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ORIGINAL ARTICLE
Year : 2013  |  Volume : 20  |  Issue : 2  |  Page : 163-167  

Awareness and knowledge of glaucoma among workers in a nigerian tertiary health care institution


1 Department of Ophthalmology, Federal Medical Centre, Owo, Nigeria
2 Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
3 Pharmaceutical Services, Federal Medical Centre, Owo, Nigeria

Date of Web Publication16-Apr-2013

Correspondence Address:
O O Komolafe
Department of Ophthalmology, Federal Medical Centre, Owo
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-9233.110609

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   Abstract 

Purpose: The aim of this study reports the level of awareness and knowledge of glaucoma among selected health care personnel at a health institution in southwestern Nigeria.
Materials and Methods: Health personnel at the Federal Medical Centre, Owo, Nigeria, a tertiary health care institution were stratified into a clinical and an administrative directorate. One-hundred twenty participants were selected from each directorate by a random sampling technique. A structured questionnaire was used to collect sociodemographic data and data on the level of knowledge and awareness of glaucoma. Statistical analyses included the independent t-test and Pearson's chi-square test for categorical variables. Statistical significance was indicated by P < 0.05.
Results: From the target population of 240 participants, 216 (98 males; 118 females) completed the questionnaire. The mean age of the participants was 35.07 ± 07 years. A total of 148 (68.6%) participants had heard of glaucoma comprising all participants from the clinical directorate and 28 participants from the administrative directorate. There was no statistically significant difference between the clinical and administrative directorates about the knowledge of the aspect of vision that is first affected by glaucoma, the painless nature of glaucoma among most Africans and the irreversible nature of glaucoma-related blindness (P > 0.05, all comparisons).
Conclusion: There is the need to update the knowledge base of these workers if they are to be useful in propagating information of the irreversible blindness that could arise from delay in glaucoma diagnosis and treatment.

Keywords: Awareness, Glaucoma, Health Care Workers, Knowledge, Medical Knowledge, Owo, Public Health


How to cite this article:
Komolafe O O, Omolase C O, Bekibele C O, Ogunleye O A, Komolafe O A, Omotayo F O. Awareness and knowledge of glaucoma among workers in a nigerian tertiary health care institution. Middle East Afr J Ophthalmol 2013;20:163-7

How to cite this URL:
Komolafe O O, Omolase C O, Bekibele C O, Ogunleye O A, Komolafe O A, Omotayo F O. Awareness and knowledge of glaucoma among workers in a nigerian tertiary health care institution. Middle East Afr J Ophthalmol [serial online] 2013 [cited 2019 Jun 17];20:163-7. Available from: http://www.meajo.org/text.asp?2013/20/2/163/110609


   Introduction Top


The World Health Organization estimated from 2010 [1] indicate that glaucoma is the second leading cause of blindness worldwide. Eight percent of global blindness is due to glaucoma. The Nigeria National Blindness survey reported the prevalence of glaucoma-related blindness at 0.75% second only to cataract-induced blindness. [2] Glaucoma progresses slowly with few, if any, noticeable symptoms in the early stage.

As glaucoma-related blindness is only avoidable with early detection and treatment, it is imperative to find asymptomatic individuals in the target population. [3] However, for people to present to eye care providers, they need knowledge about glaucoma and the benefits of early detection and treatment.

Awareness of glaucoma indicates whether or not an individual has heard of the disease or has any kind of correct understanding of the disease. The knowledge aspect deals with the level of understanding of the eye disease called glaucoma. Previous studies from Africa have reported low levels of awareness and knowledge of glaucoma among Nigerians [4],[5] and Ghanaians. [6] Among Caucasians, the rates ranged between 22.9% and 93% for awareness of glaucoma with a low level of knowledge varying between 2.3% and 35% for knowledge. [7],[8],[9],[10],[11],[12] None of these studies were conducted on health care personnel.

We believe that health care personnel can be effective in promoting the public awareness of glaucoma. However, this is only possible if these personnel are aware of glaucoma and have a fair knowledge of the disease.

In this study, we conducted a survey to evaluate for the level of awareness and knowledge about glaucoma among the workers in a health institution in southwestern Nigeria. We expect that those in the clinical directorate with their background in medical education should be more aware and more knowledgeable about glaucoma than those in the administrative directorate. The outcomes of this survey may help provide recommendations for improving public awareness campaigns for glaucoma.


