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Year : 2017 Month : February Volume : 6 Issue : 16 Page : 1239-1243

SOCIO-DEMOGRAPHIC CORRELATES OF OCULAR MORBIDITY IN SCHOOL CHILDREN OF RURAL HARYANA.

Seema Sharma1, B. M. Vashisht2, Satinder Vashisht3, Seema Chaudhary4, Neelu Saluja5, Suresh Kumar6, S. M. Pandey7

1Associate Professor, Department of Community Medicine, MAMC, Agroha, India.
2Professor, Department of Community Medicine, PGIMS, Rohtak, India.
3Senior Medical Officer, Regional Institute of Ophthalmology, PGIMS, Rohtak, India.
4Professor, Department of Community Medicine, MAMC, Agroha, India.
5Associate Professor, Department of Community Medicine, MAMC, Agroha, India.
6Medical Officer, Haryana Civil Medical Services, India.
7Assistant Professor (Statistics), Department of Community Medicine, MAMC, Agroha, India.

CORRESPONDING AUTHOR

Dr. Seema Sharma,
Email : ss4_gunu@yahoo.co.in

ABSTRACT

Corresponding Author:
Dr. Seema Sharma,
Associate Professor,
Department of Community Medicine,
Maharaja Agrasen Medical College,
Agroha, Hisar-125047,
Haryana, India.
E-mail: ss4_gunu@yahoo.co.in

ABSTRACT

BACKGROUND

Vision impairment and blindness in children are important because of their impact on the child’s development, education, future work opportunities and quality of life. These negative effects are experienced throughout the child’s life. It leads to serious social and economic burden to the family and the society.

This study was conducted with the objectives of estimating the prevalence of ocular problems among school going children in rural area and to study the association of ocular problem with socio-demographic factors.

MATERIALS AND METHODS

This cross-sectional study was done in Govt. Senior Secondary Schools of Block Lakhanmajra, Haryana. Out of 16 Govt. Senior Secondary Schools, 4 were randomly chosen. Students aged 6 - 15 years studying in class 1 to 10 were included in the study. Test performed were Visual acuity (Snellen’s E-chart), Cover Test, Ocular motility and External examination by torch, lens and loupe and an interview was done on the basis of questionnaire. The findings of clinical examination were recorded on a pre-tested Performa. After collection, the whole data was compiled; analysed and appropriate statistical tests like simple proportions, chi-square (χ2) test were applied.

 

RESULTS

Out of 1265 students 41.4% boys and 38.9% girls were suffering from one or more eye problems.Out of total 451 children (35.65%) were having one or more eye problems; however, the overall prevalence of ocular morbidity was found to be 39.9%. Defective vision was the commonest morbidity (13.6%) followed by squamous blepharitis (12.3%), vernal conjunctivitis (5.1%), conjunctivitis (4.7%), conjunctival xerosis (2.8%), squint (0.8%) and stye (0.7%). Defective vision was significantly associated with girls. Squamous blepharitis was significantly associated with boys.Except defective vision all diseases were more prevalent in boys. Eye problems were found to be more among students whose father and mother were illiterate. Association of vernal conjunctivitis with father’s literacy was found to be significant.

CONCLUSION

Ocular disorders among school going children can be easily identified by regular eye screening programmes. Prompt treatment can protect the child from future complications and blindness. The eye health awareness among children and school teachers should be improved.

KEYWORDS

Socio-Demographic, Ocular Morbidities, Rural Area, School Children.

BACKGROUND

The eyes are nature’s meticulously designed most valuable gift for mankind. Eyes act as our windows to the world. Vision contributes greatly to one’s learning capacities right since childhood.1So it is important to take care of eyes during the

development of a child. The eyes can perform their function well only if their growth and development is well established. It is therefore essential that the common afflictions of the eyes that cause visual impairment or loss of eyesight are possibly prevented and properly treated.2

Childhood eye morbidity is defined as “Any eye disease or condition that requires ophthalmic care and treatment, which if untreated can often progress to serious and sight threatening disease.”3

Around 80% of all visual impairment can be prevented or cured and that about 90% of the World’s visually impaired live in developing countries.4

Poor vision in childhood affects performance in school or at work and has a negative influence on the future life of the child.5

Most eye disorders do not manifest dramatic visual disability initially; hence, they may be detected at a late stage. If the disease affects a single eye quite often the patient is unaware of the defect until there is severe visual loss, so awareness programmes to educate the public regarding eye disorder is essential.2

With changing lifestyles eyes are under a lot of stress, younger children have much more to study. Increased use of computer, mobiles, long hours of television viewing and poor lighting all add to the problem.

