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IJCRR - 5(14), July, 2013

Pages: 69-76

Date of Publication: 29-Jul-2013

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COMPARATIVE STUDY OF PREVALENCE OF OCULAR MORBIDITY AMONG SCHOOL GOING CHILDREN OF GOVERNMENT AND PRIVATE SCHOOLS IN RURAL KARNATAKA, SOUTH INDIA

Author: Prasanna Kamath B.T, Girish M. Bengalorkar, B.S.Guru Prasad

Category: Healthcare

Abstract:Background: School children are affected by various eye disorders like refractive errors, squint, Vitamin A deficiency and eye infections. Children do not complain of defective vision. Uncorrected refractive errors form the primary cause for visual impairment and blindness in India. This warrants early detection and treatment of these problems to prevent future blindness. Aims: The study was conducted with the objective of comparing the prevalence of ocular problems among school going children studying at a government and a private school in rural area and to create 'eye-health awareness' among them. Method: This was a cross-sectional study of school children of two schools, one a government school and another private residential school in rural area of Karnataka state. The students were screened for eye disorders by visual acuity testing, anterior segment torch light examination and fundus examination with undilated pupil. Those children identified with ocular disorders were subjected for detailed examination at our tertiary care hospital. Results: A total of 700 children at government school and 600 among private school were examined. The prevalence of ocular morbidity was 74.29% among government school children and was only 10.33% among private school children. Vitamin A deficiency was conspicuously seen only among the government school children (62.7%). Refractive error was the commonest morbid condition among the private school children (6.5%). Conclusion: Ocular disorders among school going children can be easily identified by regular eye screening programmes, promptly treated can be protected from future complications and childhood blindness can be prevented.

Keywords: Eye screening, ocular disorders, refractive errors, rural area, school children.

Full Text:

INTRODUCTION
School health is an important aspect of any community health program. The school age is a formative period, physically as well as mentally, transforming the child into a promising adult. Health habits formed at this age will be carried to adult age, old age and even to the next generation. Poor vision in childhood affects performance in school and has negative influence on the future life of the child. Integration of vision screening and refractive services for school student with screening for health issues is recommended by World Health Organization.1,2 The relationship between scholastic performance and health status of children, in particular eye health is well established. School children are affected by various eye disorders like refractive errors, squint, Vitamin A deficiency and eye infections. Uncorrected refractive errors form one of the important causes of visual impairment and blindness in most developing countries including India. This along with Vitamin A deficiency forms a major preventable cause of blindness in the young age group i.e. <20years. Considering the fact that 30% of India’s blind lose their sight before the age of 20years, the importance of early detection and treatment of ocular morbidity and visual impairment in young children is obvious.3 Children do not complain of defective vision, and may not even be aware of the condition. They try adjusting to the problem of defective vision by sitting in the front benches, holding the books close to their eyes, squeezing the eyes. The earliest signs of refractive errors are strainful eyes with or without redness by evening, with watering and headache. These complaints of the child to the parents go unnoticed due to lack of awareness, more so among the children studying at a government school in the rural areas. This warrants early detection and treatment of ocular problems to prevent future blindness. Effective methods of vision screening in school children are useful in detecting correctable causes of decreased vision, especially refractive errors.4 School children form a sizeable segment of the community. Children in school going age group (6-15years) represent 25% of the population in developing countries5 . They are easily accessible and schools are the best forum for imparting health education to the children. Schools are also one of the best centres for effectively implementing the comprehensive eye health care programme4 . The importance of visual acuity was identified for the first time in United States during Second World War6 and in India; Mukherjee et al 7 stated the importance of early detection and treatment of refractive errors to prevent permanent disability. Magnitude and causes of uncorrected refractive errors differ in the urban and rural areas of India. Therefore refractive eye services are to be modified according to the situation in various areas of developing countries.8 The eye problems happen to go undetected and untreated among the government schools. More over data about these ocular problems are not available in this rural part of our country. Hence the study was conducted with the primary objective of comparing the prevalence of ocular problems among government and private school children in rural area, secondarily to provide appropriate treatment and also to create ‘eyehealth awareness’ among school children in rural area.

