OJHAS Vol. 9, Issue 4:
|Prevalence of Ocular Morbidity Among School Adolescents
of Gandhinagar District, Gujarat
Prajapati, Assistant Professor, Department of Community Medicine, MP Shah Medical College, Jamnagar, Gujarat, India
Oza, Assistant Professor, Department of Community Medicine, MP Shah Medical College, Jamnagar, Gujarat, India
Prajapati, Tutor, Department of Community Medicine, BJ Medical
College, Ahmedabad, Gujarat, India
Geeta Kedia Professor & Head, Department of Community Medicine, BJ Medical
College, Ahmedabad, Gujarat, India
Chudasama, Associate Professor, Department of Community Medicine, MP Shah Medical College, Jamnagar, Gujarat, India
Dr. Rajesh K Chudasama,
Address For Correspondence
Mato Shree Complex,
Sardar Nagar Main Road,
Rajkot Ė 360 001,
Prajapati P, Oza J, Prajapati J, Kedia G, Chudasama RK. Prevalence of Ocular Morbidity Among School Adolescents
of Gandhinagar District, Gujarat. Online J Health Allied Scs.
Submitted: Dec 23,
2010; Accepted: Dec 31, 2010; Published: Jan 20, 2011
To study the prevalence of ocular morbidity (abnormal condition) and
various factors affecting it among school attending adolescents. Methods:
A cross-sectional study was conducted to study abnormal ocular conditions
like refractive errors, vitamin A deficiency, conjunctivitis, trachoma,
ocular trauma, blephritis, stye, color blindness and pterygium among
school adolescents of 10-19 years age in rural and urban areas of Gandhinagar
district from January to July, 2009. Systematic sampling was done to
select 20 schools having 6th to 12th standard
education including 12 schools from rural and 8 from urban areas. Six
adolescents from each age year (10-19) were selected randomly to achieve
sample size of 60 from each school. In total, 1206 adolescents including
691 boys and 515 girls were selected. Information was collected from
selected adolescents by using proforma. Visual acuity was assessed using
a Snellenís chart and all participants underwent an ophthalmic examination
carried out by a trained doctor. Results:
Prevalence of ocular morbidity among school adolescents was reported
13% (7.8% in boys, 5.6% in girls); with 5.2% have moderate visual impairment.
Refractive error was most common ocular morbidity (40%) both among boys
and girls. Almost 30% of boys and girls reported vitamin A deficiency
in various forms of xerophthalmia. Prevalence of night blindness was
0.91% and of Bitot`s spot 1.74%. Various factors like, illiterate or
lower parentsí education, lower socio-economic class and malnutrition
were significantly associated with ocular morbidity. Conclusion:
Ocular morbidity in adolescents is mainly due to refractive error, moderate
visual impairment and xerophthalmia.
Adolescents; Ocular morbidity; Refractive error; Xerophthalmia; Malnutrition
Eyes are the
most treasured organ of human beings. Much ocular morbidity (abnormal
ocular conditions) originates in childhood and if undetected may result
in severe ocular disabilities, in addition to affecting development,
educational performance, social and employment opportunities. Ocular
morbidities include refractive errors, vitamin A deficiency, conjunctivitis,
trachoma, ocular trauma, blephritis, stye, color blindness and pterygium.
The majority of blindness is either potentially preventable or curable.
