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Prevalence Of Conjunctivitis Amongst Primary Shool Pupils In Owerri Municipal Area Of Imo State

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ABSTRACT

Objective: To determine the prevalence of conjunctivitis amongst primary school pupils in Owerri Municipal.

Methods: A cross-sectional community-based study involving 600 students from 5 basic schools (Primary) participated in the study. Data collection started May 2018 and was completed in September 2018.After history taking, subjects underwent a battery tests; Visual acuity, Anterior and Posterior segments examination with pen torch and a direct ophthalmoscope respectively.

Result: The prevalence of conjunctivitis was 30.8%.conjunctivitis was significantly associated with gender (p<0.05) and also with age (p<0.05).185 pupils had different forms of conjunctivitis which are; bacterial conjunctivitis, allergic conjunctivitis, viral conjunctivitis and chemical conjunctivitis. Allergic conjunctivitis shows the highest of prevalence of 118(63.8%) and chemical conjunctivitis was lowest with 8(4.3%).

Conclusion: Conjunctivitis is a preventable ocular disorder. But has become endemic due to poor awareness and lack of adequate measures to contain the condition. The ethical consent of exercise is taken into consideration, and the results obtained through modern and manual method of high standards and accuracy.

CHAPTER ONE

INTRODUCTION

1.1     BACKGROUND INFORMATION

The white of the eye and the inner surface of the lids are covered by a transparent membrane called conjunctiva  Michael (2007). Conjunctivitis is any inflammation of the conjunctiva, generally characterized by irritation, itching, foreign body sensation and watering or discharge John Epling (2007).Conjunctivitis is an inflammation (redness) of the lining of the white part of the eye and the underside of the eyelid (conjunctiva). It can be caused by infection, allergic reaction, or physical agents like infrared or ultraviolet light. O’Brien (2013)

Figure 1: conjunctivitis (eMedcine.com/opto/uveatis/conjunctivitis).

Conjunctiva is a thin, translucent membrane lining the anterior part of the sclera and inside of the eyelids. It has 2 parts,bulbar and palpebral. The bulbar portion begins at the edge of the cornea and covers the visible part of the sclera; the palpebral part lines the inside of the eyelids in figure 1. Any Inflammation or infection of the conjunctiva is known as conjunctivitis (pink eye) and is characterized by dilatation of the Conjunctiva vessels, resulting in hyperemia and edema of the conjunctiva, typically with associated discharge (eMedcine.com/opto/uveatis/conjunctivitis).

1.1.1 Anatomy of The Conjunctival

Michael (2007) said that the conjunctiva is a mucous membrane that lines the inner surface of the eyelids and folds back to cover front surface of the eyeball, except for the central clear portion of the outer eye (cornea) the entire conjunctiva is transparent.

The Conjunctiva is Composed of Three Sections:

  1. Palpebral conjunctiva-cover the posterior portion of the eyeball
  2. Bulbar conjunctiva-coats the anterior portion of the eyeball
  • Fornix-the transition forming the junction between the posterior eyelids and the eyeball.

Although the palpebral conjunctiva is moderately thick the bulbar junction is very thin, it is also very movable, easily sliding back and forth over the front of the eyeball it covers. Since it is clear, blood vessels are easily visible underneath it. Within the bulbar conjunctiva are “goblet cells” which secret “Mucin” an important component of the pre-cornea tear layer that protects and nourishes the cornea. Also an increase of goblet cell will lead to a chronic inflammation which will present as conjunctivitis (red eye).onset is insidious; patient notices a fullness of the lid and a diffuse, gritty, foreign body sensation. The conjunctiva made up of the epithelium and stoma which the epithelium evolve to flattened cells and get in the conjunctiva surface where it becomes keratinized while the stoma consist of richly vascularised connective tissue separated from the epithelium by basement membrane. The stoma also contains within it the accessory lacrimal glands, the mucoid layer of tear film is secreted by the goblet cells of the conjunctiva crypts of  henle and gland of manz having the function of converting the corneal surface from hydrophilic surface.

1.1.2  Description

Conjunctivitis is an inflammation (redness) of the lining of the white part of the eye and the underside of the eyelid (conjunctiva). It can be caused by infection, allergic reaction, or physical agents like infrared or ultraviolet light O’Brien (2013).