MATERIALS AND METHODS
Study Sample: Two schools were selected randomly of the six schools in the field practice area of Department of Community Medicine, Sri Devaraj Urs Medical College, Kolar. The government school had student strength of 715 and the other a private school had 605 students, both in rural areas. Study Setting: All the students in the two schools were included in the study considering the absentees on the days of examination. The principals and teachers of the schools were informed and explained about the study and permission for the visit was obtained in advance. Official written permission to conduct study was also taken. The principals in turn communicated to the parents and written consent was taken in their school diaries. They were ensured strict confidentiality and informed consent was taken from each participant. Design: It was a cross sectional study in two stages. In the first stage the general data regarding the age, gender, address, parents, was collected using a pre-tested structured questionnaire. Information was obtained from the children in the local language and entered in English language in the questionnaire. The students were screened for eye disorders by visual acuity testing, anterior segment torch light examination and fundus examination with undilated pupil. Visual acuity was assessed using Snellen’s chart; color blindness was checked by using Ishihara’s chart. Vitamin A deficiency was diagnosed if there was history of night blindness, or on examination there were signs of conjunctival xerosis, Bitot’s spots, corneal xerosis, or keratomalacia. Examinations were performed in the schools. All the children present at the time of visit were examined. Those children absent were informed about the same and made to undergo examination on a scheduled day. This eye screening was performed at the school itself by the doctors who were trained with the requisite skills by an eye specialist (ophthalmologist) at our hospital. In the second stage those children identified with ocular disorders were subjected for detailed examination at our tertiary care hospital by specialists on a scheduled day for further evaluation, classification and quantification of types of ocular problems, appropriate medical treatment and suitable spectacle correction. The data was analyzed using Epi Info. The chisquare test was used to test differences in proportions. The difference was considered to be statistically significant if p value was <0.05.

RESULTS
A total of 1300 children (20 students were absent in spite of our persistent efforts) were examined for ocular morbidity belonging to two schools. Table 1 shows the gender distribution of the study population. The overall proportion of boys (60.77%) was more compared to that of girls (39.23%). Boys and girls were more equally distributed among the private school (55% to 45%) as compared to the government school (65.71% to 34.29%). Table 2 shows that the proportion of children in younger age groups was more compared to older age groups, which was observed to be the same in both the schools. Table 3 shows proportion of ocular morbidity among study population. Vitamin A deficiency was the chief morbidity among the children (33.8%) followed by refractive errors (5.6%) and conjunctivitis (2.3%). The least problem was squint of 0.7%. Here the notable difference was that Vitamin A deficiency was seen only in the government school students and the prevalence was 62.7%. The refractive error was the commonest problem among the private school going children (6.5%) and all of them were detected and treated. While refractive error among the government school children was to the extent of 4.7% and none of them were detected and treated. Table 4 shows that ocular morbidity was least among primary school children (41.3%) followed by middle school and high school children with 42.9% and 56.5% respectively. Vitamin A deficiency was highest in the primary school children (57.3%) and least among high school children (17.3%).This difference was found to be not statistically significant. On the contrary refractive error increased as age increased i.e. 9.72% among primary school, 27.78% among middle school and a maximum of 62.50% among high school children. This was highly significant statistically (χ²=95.85, p<0.001). This proportionate increase in the prevalence of refractive error was seen among both the government and private school children. Middle school children were least affected with conjunctivitis and external hordeolum. Refractive errors were slightly more among the boys (55.56%) as compared to girls (44.44%). This difference was not statistically significant.