Childhood blindness is a challenging problem in developing countries. In rural areas, neither the children nor the parents are intelligent enough to detect the eye problems and gradually these problems may result in blindness.

MATERIALS AND METHODS

The present cross-sectional study was carried out from September 2006 to July 2007 in Block Lakhanmajra, which is the field practice area attached to the Department of Community Medicine, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak. The study subjects were school going children in the age group of 6 - 15 years. Out of total 16 Govt. schools existing in the block, two girls’ schools and two boys’ schools were randomly selected and all the students between 6 - 15 years of age, studying in class 1st to 10th were included in the study. The students were divided into three age groups: 6 - 10 years, 10 - 13 years and 13 - 15 years. All concerned Principals, Teachers and Students were briefed about the study. Each student was interviewed individually by the author in their local language, so that they can understand questions easily. The students present on day of visit were included in the study. No followup visits were done. The age of students was ascertained as per the school records. Visual Acuity (VA) test was performed using Snellen’s E chart. If distant visual acuity was < 6/6, then those students were subjected to refraction by ophthalmic assistant. VA < 6/6 was taken as criteria of defective vision, because criterion of low vision according to WHO (VA ≤ 6/18 in better eye) is already grossly subnormal for school children.

Information was collected on a pre-tested semi-structured schedule. After collection, the whole data was compiled; analysed (SPSS-10) and appropriate statistical tests like percentages and chi-square (χ2) tests were applied.

Inclusion Criteria

All the Children in the age group of 6 - 15 years in the selected schools.

Exclusion Criteria

Those who are not responding well and absentees on the day of examination.

RESULTS

Table I shows the distribution of different eye problems.

Table II shows most of the morbidities were found in oldest age group (13 - 15 yrs.), while least morbidities in the youngest age group (6 - 10 yrs.). Strong significant association was found with increase in age group in cases of defective vision* and xerosis*.

Table III shows that41.4% boys and 38.9% girls were suffering from one or more eye problem. Defective vision* was significantly associated with girls. Squamous blepharitis* was significantly associated with boys.Except defective vision, all diseases were more prevalent in boys as compared to girls.

Table IV shows that out of all only conjunctival xerosis* was associated significantly with caste, it was more prevalent in scheduled caste students.

Table V shows that eye problems were found to be maximum among students whose father was illiterate as compared to those whose father was literate. Association of vernal conjunctivitis* with father’s literacy was found to be significant.

Table VI shows that eye problems were found to be maximum among students whose mother was illiterate as compared to those whose mother was literate. Association of vernal conjunctivitis* with mother’s literacy was found to be borderline significant.

Table VII shows that farming and labour were common occupation of the area. Maximum no. of eye problems were found in students, whose fathers were labourer. Association of individual problems was calculated, but no significant association found.

 

Eye Problems

Total n = 1265

Percentages [%]

Defective Vision

172

13.6

Squamous Blepharitis

156

12.3

Conjunctivitis

59

4.7

Vernal Conjunctivitis

64

5.1

Stye

9

0.7

Squint

10

0.8

Conjunctival Xerosis

35

2.8

Total

505

39.9

Table I. Prevalence of Eye Problems among Study Subjects

 

Age

Groups

Eye Problems

 

Total

[%]

Defective Vision [%]

Squamous Blepharitis [%]

Conjunctivitis

[%]

Vernal

Conjunctivitis [%]

Stye

[%]

Squint

[%]

Conjunctival

Xerosis [%]

6 - 10 Years

N = 282

14 [4.97]

36 [12.8]

10 [3.6]

14 [5.0]

3 [1.1]

5 [1.8]

1 [0.4]

83 [29.4]

10 - 13 Year

N = 536

56 [10.45]

62 [11.6]

23 [4.3]

30 [5.6]

3 [0.6]

4 [0.75]

16 [2.99]

194 [36.2]

13 - 15 Years

N = 447

102 [22.82]

58 [13]

26 [5.8]

20 [4.8]

3 [0.7]

1 [0.22]

18 [4.03]

228 [51]

Total

N = 1265

172 [13.6]

156 [12.3]

59 [4.7]

64 [5.1]

9 [0.7]

10 [0.8]

35 [2.8]

505 [39.9]

χ2 Value

(df- 2)