Conjunctivitis is a common eye problem because the conjunctivas are continually exposed to microorganisms and environmental agents that can cause infections or allergic reactions. Conjunctivitis can be acute or chronic depending upon how long the condition lasts, the severity of symptoms, and the type of organism or agent involved. It can affect one or both eyes. If it is caused by infection, it can be easily transmitted to others during close physical contact, particularly among children in a daycare center. Other names for conjunctivitis include pinkeye and redeye Khurana (2012).

1.1.3 Types of Conjunctivitis

  • Allergic Conjunctivitis

It is the inflammation of conjunctiva due to allergic or hypersensitivity reactions which may be immediate or delayed. Allergic conjunctivitis occur very frequently. It is estimated to affect 20 percent of the population on annual basis and approximately one-half of these people have a personal or family history of  atopy. Allergic conjunctivitis can be divided into 5 major categories including:

  1. Seasonal allergic conjunctivitis
  2. Perennial allergic conjunctivitis
  • Vernal keratoconjunctivitis
  1. Atopic keratoconjunctivitis
  2. Giant papillary conjunctivitis
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The conjunctiva is ten times more sensitive than the skin to allergens. It is commonly associated with hay fever; with allergens such as pollens, grass and animal dandruff. It is also associated with seasonal allergens such as grass pollens. It is of very common occurrence. There is also response to perennial allergens such as house dust and mite which is not so common. Symptoms include intense itching and burning sensation in the eyes associated with watery discharge O’Brien (2013).

  • Bacteria Conjunctivitis

Bacterial conjunctivitis is inflammation of the bulbar or palpebral conjunctiva caused by bacteria. It is commonly caused by staphylococci, streptococci, chlamydial organism, and gonococci. Mild conjunctivitis is usually benign and self-limited and can be easily treated with antibiotics Khurana (2012). Conjunctiva scrapings and cultures are commonly used to confirm the microbe in severe and bacterial conjunctivitis and that resistant to antibiotic treatment. The mainstay of treatment of bacterial conjunctivitis is topical antibiotic therapy. Systemic antibiotics are indicated for chlamydial conjunctivitis. Surgical intervention is required only if the cornea is involved and results in corneal opacification. Signs and symptoms include follicles or papillae on the inflamed conjunctiva, discharge, enlarged preauricular lymph node, lid edema O’Brien (2013).

 

 

  • Acute Bacteria Conjunctivitis

Acute bacterial conjunctivitis is characterized by marked Conjunctiva hyperemia and mucopurulent discharge from the eye. So clinically it is called acute mucopurulent conjunctivitis. It is the most common type of bacteria conjunctivitis. Common causative bacteria are staphylococcus aureus, Pneumococcus and Streptococcus Abah et al., (2011). Symptoms include discomfort and foreign body sensation due to engorgement of vessels. Mucopurulent discharge from the eyes, sticking together of lid margins with discharge during sleep, slight blurring of vision, and mild photophobia. The signs include chemosis, conjunctiva congestion, and eyelids maybe slightly oedematous.  It reaches its height in three to four days. If untreated, in mild cases the infection may be overcome and the condition is cured in 10-15 days or it may pass to less intense form, the chronic catarrhal conjunctivitis O’Brien (2013).

Figure 2: Acute bacterial conjunctivitis (Slideshare.net/conjunctivitis)

  • Hyperacute Bacterial Conjunctivitis

Hyperacute bacterial conjunctivitis is a severe sight threatening ocular infection that warrants immediate ophthalmic workup and management. The infection has an abrupt onset and is characterized by a copious yellow-green purulent charge that re accumulates after being wiped away. The symptoms of hyperacute conjunctivitis which typically are rapidly progressive also include redness, irritation and tenderness to palpation. Patients demonstrate marked conjunctivainfection, conjunctivachemosis (excessive edema), lidswelling and tender pre-auricular adenopathyAdenuga et al., (2012).

The most frequent causes of hyperacute purulent conjunctivitis are Neisseria gonorrhea and Neisseria meningitis. These two infections have similar clinical presentation and they can be distinguished only in the microbiology laboratory Abbot et al., (1998).