According to World Health Organization (WHO) statistics, there were
0.7 million of the world`s blind children living in South-East Asia
region.1 Blindness is one of the most significant social
problems in India. A national survey on blindness 2001-02 showed that
7% of children aged 10-14 years have problems with their eye sight.2
Considering the fact that 30% of India`s blind lose their sight before
the age of 20 years, the importance of early detection and treatment
of ocular morbidity and visual impairment in young children is obvious.3
Refractive error, trachoma, conjunctivitis and malnutrition (vitamin
A deficiency) are important causes of blindness among the younger age
groups and all are avoidable and curable. VISION 2020: The Right to
Sight is a global initiative launched by WHO in 1999 to eliminate avoidable
blindness like cataract, xerophthalmia, refractive error, trachoma and
other causes of childhood blindness by year 2020.4
based studies have estimated the prevalence for blindness as 1.25 per
1000 children in rural5 and 0.53 in urban areas6
in age group of 5-15 years. But population based data concerning
the prevalence of visual impairment due to uncorrected refractive errors
and ocular diseases in adolescents not readily available. Early detection
through regular surveys helps in ensuring prompt treatment and prevention
of serious complications such as corneal scarring from various ocular
morbidities. The present study was conducted with the objective to study
the prevalence of ocular morbidity and various factors affecting it
among the school attending adolescents in Gandhinagar district, Gujarat.
of study population & sample size:
A cross sectional study was conducted among adolescents studying from
6th to 12th standard in the age group 10-19 years.
Rural and urban areas were selected for study from Kalol taluka of Gandhinagar
district. The study was conducted from January, 2009 to July, 2009.
A pilot study was conducted before starting the study in the Kalol town
to estimate the prevalence of ocular morbidity. Total sample size was
calculated of 1200 adolescents considering a 25% prevalence of ocular
morbidity in the pilot study.
method: A systematic sampling method was used to select the study
population. The village and town wise information was collected from
district and taluka panchayats. There were in total 69 villages and
one town in the Kalol taluka with population of 3, 10, 081 as per 2001
census.7 Kalol taluka has a total of 184 schools including
primary, secondary and higher secondary education. Every 9th
school was selected and 60 adolescents were examined to achieve the
desired sample size. In total 20 schools were selected including 12
from rural areas and 8 from Kalol town as per population proportionate
to size method to get adequate representation from each standard and
area. Six adolescents from each age year (10-19) were selected randomly
to achieve a sample size of 60 from each school. In total 1206 adolescents
including 691 boys and 515 girls were selected from 20 schools studying
in 6th to 12th standard.
& Survey technique: Training for identification of various ocular
morbidity conditions and the use of a Snellenís chart was conducted
at a local institute. The trained doctor was assessed for eye examination
by an ophthalmologist in the field during pilot study. The principles
of identified schools were informed telephonically before the visit
to respective schools. In total two visits were made to each school.
During the first visit, study subjects were selected as per the sample
size for their ophthalmic examination at school level. Study subjects
were selected from those who were present on that day. Body mass index
for adolescents based on percentile developed by Agarwal KN 8
et al was used to determine the nutritional status and its effect on
occurrence of ocular morbidity. According to that criteria, adolescents
classified as (1) Underweight- <5th percentile of BMI,
(2) Normal weight- >5th to <85th
percentile of BMI, (3) Overweight- >85th to <95th
percentile of BMI, and (4) Obese- >95th percentile
and pretested proforma was given to study participants to be completed
at home by their parents/guardians regarding their socio-demographic
status and previous ocular history (previous eye examinations or injuries).
An Ophthalmic examination was carried by a trained doctor investigating
any signs of ocular morbidity with torchlight. All participants were
assessed including those not wearing or wearing glasses for refractive
error correction. A Snellen chart and refractive glasses were used to
assess the visual acuity of study participants at a distance of six
meters. If participant was not able to read a line up to 6/18 without
any refractive error correction, then we underwent for further evaluation.
Moderate visual impairment was defined by the WHO as a presenting visual
acuity < 6/18 but > 6/60 in the better eye.