DISCUSSION
The present study shows high prevalence of ocular morbidity among school children in rural areas. This shows the need to implement the eye checkup compulsorily in the school health appraisal programme. In the present study, prevalence of ocular morbidity was 44.77% comparable to the one reported by Chaturvedi et al (more than 40%) in rural Delhi9 and Kalikivayi et al (43.5%) at Hyderabad10 but a lower prevalence was reported by Rajesh Kumar et al (24.6%) from Delhi11 , Jayanth D and Malathi K (27.65%) from rural Maharashtra12 and Madhu Gupta and others (31.6%) from Shimla13. Least prevalence of 13% was reported by Prajapati P et al among adolescents of Gandhinagar district3 and 15.6% by Wedner SH et al in rural Tanzania 14. The prevalence of ocular morbidity varies at different places due to different factors prevailing at different places. Vitamin A deficiency was the commonest ocular morbidity (33.8%) which manifested as bitot spots and conjunctival xerosis. In a study at rural north Mahrashtra by Jayant D and Malathi, 25.58% Vitamin A deficiency was reported 12 and 29.3% was noted by Prajapati et al at Gandhinagar3 . Mausami Basu et al reported 11.83% of conjunctival xerosis among students at Surat15 and Bhattacharya et al observed 8.16% Vitamin A deficiency among primary school students in Darjeeling district16 but S.Mahapatro et al noted least prevalence 2.25% Vitamin A deficiency in Bhubanesar17 . In the present study Vitamin A deficiency was more among primary school children and decreased as they reached high school. This was probably due to better eating habits as the child grew up. The reason for high prevalence of Vitamin A deficiency in our study may be that the study was done in rural area where majority of them belonged to low socioeconomic status and also under nutrition was seen. Vitamin A deficiency manifestations in eye were more among girls as compared to boys which was highly significant statistically (p<0.001). This may be due to the fact that male children are given more importance with respect to diet in terms of types of food given. Uncorrected refractive error was the second common morbid condition (5.6%) among the children comparable to the study by Jayant D and Malathi K in rural Maharashtra12 and S Mahapatro et al at Bhubanesar17. Madhu Gupta et al at Shimla had identified refractive error as the commonest morbidity among children (22%) 13 in their study and Prajapati et al also had observed it as the commonest with a prevalence of 40.1% in their study at Gandhinagar3 . Higher prevalence of refractive error of 32% has been reported by Kalikivayi in a study from South India10 and 61% among children in rural population of India by Dandona R et al18. In a study at Pune among adolescent school children Col A Datta et al noted 21.19% of refractive error19 . In our study refractive error increased with age and this was statistically significant. Similar pattern has been noted by S Mahapatro et al at Bhubanesar17 and also by Goh PP et al in Malaysia20. Screening for refractive errors is an integral part of School health problem. Unfortunately it is not taken seriously and children suffering with refractive errors are still high. Prevalence of conjunctivitis was 2.3% in our study, similar to the one reported by Jayant D and Malathi K (2.57%) at rural Maharashtra12 , but more than that studied in Shimla (0.8%) by Madhu Gupta et al13 and less than that by Prajapati (3.8%) et al at Gandhinagar3 , and Kumar R et al (4.6%) in urban and rural Delhi21 . This high prevalence may be explained by the fact that most of the children were from lower socioeconomic status and so more likely for the poor personal hygiene. Table 5 shows the comparison of the prevalence of different ocular morbidities in our study and other studies at different places. Prevalence of Vitamin A deficiency was significantly high in our study and that was seen only among the government school children and this could be due to the fact that the students in the government school belong to lower socio economic status and our area is one of the most backward areas in the country. Prevalence of refractive errors was least among the various studies and this may be because the children did not have risk factors like reading in badly illuminated areas, over exposure to television or the computers due to their rural background. Conjunctivitis was similar in other studies but for that conducted at Shimla which is an urban area.12, 13, 17 The study showed an increase in morbidity with age. This may be due to the fact that the dropout rate from school was high due to poverty, and refractive error related to habits like prolonged study hours, watching television bad reading posture increased and hygienic practice related problems like blepharitis, external hordeolum also increased.

CONCLUSION
The study clearly indicates the prevalence of ocular morbidity among school going children in rural Karnataka, India is high. Vitamin A deficiency and refractive errors are the most common ocular disorders identified which are the preventable and treatable causes of childhood blindness and visual impairment identified by the World Health Organization under Vision 2020 programme. The undetected refractive errors are seen in the government school children and need to be provided with corrections and regular follow up. Both these conditions can be easily identified by regular eye screening programmes and promptly treated so that the future citizens of our country are protected from becoming blind. The awareness among school teachers should also be improved and they should play an active role in identifying the ocular problems and referring them for timely management. Lastly, it is high time that we identify one month in a year and designate it as “Child’s Eye Health and Safety Month” to conduct eye screening for morbidities among school children, their management and to spread awareness regarding Eye Health. In India importance is given when a program is conducted in a campaign mode, but when it is integrated into regular health services the programme loses its importance. A strict monitoring of school health programme has to be implemented with accountability and suitable action needs to be taken.

ACKNOWLEDGEMENTS
We would like to thank the heads of the institution, the teachers and more so the students for having been very co-operative in the collection of the data. We thank our entire department faculty for being encouraging and supportive throughout this study. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Name of Ethical Committee-Institutional Ethics Committee of Sri Devaraj Urs Medical College, Kolar, Karnataka, India

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A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19

A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18

A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17

A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16

A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15

A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020

A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"

A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13

A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for Vol 12 issue 12

A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for Vol 12 issue 11

A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for Vol 12 issue 10

A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for Vol 12 issue 09

A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for Vol 12 issue 08

A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for Vol 12 issue 07

A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20

A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR

A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13

A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR

A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR.

A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award

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