   Materials and Methods Top


This study was approved by the Ethical Review Committee of the Federal Medical Centre, Owo, Nigeria. All the participants underwent an informed consent procedure and agreed to participate in the survey.

The study population consisted of staff from the Federal Medical Centre, Owo, Nigeria. This center is a tertiary health institution located in Owo, southwestern Nigeria with approximately 1,200 personnel at the time of the survey. There are two major directorates in the hospital: the clinical directorate comprised of the medical doctors, nurses, pharmacist, physiotherapists, and laboratory staff and; the administrative directorate comprised of administrative, account, and audit section staff. The survey was conducted in March 2009.

A minimum sample size (n) of 185 individuals was calculated assuming a 95% confidence interval (z = 1.96) and a 14% glaucoma prevalence (p) with the precision level (d) set at 0.05. Simple random sampling by balloting was used in selecting 120 participants from each arm of the directorate.

A structured questionnaire comprising of 20 closed questions was designed by the first author (OOK) to capture information about the demographics, awareness, and knowledge of glaucoma. It was designed to be brief and understandable and participants were asked to answer all questions to the best of their knowledge and most questions required "yes" or "no" answer or "true" or "false" response. The participants were asked to tick the boxes opposite the chosen response. A high school certificate was the minimum qualification for all participants which meant they were proficient in English. Hence, the questionnaire was in the English language. The questionnaires were self-administered and participants were not allowed to take the questionnaires away.

The questions used for the survey were validated by first testing them on 10 consecutive literate nonglaucoma patients presenting to the eye clinic at the Federal Medical Centre. On the basis of the results of this beta testing, the questions were modified appropriate for the final questionnaire. Staff from the eye clinic in the Federal Medical Centre were excluded from the survey.

The questions that assessed awareness are as follows:

  • Have you heard of the condition glaucoma and the source of information?
The section on knowledge assessment consisted of the following questions:

  • What glaucoma is?
  • The likely risk factors for glaucoma.
  • The presence of symptom in early glaucoma and the likely outcome of untreated glaucoma.
  • The aspect of vision that is affected early in glaucoma and the reversibility of glaucoma blindness.
  • The ways of preventing glaucoma-related blindness.
  • Whether activities such as stress, reading, and computer use can make glaucoma worse.
All the data were entered and analyzed with SPSS 18 (IBM Corp., Armonk, NY, USA). Categorical variables were analyzed with the independent t-test and Pearson's chi- square test. A P value of less than 0.05 was considered statistically significant (two- sided).


   Results Top


Of the 240 participants that were invited for the survey, 216 (90%) completed the questionnaire. The 90% of participants represent 18% of the study population. All 120 participants from the clinical directorate completed the questionnaire. Ninety-six participants from the administrative directorate completed the questionnaire.

There were 60 males and 60 females from the clinical directorate that participated in the survey. There were 38 males and 58 females from the administrative directorate that participated in the survey. The mean age of the participants was 35.83 years for the clinical directorate and 34.13 years for the administrative directorate.

Three participants had chronic open-angle glaucoma, one from the clinical directorate. Two of these participants were known glaucoma patients and one of the two from the administrative directorate was diagnosed at the time of the survey.

[Table 1] presents the sociodemographic profile of the study cohort.
Table 1: Demographic profile of the participants and the study group


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Lectures and seminars were the most common source of information among participants who had heard about glaucoma (62 participants) followed by information from doctors/ ophthalmologist during routine eye consultation in 36 (24.4%) participants. Eight (5.4%) participants were informed through family members who had been diagnosed with glaucoma.