9 Those study participants with visual acuity 6/18 requiring further
management or having some ocular abnormal condition were referred to
the district hospital for further investigation and management. Ishihara's
isochromatic chart was used to identify the cases of red-green color
blindness. A second visit to same school was made on the next
day for collection of the given proforma. Modified Prasad`s classification
was used to calculate socio-economic class.10
All the data were entered in MS excel 2007 and analyzed by using Epi
Info software, version 3.5.1. Appropriate statistical test like chi-square
or Fischerís tests were applied to detect any significant association
at 95% Confidence Interval (CI) was there or not.
study was conducted among school adolescents aged 10-19 years in Gandhinagar
district. In total, 1206 students were examined including 57.3% boys
and 42.7% girls (Table 1). Among study participants, 58% were residing
in a rural area, and 55% have nuclear family. Only 5% of fathers and
17.5% of mothers were illiterate. The majority of fathers (65.9%) were
engaged in unskilled work. Almost 50% of families belonged to lower
(IV & V) social class as per modified Prasad`s classification. The
prevalence of ocular morbidity among school adolescents was reported
13% (7.8% in boys, 5.6% in girls) having at least one abnormal ocular
condition; with 5.2% have moderate visual impairment. Body mass index
was measured and 15.2% adolescents found overweight/obese and 5.2% underweight.
Table 1: Socio-demographic characteristics of school going adolescents aged 10-19
years in Gandhinagar district
Graduate & more
Graduate & more
wise ocular morbidity |
Mass Index (BMI)|
Table 2 shows
sex wise distribution of ocular morbidity among school adolescents.
Refractive error was the most common ocular morbidity (40%) both among
boys and girls. A positive family history of refractive error was reported
in half of the patients with moderate visual impairment. Almost 30%
of boys and girls reported vitamin A deficiency in various forms of
xerophthalmia. Few adolescents reported other abnormal ocular conditions
like blephritis (5.7%), stye (5.1%), pterygium (5.1%), conjunctivitis
(3.8%), injury (3.1%) and trachoma (2.5%).
Sex wise distribution of ocular morbidity among school going adolescents
of Gandhinagar district
||Boys (%) (n=89)
||Girls (%) (n=68)
||Total (%) (n=157)|
As per WHO
standards of prevalence of night blindness >1% and of Bitot's spot,
>0.5% considered as public health problem among preschool and school
children. The prevalence of night blindness was 0.91% and of Bitot's
spot, 1.74% (Table 3) in present study. A statistically significant
association was found between consumption of dark green leafy vegetables
(χ2=3.89, p=0.04) and animal origin food < 3 times
per week and > 3 times per week (χ2=44, p=0.00) among
adolescents showing vitamin A deficiency (n=46).
Prevalence of Xerophthalmia among school adolescents of Gandhinagar
district and its comparison with WHO standards11
Total no. (n=46)
Prevalence (%) observed
in present study
Prevalence (%) as per WHO standards*
|Corneal xerosis/ scarring
more than WHO standards will be considered as public health problem
like type of family-nuclear or joint, number of siblings, paternal education,
maternal education, parents occupational status-whether both parents
working or father only working, social class as upper & middle (I,
II & III) or lower (IV & V), and nutritional status- normal
weight or malnourished (underweight, overweight, or obese) were assessed
to determine any association with ocular morbidity among adolescents
Factors affecting ocular morbidity among school going adolescents of Gandhinagar district
|I, II &
|IV & V
significance (χ2=1.64, p=0.20) was found for school adolescents
residing in nuclear or joint family. Similarly no association (χ2=0.15,
p=0.69) was found between ocular mortality and number of siblings two
or more than two. Education of parents affects the occurrence of ocular
morbidity. Either illiterate or lower education (only up to primary
level) of father (χ2=17.71, p=0.00) and mother (χ2=5.1,
p=0.00) was significantly associated with occurrence of ocular morbidity.
No association (χ2=3.65, p=0.05) was found for parents working
status (both parents working or father only working) and ocular morbidity.
