A. Vernal keratoconjunctivitis Eye. 2004; 18:345-351.
Climate-data.org accessed 01/25/2018
Onakpoya OH, Adeoye AO.Childhood Eye Diseases in South Western Nigeria: A Tertiary Hospital Study, Clinics (Sao) Paulo, 2009, 64 (10); 947-51.
Isawumi M, Agboola S, Ayegoro B .Paediatric Refractive Errors in an Eye Clinic in Osogbo, Nigeria. Ethiop J Health Sci 2016; 26(2):147-154.
Sandra J, Erich K, Chistian V. The prevalence rates of refractive errors among children, adolescents, and adults in Germany Clin Ophthalmol. 2008; 2(3): 601–607.
Jaya B, Indranil S, Debabrata D, Sabyasachi B. Ocular Morbidity Among Children at a Tertiary Eye care Hospital in Kolkata, West Bengal, Indian J Public Health 2012;56 ( 4):294-6.
Fitch CP, Rapoza PA, Owens S. Epidemilogy and diagnosis of acute conjunctivitis at an inner-city hospital. Ophthalmology 1989; 96 (8): 1215-1220.
Hovding G. Acute bacterial conjunctivitis. Acta Ophthalmol 2008; 86 (1):5-17.
Meltzer JA, Kunkov S, Crain EF .Identifying children at low risk for bacterial conjunctivitis. Arch Pediatr Adolesc Med.2010; 164(3):263-267.
Mariotti SP, Pascolini D, Rose-Nussbaumer J. Trachoma: Global magnitude of a preventable cause of blindness. Br J Ophthalmol. 2009; 93:563–8.
Frick KD, Hanson CL, Jacobson GA. Global burden of trachoma and economics of the disease. Am J Trop Med Hyg. 2003; 69:1–10.
Babalola OE. Trachoma in Kaduna, northern Nigeria. Recent observations on pattern of clinical presentation. Trop Geogr Med. 1989; 41:41–4.
Ochigbo SO, Ibanga A, Uzomba I. Prevalence of Ophthalmia Neonatorum in Calabar, South-South Nigeria: A 3-Year Review I JN 2016; 7(3):1-4.
Iyamu E, Enabulele O. A survey on opthalmia neonatorum in Benin City, Nigeria (Emphasis on gonoccocal opthalmia). Online J Health Allied Sci. 2003; 2(2):1-6
Murtala MU, Ahmed A , Ibrahim A, Mahmoud BA , Amina H .Pediatric Cataract Surgery in National Eye Centre Kaduna, Nigeria: Outcome and Challenges Middle East African Journal of Ophthalmology 2015 ;22(1):92-93.
Adekoya BJ, Balogun, MM, Balogun BG. Spectrum of congenital defects of the eye and its adnexia in the pediatric age group; experience at a tertiary facility in Nigeria Int Ophthalmol 2015; 35: 311.
Bodunde OT, Ajibode HA .Congenital eye diseases at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria Nigerian Journal of Medicine: Journal of the National Association of Resident Doctors of Nigeria 2006; 15:291-294.
Biswas J, Saha I, Das D, Bandyopadhyay S, Ray B, Biswas G. Ocular morbidity among children at a tertiary eye care hospital in Kolkata, West Bengal Indian J Public Health 2012; 56:293-6.
Jugnoo SR, Carol D .Congenital and Infantile Cataract in the United Kingdom: Underlying or Associated Factors Invest Ophthalmol Vis Sci. 2000; 41:2108–2114.
Enock ME, Omoti AO, Momoh RO. Glaucoma in a Suburban Tertiary Care Hospital in Nigeria J Ophthalmic Vis Res 2010; 5 (2): 87-91.
Olusanya BA, Ugalahi MO, Malomo MO, Baiyeroju A. Trabeculectomy for congenital glaucoma in University College Hospital, Ibadan: A 7 year review of cases. Niger J Ophthalmol 2015; 23:44-7.
Jodi L, Kristin F, Amanda M, Kayte T. Insights from Parents about caring for a child with birth defects. Int J Environ Res Public Health 2013; 10(8): 3465-3482.
Abiose A,Adido J, Agarwal SC. Childhood malignancies of the eye and orbit in Northern Nigeria Cancer 1985; 55(12): 2889-2893.
Mohammed A ,Ahmed SA, Ahmedu NE, Maisamari JS. Orbito-ocular malignant tumours in Zaria, Nigeria: A 10-year review Ann Afri Med 2006; 5(3):129 – 131
Adegbehingbe BO, Taiwo OA .Prevalence and pattern of childhood blindness in a resource limited teaching hospital in Nigeria. East Afr. J. Ophthalmol 2007; 43-7
Vasudha K , Kaushik H , Subramanya KG , Bhujanga KS, Kumaramanickavela G, McCarty CA .Prevalence of Childhood Blindness and Ocular Morbidity in a Rural Pediatric Population in Southern India: The Pavagada Pediatric Eye Disease Study-1 Ophthalmic Epidemiol 2016;23( 3):185–192.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Causes and pattern of eye diseases in children attending the paediatric eye unit of Ahmadu Bello University teaching hospital, Shika, Zaria

Status:

Version 1

Abstract

Background

Methods

Results

Discussion

Conclusions

Limitation of the study

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1