 

 

 

 

 

Figure 3: Hyperacute bacterial conjunctivitis (eMedcine.com/opto/uveatis/).

  • Chlamydial Conjunctivitis

Ocular chlamydial trachomitis infection can occur in two distinct clinical forms: trachoma (associated with serotypes A through C) and include conjunctivitis (associated with serotypes D through K).Trachoma a chronic keratoconjunctivitis is the most common cause of ocular morbidity and preventable blindness throughout the world. It is a major public health concern in the rural area of developing countries, particularly in Africa, Asia and the Middle East Bonini et al., (1995).Active trachoma is common in North America. however, patients who have immigrated to north America countries from region in which trachoma is endemic usually present to ophthalmologist with cicatrical ocular and eyelid changes secondary to previous recurrent infectious inclusion conjunctivitis is a common, primarily sexually transmitted disease that occur in both new born (ophthalmia neonatorum) and adults(adults inclusion conjunctivitis)it is the most frequent cause of conjunctivitis in neonates followed in order of decreasing prevalence by infections with several bacteria species and finally Neisseria gonorrhea. Abbot et al., (1998).

     Figure 4: chlamydial conjunctivitis( Slideshare.net/conjunctivitis)

  • Toxic conjunctivitis:It is an irritative follicular conjunctivaresponse which occurs after prolonged administration of topical medication.The common topical preparations associated with chronic follicular conjunctivitis are : idoxuridine, serine, pilocarpine, adrenaline, neomycin and preservatives including contact lens solution Khurana (2007).Other forms of conjunctivitis can arise from;chemical causes,ocular diseases which by involvement affects the conjunctiva Weissman,B.A. (2001).
  • Viral Conjunctivitis

Conjunctivitis may be caused by a viral infection, such as a cold, acute respiratory infection, or disease such as measles, herpes simplex, or herpes zoster. Symptoms may include mild to severe discomfort in one or both eyes; redness; swelling of the eyelids; and a watery, yellow, or greenish discharge. The symptoms may last anywhere from several days to weeks. Infection with an adenovirus, however, may also cause a significant amount of pus-like discharge and a scratchy sensation in the eye. These symptoms may also be accompanied by swelling and tenderness of the lymph nodes near the ear O’Brien (2013).

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Figure 5:  viral conjunctivitis (Slideshare.net/conjunctivitis)

1.1.4 Causes & Symptoms Of Conjunctivitis

Conjunctivitis may be caused by a viral infection, such as a cold, acute respiratory infection, or disease such as measles, herpes simplex, or herpes zoster. Symptoms may include mild to severe discomfort in one or both eyes; redness; swelling of the eyelids; and a watery, yellow, or greenish discharge. The symptoms may last anywhere from several days to weeks. Infection with an adenovirus, however, may also cause a significant amount of pus-like discharge and a scratchy sensation in the eye. These symptoms may also be accompanied by swelling and tenderness of the lymph nodes near the ear Shepard (2012).

Bacterial conjunctivitis may occur in adults or children. It is caused by such organisms as Staphylococcus, Streptococcus pneumonia, and Haemophilus. Symptoms of bacterial conjunctivitis include a pus-like discharge and crusty eyelids after awakening. Redness of the conjunctivae can be mild to severe and may be accompanied by swelling. Persons with symptoms of conjunctivitis who are sexually active may possibly be infected with chlamydia or with the bacteria that cause gonorrhea. There may be large amounts of pus-like discharge. Symptoms may include hypersensitivity to light (photophobia), a watery mucous discharge, and tenderness in the lymph nodes near the ear that may persist for up to three months Adenuga et al., (2012).

Conjunctivitis may also be caused by such environmental hazards as wind, smoke, dust, and allergic reactions caused by pollen, dust, or grass. Symptoms range from itching and redness to a mucous discharge. Persons who wear contact lenses may develop allergic conjunctivitis caused by the various eye solutions and foreign proteins contained in them.