[Table 2] presents the source of information about glaucoma for both directorates.
Table 2: Source of information about glaucoma


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All 120 participants from the clinical directorate had heard of glaucoma but the level of knowledge varied. One hundred six (88.3%) participants from the clinical directorate knew glaucoma was an increase in eye pressure that damaged the back of the eye. Thirty-eight (31.7%) participants from the clinical directorate knew that a family history of glaucoma-related blindness was a strong risk factor for developing glaucoma and 32 (26.7%) had no knowledge about any risk factors. [Table 3] presents the responses of participants from the clinical directorate regarding their knowledge of glaucoma.
Table 3: Response of non-ophthalmic health staff to questions on knowledge and awareness of glaucoma


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Twenty-eight (29.2%) of the 96 participants from the administrative directorate had heard of glaucoma. Twelve (42.9%) of these participants from the administrative directorate correctly identified glaucoma as an increase in pressure that damages the back of the eye, while six (21.4%) regarded glaucoma as a whitening that grows across the eye. Two (7.0%) regarded glaucoma as an age-related eye problem.

Eighteen (64.3%) participants from the administrative directorate had no knowledge of any strong risk factors for glaucoma and six (21.4%) had knowledge of the hereditary nature of glaucoma. Eighteen (63.4%) had the knowledge that glaucoma will result in blindness without treatment, while eight (28.6%) felt that visual loss from glaucoma can be restored. Sixteen (57.2%) participants from the administrative directorate felt that glaucoma patients will be symptomatic in the early stage of the disease and 10 (35.7%) regarded glaucoma as a painful ocular condition among those of African descent.

The majority of participants from the administrative directorate [22 (78.6%)] knew that regular eye examination could prevent glaucoma-related blindness, while four (14.3%) felt that healthy nutrition alone is preventative. Six (21.4%) participants from the administrative directorate claimed knowledge of any form of treatment for glaucoma.

In response to questions on factors that could worsen the progression of glaucoma, 18 (64.3%) participants from the administrative directorate thought that stress and excessive thinking can worsen glaucoma and 14 (50%) felt that prolonged computer use could make glaucoma worse. Ten (35.7%) participants from the administrative directorate thought that lots of reading will worsen the progression of glaucoma.


   Discussion Top


Some studies [5],[6] have evaluated awareness and knowledge of glaucoma among Nigerians; however, to the best of our knowledge our survey is the first to be conducted among workers in a health institution. Agbeja-Baiyeroju et al., [13] assessment of chronic open-angle glaucoma among workers in a tertiary health institution in southwestern Nigeria presented additional information from an epidemiological review on prevalence and risk factor of glaucoma.

Health education and counselling remains a key tool in reducing morbidity associated with most chronic diseases, especially when the conditions are asymptomatic at an early stage. The need to involve nonophthalmic health care workers in reducing blindness related to glaucoma cannot be overemphasized. Often, nonophthalmic health care workers are the first point of contact for patients. Hence, for these health care personnel to effectively assess or educate patients regarding glaucoma requires a good understanding of the disease process.

The high level of awareness demonstrated by the nonophthalmic clinical staff was expected.

The level of knowledge of the participants from the clinical directorate with regard to the asymptomatic nature of early glaucoma, some presumed factors that can make glaucoma worse and known risk factors for glaucoma is disappointingly inadequate. Some of this information is the key for proper counselling and for motivating individuals at-risk to present early to eye care givers. The low level of knowledge could be a result of the low interest these participants had in ophthalmology while in training, as this information is generally garnered from seminars and lectures while in training.

The curriculum of the medical, nursing schools, and other allied health care training colleges in Nigeria involves period of lectures and rotation through ophthalmology during which some important eye diseases are covered. Some regard these rotations as mere prerequisite to passing an examination rather than knowledge to be retained and used during their career. Another factor that could explain the low level knowledge is the interval between graduation and the time the questionnaire was administered. However, this was not assessed in this study. Also some of the participants who were not in the core clinical section, such as the laboratory and physiotherapy sections, may have had very few lectures on glaucoma. Studies from West Africa on glaucoma awareness [5],[6] have reported a positive correlation between the level of education and the degree of awareness; however, this observation does not extent to the level of knowledge.

The absence of symptoms such as pain in glaucoma among African population and the preservation of the central vision until late in the disease process remain key factors for the late presentation of glaucoma patients as well as poor compliance with medical therapy.

The level of awareness and knowledge of glaucoma among the participants from the administrative division was very low. Only 29.2% had heard of glaucoma. This group represents the elite working community. The low awareness and poor understanding could be due to the paucity of written material, poor access to information, and lack of media coverage similar to what obtained with other diseases such as HIV/AIDS.

