1. A REVIEW OF SEVERE OCULAR TRAUMA IN CHILDREN ADMITTED IN SABATIA EYE HOSPITAL
Principal investigator: 
Dr Esevwe Sylvia Sagina
Supervisors:
Dr Kahaki Kimani
Dr Sheila Marco
Dr Sarah Sitati

2. INTRODUCTION
Ocular trauma is injury to the eyeball, adnexa, orbital and/or periorbital tissues
Most injuries occur when supervision is minimal

3. LITERATURE REVIEW

4. Background
Ocular trauma is an important, preventable, worldwide public health problem1
Estimated 18 million people worldwide with uniocular blindness from traumatic injury2
1/4 million children present with serious ocular trauma every year, majority of which is preventable2
1. Whitcher JP, Srinivasan M, Upadhyay MP: Corneal blindness: a global perspective. Bulletin of the World Health Organization, 2001, 79: 214–221.
2. Abbott, J., Shah, P. The epidemiology and etiology of paediatric ocular trauma. Surv Ophthal. 2013;58:476–485.

5. Background Cause of significant morbidity in young children 3
Murithi found that in a series of 182 children in KNH, amblyopia therapy was done in 18% of the children while refraction in only 1.6%4
3. Shoja , Miratashi AM. Pediatric ocular trauma. Aeta Medica Iranica ; 44(2):
4. Murithi, I., Gichuhi, S., Njuguna, M.W. Ocular injuries in children. East African Medical Journal. 2008; 85(1) 39-45

6. Epidemiology
Accounted for 9% in KNH Kenya5, 13.3% in Nigeria6, 11.8% in Ethiopia of childhood ocular morbidity7
In KNH, Murithi found 47.8% were blind while 5.5% were severely visually impaired in one eye4
5. Echelu, C. Traumatic eye injuries in children. M.Med Dissertation, Department of Ophthalmology, University of Nairobi, 1990.
6. Isawunmi MA: Ocular disorders amongst school children in Ilesa east Local Government area. Osun State, Nigeria: National Postgraduate Medical College of Nigeria; Dissertation; 2003.
7. Mehari: Pattern of childhood ocular morbidity in rural eye hospital, Central Ethiopia. BMC Ophthalmology :50.
4. Murithi, I., Gichuhi, S., Njuguna, M.W. Ocular injuries in children. East African Medical Journal. 2008; 85(1) 39-45

7. Classification
Adapted from Kuhn F, Morris R, Witherspoon CD: Birmingham eye trauma terminology (BETT):
Terminology and classification of mechanical eye injuries. Ophthalmol Clin North
Am 2002, 15(2):139–43.

8. JUSTIFICATION Management is challenging in children
Large numbers of children with ocular trauma in Sabatia
Scanty literature in Kenya rural setting

9. STUDY OBJECTIVES Broad objective
To review the pattern and outcome of ocular trauma in children hospitalized in Sabatia Eye Hospital between 1st January 2012 and 31st December 2014

10. Specific objectives
To determine the etiology and presentation of childhood ocular trauma in Sabatia Eye Hospital
To determine treatment of childhood ocular trauma
To determine the visual outcome and complications post ocular trauma
iv. To identify risk factors associated with ocular trauma

11. MATERIALS & METHODS

12. Study design Study area Retrospective, hospital-based case series
Sabatia Eye Hospital -tertiary/ referral eye hospital

13. Study setting
Catchment area of 15 million people; > 30,000 patients/year
Estimated no. of children managed for ocular trauma is /yr over the past 3 yrs, estimate 350 over study period

14. Study population/case
Study period
Sept 2014 to May 2016
Study population/case
All children below 16 years of age admitted with eye injuries at Sabatia Eye Hospital from 1st Jan to 31st Dec. 2014

15. Sample size
Sample size calculation was done using the following sample size formula for finite (small) population14
For statistical power purposes, an estimated 93 patients would form the minimum sample size
14. Wanga SK, Lemeshow S. Sample size determination in health studies. A practical manual. Ginebra: World Health Organization, 1991.  

16. Outcome measures
Primary outcome measure - visual acuity at last follow up period
Secondary outcomes will include complications post trauma & globe preservation

17. Data collection tool Inclusion criteria Questionnaire
All children below 16 years admitted & treated for ocular trauma at Sabatia Eye Hospital within the study period

18. Exclusion criteria
Children below 16 years admitted for treatment of long–standing complications related to trauma sustained before Jan 2012
Missing or incomplete data

19. Data collection procedure
The name, age, in-patient no. & date of admission will be obtained from theatre and in-patient registers
Files will then be retrieved from records department
Questionnaire will be used to collect data
WHO classification of VA & BETT classification of ocular trauma will be used

20. Data management
Each questionnaire will have a unique identification code
It will be coded, cleaned, validated and stored & into a computer prior to analysis
Back up will be created in an external hard disk

21. Data analysis
Data analysis will be done with the help of a biostatistician using SPSS version 20.0.
Descriptive analysis will be done to determine the frequencies and proportions of causes, epidemiology & treatment outcomes
Chi-square (χ2) test / logistical regression will be used for comparison of proportions

22. Data analysis
Statistically significant differences and associations will be based on a p-value less than 0.05
Results will be presented in form of tables, charts graphs

23. ETHICAL CONSIDERATIONS
Ethical approval will be obtained from the KNH/UON Ethical and Research Committee before undertaking the study
Patients and clinicians confidentiality will be observed
Safe keeping of files & raw data
Raw data will be discarded once all publications have been made