Significant number (χ2=6.57, p=0.01) of ocular morbidity
was reported among lower socio-economic adolescents (class IV &
V). Ocular morbidities were significantly (χ2=66.5, p=0.00) associated
with malnutrition (underweight, overweight or obese).
is very important to people of all ages, it is more so in children and
adolescents as it has a key role in their mental, physical and psychological
development. Most of adult blindness is easily treatable and preventable;
however, if it is not detected and prevented in time it may lead to
a permanent disability. Few reports exist regarding population based
data of the prevalence of ocular morbidity or visual impairment among
adolescents. The information gathered in the present study is vital
for planning appropriate eye care programs to reduce the burden of visual
impairment in the younger population. The present study was conducted
to determine the prevalence of ocular morbidity among the adolescents.
of ocular morbidity among boys (7.8%) was slightly higher than in girls
(5.6%). Urmil AC et al 12 reported an even higher prevalence
of ocular morbidity for boys (38.5%) and girls (28.6%) in school children
in Pune during 1988. Similar findings were reported by Kumar D et al
13 in their study at Lucknow. The present study reported ocular
morbidity in 13% school adolescents, which were lower then other studies
reported in Lucknow, India13 and in neighboring country
Nepal.14 Lower prevalence of ocular morbidity in current
study compare to previous studies may be due to improved living conditions
compare to past, with better availability of health services. Moderate
visual impairment prevalence was 5.2% reported in current study, similar
to Pune12 and Lucknow.13 The age trend in the prevalence rate was in conformity with
the Datta A et al15 study, higher in the age group 10-11
years. Prevalence of moderate visual impairment was significantly higher
among those who had family history of refractive errors.
was reported in 3.8% of school adolescents including night blindness,
Bitot`s spot and conjuctival xerosis. A nine percent prevalence of xerophthalmia
was reported in Calcutta Corporation15 and 4% in Delhi16 among primary school children. Vitamin A deficiency leads to
xerophthalmia. To reduce the prevalence of xerophthalmia, Government
of India has introduced the National programme for prophylaxis against
blindness in children caused due to vitamin A deficiency under Reproductive
and Child Health (RCH) programme.17 The prevalence of night
blindness (0.91%) does not exceed WHO standards but the prevalence of
Bitot`s spot (1.74%) suggests a public health problem of vitamin A deficiency
as per the WHO criteria.10 WHO report has stated that conjuctival
xerosis is not recommended for community diagnosis.18 The
highest numbers of xerophthalmia cases were observed in the age group
10-11 years (12.6%) and lowest in 16-17 years (1.3%). Urmil AC et al
12 reported a higher prevalence of vitamin A deficiency in boys
(17%) and girls (9.7%) compare to these study.
children, 45% adolescents were malnourished with 25.5% of these children
being overweight (25.5%). A significant association was found between
malnourished children and ocular morbidity. There was significant association
found between parents` education and development of ocular morbidity.
High prevalence of ocular morbidity was reported in adolescents whose
parents were illiterate or less education and in adolescents with both
parents working. Ahmed F et al19 have reported similar observations
in their study among school adolescents.
difference was observed between lower social class and ocular morbidity.
This may be due to better economic stability of medium and higher class
which ultimately leads to improved nutrition and hygiene of the adolescents.
The proportion of children with vitamin A deficiency was highest among
lower socio-economic class, as observed by other authors.20,21
Significant number of adolescents with vitamin A deficiency were consuming
green leafy vegetables and animal origin foods up to 3 times per week
only. Dietary deficiency of vitamin A leads to development of xerophthalmia
in those children taking insufficient green leafy vegetables and food
of animal origin as reported by other studies.19,22 A limitation of
the present study is that adolescents were selected from schools only.
The main causes
of ocular morbidity in adolescence are refractive error, moderate visual
impairment and xerophthalmia. These results and findings underline the
magnitude and severity of ocular morbidity in an age group that policy
makers do not usually consider to be at risk in this respect.
Authors are thankful to staff of schools of Gandhinagar district for
giving permission to conduct the study and all the children who participated
in the study.
Source of Funding and Competing Interests
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