46.07

0.496

2.13

0.51

0.690

5.355

8.807

 

P value

< 0.000*

0.78

> 0.10

0.50

0.70

0.07

0.012*

 

Table II. Age Wise Distribution of Eye Problems

 

Eye Problems

Sex

Total [%]

n = 1265

χ2  Value

(df-1)

P

Value

Boys [%] n = 510

Girls [%] n = 755

Defective Vision

46 [9.02]

126 [16.69]

172 [13.6]

15.40

< 0.000*

Squamous Blepharitis

75 [14.7]

81 [10.7]

156 [12.3]

4.491

0.034*

Conjunctivitis

30 [5.9]

29 [3.8]

59 [4.7]

2.65

> 0.10

Vernal Conjunctivitis

33 [6.5]

31 [4.1]

64 [5.1]

3.35

> 0.05

Stye

4 [0.78]

5 [0.66]

9 [0.7]

0.064

0.80

Squint

5 [0.98]

5 [0.66]

10 [0.8]

0.393

0.531

Conjunctival Xerosis

18 [3.5]

17 [2.2]

35 [2.8]

1.858

0.173

Total

211 [41.4]

294 [38.9]

505 [39.9]

 

 

Table III. Sex Wise Distribution of Eye Problems

 

Eye Problems

Caste

Total

n = 1265 [%]

χ2

(df-2)

p

Value

Backward Class

n = 291 [%]

General Caste

n = 551 [%]

Scheduled Caste

n = 423 [%}

Defective Vision

32 [11]

85 [15.4]

55 [13.0]

172 [13.6]

3.40

> 0.1

Squamous Blepharitis

36 [12.4]

68 [12.3]

52 [12.3]

156 [12.3]

0.001

1.00

Conjunctivitis

8 [2.8]

25 [4.5]

26 [6.2]

59 [4.7]

4.63

0.10

Vernal Conjunctivitis

15 [5.2]

28 [5.1]

21 [5.0]

64 [5.1]

0.02

> 0.50

Stye

1 [0.3]

5 [0.9]

3 [0.2]

9 [0.7]

0.852

0.653

Squint

0 [0.0]

5 [0.9]

5 [1.2]

10 [0.8]

3.249

0.197

Conjunctival Xerosis

9 [3.1]

8 [1.5]

18 [4.3]

35 [2.8]

7.166

0.028*

Total

101 [34.7]

224 [40.7]

180 [42.6]

505 [39.9]

 

 

Table IV. Caste Wise Distribution of Eye Problems

 

Eye

Problems

Father’s Literacy

Total

n = 1223

[%]

χ2

(df-4)

P

Value

Illiterate

n = 257

[%]

Primary

n = 193

[%]

Middle

n = 270

[%]

Matric

n = 349

[%]

≥Intermediate

n = 154

[%]

Defective Vision

36 [14]

28 [14.5]

40 [14.8]

39 [11.2]

19 [12.3]

162 [13.3]

4.78

0.869

Squamous

Blepharitis

33 [12.8]

27 [14.4]

26 [9.6]

43 [12.3]

22 [14.3]

151 [12.4]

3.313

0.855

Conjunctivitis

11 [4.3]

5 [2.6]

16 [5.9]

17 [4.9]

7 [4.5]

56 [4.6]

3.34

> 0.1

Vernal

Conjunctivitis

17 [6.6]

6 [3.1]

12 [4.4]

17 [4.9]

9 [5.8]

61 [4.9]

82.08

< 0.000*

Stye

4 [1.6]

2 [1.0]

0 [0]

3 [0.9]

0 [0]

9 [0.7]

6.349

0.50

Squint

2 [0.8]

0 [0]

3 [1.1]

3 [0.9]

2 [1.3]

10 [0.8]

2.793

0.903

Conjunctival

Xerosis

11 [4.3]

8 [4.2]

4 [1.5]

11 [3.2]

0 [0]

34 [2.8]

9.886

0.1959

Total

114 [44.4]

76 [39.4]

101 [37.4]

133 [38.1]

59 [38.3]

483 [39.6]

 

 

Table V. Father’s Literacy in Relation to Eye Problems

 

Eye Problems

Mother’s Literacy

Total

n = 1254

[%]

χ2

(df-4)

p

Value

Illiterate

n = 656

[%]

Primary

n = 292

[%]

Middle

n = 163

[%]

Matric

n = 105

[%]

≥ Intermediate

n = 38

[%]

