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Background: There is a high prevalence of childhood eye disorders with significant potential of causing blindness or systemic co-morbidities, and even death if left untreated. Various challenges are encountered in prompting accurate and timely diagnosis of these childhood eye disorders to ensure proper management or referral. In developing countries, primary health workers are very crucial in determining the plan of management of these conditions as majority of affected individuals do not get the privilege of meeting eye specialists at initial presentation. Being the health workers on the ground, it is important for them to have knowledge of key childhood eye disorders.

Aim: This study determined the knowledge, attitude and practice in assessment of childhood ocular disorders among primary health workers in Garissa district in Kenya.

Methods: A cross-sectional study was conducted between December, 2013 and January, 2014 in health centers and dispensaries within Garissa district. Quantitative data was collected using semi-structured questionnaires among 45 PHW. The process was through direct interview where the participants were asked questions and shown pictures of various childhood ocular disorders. All analyses were performed using STATA version 11(Stata Corp. College Station, Texas)

Results: Only 1(2.22%)  PHW had post qualification primary eye care training. The duration of training was 5 days. About half  (51.11%) of PHW accurately diagnosed ophthalmia neonatorum although 66.67% were able to identify both purulent discharge and swollen eyelids. 93.34% mentioned eye medication for treatment, 88.89% would use TEO alone. Only 6 (13.33%) PHW correctly diagnosed congenital glaucoma while most (71.11%) would refer. Among the respondents, 36 (80.00%) correctly diagnosed squint and 29(64.44%) would refer immediately. Majority (91.11%) of the respondents were able to identify leukocoria correctly, (46.67% mentioned white eye reflex while 44.44% identified it as lens opacity). Majority (64.44%) attributed the condition to cataract and only 3% to retinoblastoma. There is poor knowledge of other possible causes of leukocoria, especially life threatening conditions such as retinoblastoma, however 43 (95.55%) of the PHW interviewed would refer a child with leukocoria. Only 6 (13.33%) PHW identified corneal ulcer and 35(77.78%) would refer immediately. All the respondents were able to identify the red eye and majority (64.44%) would give eye medication alone. Most (80.00%) of PHW attributed use of spectacles to poor vision and only 2(4.44%) mentioned refractive error. Majority (77.78%) of PHW would refer a child with refractive error to eye clinic for evaluation and further management. Most (66.67%) PHW would diagnose child with ocular manifestations of vitamin A deficiency through history of night blindness (93.33%) and 31(68.89%) would give vitamin A. Only 2(4.44%) PHW use Kenya childhood eye diseases manual and 16 (35.56%) reported that they fill eye section in MCH booklets. Over 50% of PHW believe that the childhood ocular conditions could lead to visual loss except for squint where 53.33% disagreed.

Conclusion: There was generally poor knowledge in diagnosing glaucoma, corneal ulcer, refractive error, ocular manifestations of vitamin A deficiency and identification of other possible causes of leukocoria apart from cataract. However identification of ophthalmia neonatorum, squint, red eyes and leukocoria was good. Most PHW were positive that childhood ocular disorders could lead to vision loss except for squint. They also showed good advocacy for use of spectacles in children. Approach in management was poor for ophthalmia neonatorum, vitamin A deficiency, red eyes and corneal ulcers. There was also poor utilization of childhood eye disease manual and eye section in MCH booklets among the participants.


Dr Samuel Mbogo
Dr Kahaki Kimani
Dr Lucy Njambi

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