Other less common causes of conjunctivitis include looking at the sun, sun lamps, plant lamps, or the electrical arcs used during welding, as well as defective tear ducts (http: www.emedecine.com/conjunctivitis)

1.1.5 Diagnosis

Accurate diagnosis of conjunctivitis centers on taking the patient’s history to learn when symptoms began, how long the condition has been going on, the symptoms experienced, and other predisposing factors. Diagnostic tests may include an eye examination, culture, or laboratory test. The discharge may be cultured and Gram stained to determine the organism responsible for causing the condition. Cultures and smears are relatively painless.

1.1.6 Treatment

Conjunctivitis caused by gonococci or chlamydial infection usually requires prescription antibiotics. Internal immune enhancement with dietary supplements can aid in the resolution of allergic and viral conjunctivitis. Removal of the allergic agent is an essential step in treating allergic conjunctivitis. As with any of the recommended treatments, however, if no improvement is seen within 48–72 hours, a physician should be consulted.

1.1.6.1 Nutritional Therapy

The following dietary changes may be helpful in managing conjunctivitis:

  • Taking 25,000 IU (international units) of beta-carotene twice daily for 7 days.
  • Taking 500–1000 mg of vitamin C three times daily for 7 days.
  • Taking 25 mg of zinc with meals three times daily for 7 days.

1.1.6.2 Homeopathy

There are a number of homeopathic remedies designed to treat acute conjunctivitis. These include Argentum nitricum (silver nitrate), pulsatilla (windflower), belladonna,Arsenicum album(arsenic trioxide), sulphur (elemental sulphur) and eyebright (Euphrasiaofficinalis). Eye drops prepared with homeopathic remedies can be a good substitute for pharmaceutical eye drops.

1.1.6.3 Allopathic Treatment

The treatment of conjunctivitis depends on what caused the condition. In all cases, warm compresses applied to the affected eye several times a day may help to reduce discomfort.

Conjunctivitis due to a viral infection, particularly those due to adenoviruses, are usually treated by applying warm compresses to the eye(s) and applying topical antimicrobial ointments to prevent secondary bacterial infections.

Viral conjunctivitis may cause blindness and should be referred to an ophthalmologist. Topical steroids are commonly prescribed in combination with antiviral therapy.

In cases of bacterial conjunctivitis, a physician may prescribe an antibiotic eye ointment or eye drops containing sodium sulfacetamide (Sulamyd) to be applied daily for 7–14 days. Patients should contact their doctors if the eyes fail to improve after 72 hours. Antibiotic eye drops are instilled (put in drop by drop) into the eye by having the patient tilt the head back and pulling down the lower eye lid. The patient is asked to look upward while the medication is instilled into the Conjunctivasac. It is important to avoid touching the dropper to the skin, in order to prevent the eye discharge from contaminating the antibiotic solution. After the drops have been instilled, the patient should gently close the eyes for 1 minute in order not to squeeze out any of the medication.

For cases of conjunctivitis caused by a gonococcus (the bacteria that causes gonorrhea), a physician may prescribe an injection of ceftriaxone (Rocephin) and a topical antibiotic ointment containing erythromycin or bactracin to be applied four times daily for 2–3 weeks. For chlamydial infections, a topical antibiotic ointment containing erythromycin (Ilotycin) may be prescribed to be applied 1–2 times daily. To apply an antibiotic ointment, the eye should be gently wiped with a sterile cotton ball moistened with sterile water to remove any discharge. Then, the lower eyelid can be pulled down and a thin ribbon of ointment applied in the lower Conjunctivasac. If possible, single-dose dispensers of ointment should be used as a protection against contamination of the medication. The eyelids can be closed and massaged gently to distribute the ointment. Patients may find that their vision is blurry for a few minutes after the ointment is applied, but this is a normal side effect. In addition to topical antibiotics, oral erythromycin or tetracycline therapy may be indicated for 3–4 weeks. Sexual partners should also be treated Vanghan et al., (1971).

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Children with conjunctivitis should typically receive topical antibiotics, according to clinical evidence published in 2002. But the evidence re-emphasized that adults who have non-gonococcal conjunctivitis usually do not need antibiotic treatment, because antibiotic resistance is a growing problem.