Defective Vision

95 [14.5]

36 [12.3]

18 [11]

15 [14.3]

4 [10.5]

168 [13.4]

3.25

0.904

Squamous

Blepharitis

75 [11.4]

33 [11.3]

24 [14.7]

13 [12.4]

8 [21.1]

153 [12.2]

6.098

0.297

Conjunctivitis

30 [4.6]

16 [5.5]

7 [4.3]

6 [5.7]

0 [0]

59 [4.7]

2.58

>0.50

Vernal

Conjunctivitis

43 [6.6]

14 [4.8]

4 [2.5]

1 [0.9]

1 [2.6]

63 [5.0]

9.29

0.056*

Stye

5 [0.7]

2 [0.6]

1 [0.6]

1 [0.9]

0 [10]

9 [0.7]

0.495

0.992

Squint

6 [0.9]

3 [1.0]

1 [0.6]

0 [0]

0 [0]

10 [0.8]

1.641

0.896

Conjunctival

Xerosis

23 [3.5]

8 [2.7]

0 [0]

2 [1.9]

1 [2.6]

34 [2.7]

7.652

0.176

Total

277 [42.2]

112 [38.4]

55 [33.7]

38 [36.8]

14 [36.8]

486 [38.8]

 

 

Table VI. Mother’s Literacy in Relation to Eye Problems

 

Eye Problems

Occupation

Total

n = 1223

[%]

χ2

(df-5)

P

Value

Farmer

n = 437

[%]

Labourer

n = 435

[%]

Shop Keeper

n = 163 [%]

Govt. Job

n = 71

[%]

Driver

n = 41

[%]

Others

n = 76

[%]

Defective Vision

62 [14.2]

60 [13.8]

16 [9.8]

7 [9.9]

5 [12.2]

12 [15.8]

162 [13.3]

3.29

>0.50

Squamous

Blepharitis

57 [13.0]

60 [13.8]

15 [3.1]

5 [7.0]

1 [2.4]

13 [17.1]

151 [12.4]

11.652

0.167

Conjunctivitis

23 [5.3]

22 [5.1]

5 [3.1]

2 [2.8]

1 [2.4]

3 [4.0]

56 [4.6]

2.69

>0.50

Vernal

Conjunctivitis

19 [4.3]

22 [5.1]

10 [6.1]

4 [5.6]

2 [4.9]

4 [5.3]

61 [5.0]

1.03

>0.50

Stye

4 [0.9]

4 [0.9]

0 [0]

0 [0]

0 [0]

1 [1.3]

9 [0.7]

3.304

0.914

Squint

4 [0.9]

4 [0.9]

0 [0]

1 [1.4]

1 [2.4]

0 [0]

10 [0.8]

4.195

0.839

Conjunctival

Xerosis

12 [2.7]

15 [3.5]

3 [1.8]

1 [1.4]

0 [0]

3 [4.0]

34 [2.8]

3.566

0.894

Total

181 [41.4]

187 [42.8]

49 [30.1]

20 [28.2]

10 [24.4]

36 [47.4]

483 [39.5]

 

 

Table VII. Relation of Eye Problems with Father’s Occupation

 

DISCUSSION

The present study observed that out of total 451 children (35.65%) were having one or more eye problems. This finding is similar to those of Shreshtha et al6 (34.2%). Gupta Madhu et al7 observed 31.6%, Rajesh et al8 observed 24.6%,  Kuruvilla et al9 observed 12.5%, Pankaj Kumar et al10 found 11.5% and Nepal et al11 observed 11% prevalence of ocular morbidity in school children. In this study, overall prevalence of ocular morbidity was 39.9%.

Khurana et al12 observed 58.77% ocular morbidity in 1984 in school children (4 - 18 yrs.) of Rohtak City. The observed difference may be due to difference of studied age group and urban area and the study being old.

In this study, most of the morbidities (51%) were found in oldest age group (13 - 15 yrs.), while least morbidities (29.4%) in the youngest age group (6 - 10 yrs.). Strong significant association was found with increase in age group in cases of defective vision and conjunctival xerosis. Prasanna et al13 also showed an increase in ocular morbidity with age.

Fathers of 503 students (39.8%) were educated up to matriculation and above. While mothers of only 143 students (11.3%) were educated up to this level. Vernal Conjunctivitis shows significant association with father’s literacy. Pankaj                et al10 and Deshpande et al14 observed a significant association of ocular morbidity with mother’s and father’s literacy status. Dandona et al15 Murthy et al16 and Trivedi et al17 observed a significant association of myopia in the child with higher educational status of the father.

