Dr. Margaret W Njuguna Dr. Lucy Njambi Ombaba PREVALENCE, KNOWLEDGE, ATTITUDE AND PRACTICES IN REFRACTIVE ERROR AMONG HIGH SCHOOL STUDENTS IN NAIROBI COUNTY Dr. Margaret W Njuguna Dr. Lucy Njambi Ombaba

Review of research literature Uncorrected refractive error(RE) Global magnitude of uncorrected RE- leading cause of visual impairment and blindness 43% of visual impairment due to Uncorrected RE 80% of visual impairment worldwide can be avoided or cured In children it may hinder school performance and lead to development of amblyopia. Among the causes of blindness, refractive error ranks second to cataracts as a cause of blindness. Uncorrected refractive error accounts for visual impairment in 153 million people. Eighty percent of all visual impairment worldwide can be avoided or cured. About 90% of the world’s visually impaired live in developing countries1. Uncorrected refractive errors have a huge socioeconomic and psychological impact. In children it may hinder school performance and lead to development of amblyopia 1.Resnikoff S, Pascolini D, Mariotti SP, et al. Global Magnitude of visual impairment caused by uncorrected refractive errors in 2004. Bull world health Organ 2008; 86 2.WHO fact sheet on RE 2014

Review of research literature Knowledge, attitude and practices(KAP) of refractive error Lack of knowledge and stigmas plays a major role in uptake of refractive services in different continents the lack of knowledge and awareness of RE are important risk factors for uncorrected RE 2,3,4 2.Congdon N., Z. m. (2008). prevalence and determinants of spectacle non-wear among rural Chinese secondary school children. Arch Ophthalmol., 1717-1723. 3.Ebeigbe, J. (2013). attitude and beliefs of Nigerian undergraduates to spectacle wear. Ghana Medical Journal. 4.Rosman M, W. T. (2009). Knowledge and beliefs associated with refractive errors and undercorrection: the Singapore Malay Eye Study. Br J Ophthalmol.

Study justification Uncorrected RE -public health concern. Uncorrected RE hampers performance at school, reduces productivity and impairs quality of life. Lack of knowledge, stigma and erroneous beliefs towards RE plays a major role in uptake of refractive services .2,3,4 Hardly any studies address KAP in refractive error Assessing KAP gaps will justify intervention programmes 1.H.Nzuki. (2004). 2. Helen Significant refractive errors as seen in standard eight pupils attending public schools in langata Division, Nairobi, K 2.Congdon N., Z. m. (2008). prevalence and determinants of spectacle non-wear among rural Chinese secondary school children. Arch Ophthalmol., 1717-1723. 3.Ebeigbe, J. (2013). attitude and beliefs of Nigerian undergraduates to spectacle wear. Ghana Medical Journal. 4.Rosman M, W. T. (2009). Knowledge and beliefs associated with refractive errors and undercorrection: the Singapore Malay Eye Study. Br J Ophthalmol enya 2004

Study Objectives Broad objective To determine the prevalence, knowledge, attitude and practice in refractive errors among high school students in Nairobi county. Specific objectives To determine the prevalence of refractive error among high school students To assess the knowledge of refractive error among high school students To determine the attitude of high school students towards refractive errors To determine the practice in refractive error of high school students

Methodology Study design Cross sectional school based study with a qualitative component Study population Form 3 high school students in public high schools in Nairobi County Study area Nairobi county-80 public high schools in 10 divisions

Methodology Sample size calculation and Sampling Method Parameters Estimate of the expected proportion (p) Desired level of absolute precision (d) Estimated design effect (DEFF) Confidence limit (usually 95% and Z score

Methodology Sample size calculation and Sampling Method n = 1.962 x 0.1 x 0.9 (1.5) 0.022 n = 1297 To estimate the assumed prevalence of refractive error 10% with 95% CI (8% - 12%) among high school students, adjusting for the design effect of 1.5 and confidence limit (usually 95% and Z score = 1.96), the final minimal sample size will be 1297 Factor 10% to end up with 1500 Total number 37580

Methodology Sampling the Procedure Stratification/Categories of schools- National schools, County schools and District schools Sub-stratified into boy, girl & mixed Schools from each category will be randomly selected using spreadsheet program Participants will be form 3 students Participants will be allocated a study number

Study area- Nairobi County starehe westlands dagoretti

Sampling frame of high school students in Nairobi County News letter of high school performance 1000-1500 in National schools, 300-900 in County schools and 200-400 in the District schools

Data collection procedure Presenting VA-Log MAR chart 3m VA better than 6/12 in better eye. Record VA Spectacles-VA sc&cc RE&LE VA worse or equal to 6/12 in the better eye Power of spectacle - Lensometer Objective refraction & subjective refraction Plano/ 0.25 DS/DC RE ≥0.50 DS/DC VA doesn’t improve by 2 lines VA improves 2 lines or more=RE Anterior and posterior segment examination- recordyytyffcnhhg KAP=FGD or IDI KAP FGD or IDI

Data management Data analysis -SPSS 20.0. and Computer Assisted/Aided Qualitative Data Analysis Software (CAQDAS). Double data entry to ensure accuracy. Proportions will be used to estimate the prevalence of R.E and proportion of students knowledgeable in refractive errors. Responses to the KAP questions will be scored. Participants with RE will be assessed in terms of KAP towards RE and access to ophthalmic services. Results will be presented using ratio, proportion, rates, tables and diagrams wherever appropriate.

Ethical considerations Approval -Ethical Committee of University of Nairobi – Kenyatta National Hospital. Permission -Permanent Secretary, Ministry of Education and Head teachers of schools Assent- Participants. Confidentially of participants records. Spectacle prescription and follow up for participants with RE. Students with other ocular disease will be referred to eye centers.

Tentative Timetable Ethical Approval by April 2014 Collection of data May- June 2014 Data Analysis July-August 31st 2014 Presentation of results September 2nd 2014 Hand in bound book by January 1st 2015