Allergic conjunctivitis can be treated by removing the allergic substance from a person’s environment, if possible; by applying cool compresses to the eye; and by administering eye drops 4–6 times daily for four days. Also, the antihistamine diphenhydramine hydrochloride (Benadryl) may help to relieve itchy eyes. In 2002, a new study showed that loteprednol and azelastine are two potential treatments for allergic conjunctivitis. Some doctors have prescribed ophthalmic steroids, but they can cause complications in patients. These potential new treatments offer alternatives to steroids for patients with allergic conjunctivitis Magaret (2011). The table below shows a detailed differential diagnosis of the common causes of conjunctivitis. 

DIFFERENTIATING FEATURES OF COMMON TYPES OF CONJUNCTIVITIS

Signs Bacterial Viral Allergic Chlamydial
Congestion

 

Marked Moderate Mild- Moderate Moderate
Chemosis + + + – + + + –
Subconjunctivahemorrhage + – + –
Discharge Purulent or mucopurulent Watery Ropy/Watery Mucopurulent
Papillae + – + + + –
Follicles + + +
Pseudomembrane + – + –
Pannus +
Pre-auricular lymph node + + + + –

Table 1: Differential diagnosis of common causes of conjunctivitis Khurana (2007)

1.2 PROBLEM STATEMENT

Conjunctivitis as a disease  has deprived so many people economically, socially and even educationally especially the school age children in Owerri and Imo state at large making them stay away from school especially when they are having  this diseases.   It is therefore necessary, to carry out a research study which will establish the prevalence of conjunctivitis, the relative causes and recommendations that can help the government and other relevant authorities come up with proactive measures to tackle this disorders, taking into consideration its etiology, gender and age distribution.

1.3 GENERAL OBJECTIVES

The general objective of this project study was to find out the prevalence of conjunctivitis among primary school pupils in Owerri Municipal, their common causes, and applying these findings to further preventing and correcting them.

Specific Objectives

  1. To determining the prevalence of conjunctivitis among primary school pupils in Owerri municipal.
  2. To identify the prevalence according to age group mostly affected with conjunctivitis.
  3. To identify the prevalence according to gender mostly affected with conjunctivitis

1.4  RESEARCH QUESTIONS

  1. What is the prevalence of conjunctivitis among primary school pupils in Owerri Municipal?
  2. Which age group is conjunctivitis significantly prevalent among?
  • Which gender is conjunctivitis significantly prevalent among?

1.5 RESEARCH HYPOTHESIS:

The following hypothesis were tested

  1. NULL HYPOTHESIS (H0): There is no significant prevalence of conjunctivitis among primary school pupils in Owerri municipal

ALTERNATE HYPOTHESIS (H1): There is significant prevalence of conjunctivitis among primary school pupils in Owerri municipal

  1. H0: There is no significant prevalence of conjunctivitis among the different age groups of the primary school pupils in Owerri municipal

H1: There is a significant prevalence of conjunctivitis among the different age groups of the primary school pupils in Owerri municipal

  1. H0: There is no significant prevalence of conjunctivitis among the genders of the primary school pupils in Owerri municipal

H1: There is significant prevalence of conjunctivitis among the genders of the primary school pupils in Owerri municipal

1.6     SIGNIFICANCE OF STUDY

  1. The study may help in reducing ignorance and increasing the knowledge of conjunctivitis.it also stands as a guide for future researches.
  2. It creates awareness of certain diseases that cause conjunctivitis and aims at making people to be cautious of hygiene
  • This research may alert the populace on the causes of conjunctivitis and educate them on precautionary measures
  1. The study may enable the optometrist to know the prevalence of conjunctivitis the cause and so be prepared for better and effective management of these pathologies.

1.7 SCOPE AND DELIMITATION OF STUDY

This study was carried out on primary school children in Owerri municipal, council of Nigeria whose age ranges from 5-13 years.

1.8 JUSTIFICATION OF STUDY

Given the scarcity of data on the prevalence of conjunctivitis among primary school pupils in the study area,this study will provide a thorough and comprehensive data regarding the problems in the community.


Pages:  107

Category: Project

Format:  Word & PDF

Chapters: 1-5

Material contains Table of Content, Abstract and References.

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