In the present study, the prevalence of squamous blepharitis was found to be 12.3%, which was much more than the prevalence found in other studies, i.e. Prajapati P et al18 observed 5.7%, Rajesh et al8 observed 1.3%, Kumar R et al19 observed 1%, Deshpande et al14 observed 0.96%, Trivedi et al17 observed 0.93% and Kuruvilla et al9 observed 0.14% prevalence of squamous blepharitis. The difference may be because of rural area chosen for the present study.

In this study, the prevalence of conjunctivitis was found to be 4.7%. This is similar to those of Kumar R et al,19 where in the prevalence was found to be 4.6%. Trivedi et al17 observed 5.1%, Rajesh et al8 4.3%, Prajapati P et al18 3.8%, Deshpande et al14 2.57%, Prasanna et al13 2.3%, Shaffi et al20 1.5%, Kuruvilla et al9 observed 1.1% prevalence and Khurana et al12 observed 23.43% prevalence.

In the present study, the prevalence of vernal conjunctivitis was found to be 5.1%. This is higher than that found in other studies like Kehinde AV et al21 (4.55%), Shaffi et al20 (0.7%) and Kuruvilla et al9 (0.66%). The higher prevalence may be because the spring season was also included in this study.

In the present study the prevalence of stye was found to be 0.7%, which is slightly lower than that reported by Deshpande et al14 (1.74%) and Kumar R et al19 (1.3%). Rajesh                et al11 found 1.0% and Madhu et al7 observed 0.9% prevalence.

In this study, the prevalence of strabismus was found to be 0.8%. This finding is similar to those of Prasanna13 (0.77%). Khurana et al12 reported 0.66%, Murthy et al16 reported 0.53%, Kuruvilla et al,9 Gupta Madhu et al7 and Singh Harpal et al22 reported 2.02%, 2.5% and 2.08% prevalence of strabismus respectively. In the present study, strabismus was more prevalent in lower age groups.

In this study the prevalence of Vit. A deficiency was found to be 5.4%, which is more than Kehinde AV21 (4.55%). Singh Harpal22, Deshpande et al14 and Prajapati P et al18 recorded much higher prevalence of 13.66%, 25.58% and 29.3% respectively in school children.

In the present study, night blindness was observed in 2.6% children. This finding is greater than 0.30% as reported by Khurana et al.12

Conjunctival xerosis was recorded in 2.8% students in this study. Nepal et al11 recorded 0.36% prevalence. In the present study, conjunctival xerosis was found to be more in higher age groups and this association was significant.

Not a single case of Bitot’s spot was recorded in this study. This finding is similar to those of Shaffi et al,20 wherein the Bitot’s spots were prevalent in only 0 - 5 yrs. of age and no case was found in 6 - 15 yrs. of age group. Trivedi et al18 recorded 3.9% prevalence. Kuruvilla et al9 recorded 0.43% prevalence.

In this study, the prevalence of corneal opacity was found to be 0.15%. This finding is quite similar to 0.18% recorded by Khurana et al.12 Kehinde et al21 recorded 0.08% and Singh Harpal22 observed much higher prevalence 5.86% in school children.

In the present study, the prevalence of ocular injuries was found to be 2.13%. Deshpande et al14 and Singh Harpal et al22 reported 3.48% and 5.33% prevalence. In this study, prevalence of ocular injuries was more in boys as compared to girls and this difference is statistically significant. The reason may be the higher outdoor exposure in boys. Nystagmus was found in 5 students (0.4%) in this study.

 

CONCLUSION

Ocular morbidities among school going children can be easily identified by regular eye screening programmes and if treated promptly reduces the visual disabilities. The present study shows defective vision in one or both eyes and squamous blepharitis are the main causes of visual disability in school children. The eye health awareness among school children and school teachers help in reducing ocular morbidity, so that they can attain their full potential in the course of their education.

Recommendations

Eye checkup should be done at the time of entry in school and periodic evaluation of eye screening programme should be done. A good functioning referral system should be attached to the school health services. School health records should be maintained for followup. Community based vision screening programme should be encouraged and provision of good quality and affordable spectacles should be an integral part of the vision screening programme. Chaupal and other religious places can be used for spreading awareness regarding common eye diseases and advocating the need to focus on the health status of the growing children.

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