In a study sample from Australia, Livingstone et al., [9] reported that 70% had heard of glaucoma. Gasch et al., [12] surveyed a sample of patients presenting to a general eye clinic in USA and reported that 72% of the cohort knew about glaucoma. These outcomes are higher than that reported for the nonclinical staff in our study. The difference may due to factors discussed above coupled with greater utilization of eye care services in developed countries. In the study population, spectacle correction for presbyopia is routinely obtained without a prescription. Hence, an opportunity for a proper ophthalmic consult is missed where some information of various eye ailments including glaucoma could be available. These results of the survey form our survey indicate that contact with physicians and ophthalmologists has not imparted much knowledge of glaucoma to the participants.

An advantage of this survey was the inclusion of random sampling in selecting the participants as it reduces or eliminates the bias that could arise from self-selection. Additionally, we used a study sample slightly higher than the calculated sample size to ensure the cohort remained representative of the study population despite nonresponders. A limitation of this survey is not selecting participants from the clinical and the administrative directorates in proportion to the size of each directorate. For example, there were a greater number of staff in the clinical directorate. We believe this may not have biased the results as the finding from the two groups was analyzed differently. Another strong limitation was the lack of a five-graded response to the questions that evaluated for the level of knowledge of the participants. This was done in an attempt to remove all ambiguity in responses.

On the basis of the finding from this survey, we recommend that stakeholders involved in prevention of glaucoma-related blindness such as the Ophthalmological Society of Nigeria and Nigerian Glaucoma Society should partner with licensing and health regulatory bodies in Nigeria such as the Nigerian Medical and Dental Council, the Pharmaceutical Council of Nigeria, and the Nursing Council of Nigeria to provide lectures centered on enhancing knowledge of glaucoma. Furthermore, this glaucoma-based lectures should be included as part of the continuous medial education and continuous professional development program of these licensing bodies. At the conclusion of the survey, the findings were discussed with the hospital management and a lecture on glaucoma awareness was organized for members of staff of the institution as part of the monthly clinical hospital seminar.


   Conclusion Top


Even though the level of awareness of glaucoma among the clinical directorate of health care workers is good, their knowledge base is still inadequate. It may be difficult to involve these personnel in helping educate the public and/or patients on glaucoma and the visual disabilities due to glaucoma. Proactive measures to improve the knowledge of health care personnel such as continuous professional development program are warranted. The level of awareness and knowledge displayed by the nonclinical staff was very low.

 
   References Top

1.Pascolini D, Mariotti SV. Global estimates of visual impairment: 2010. Br J Ophthalmol 2012;96:614-8.  Back to cited text no. 1
    
2.Abdull MM, Sivasubramaniam S, Murthy GV, Gilbert C, Abubakar T, Ezelum C, et al. Causes of blindness and visual impairment in Nigeria: The Nigeria National Blindness and Visual Impairment survey. Invest Ophthalmol Vis Sci 2009;50:4114-20.  Back to cited text no. 2
    
3.Cross V, Shah P, Bativala R, Spurgeon P. ReGAE 2: Glaucoma awareness and the primary eye care service: Some participants among African Carribbeans in Birmingham UK. Eye (Lond) 2007;21:912-20.  Back to cited text no. 3
    
4.Nwosu SN. Patients′ knowledge of glaucoma and treatment options. Niger J Clin Pract 2010;13:74-7.  Back to cited text no. 4
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5.Bodunde OT, Daniel OJ, Onabolu OO. Knowledge, attitude and health believes of glaucoma patients in a Nigerian hospital. Niger Med Pract 2006;50:62-4.  Back to cited text no. 5
    
6.Ntim-Amponsah CT, Winfried MK, Ofosu-Amaah S. Awareness and knowledge of glaucoma and other diseases associated with blindness in a Ghanaian community. Niger J Ophthalmol 2004;12:50-4.  Back to cited text no. 6
    
7.Landers JA, Goldberg I, Greham SL. Factors affecting awareness and knowledge of glaucoma among patients presenting to an urban emergency department. Clin Experiment Ophthalmol 2002;30:104-9.  Back to cited text no. 7
    
8.Mansouri K, Orgül S, Meur-Gibbons F, Mermond A. Awareness about glaucoma and related eye health attitudes in Switzerland. A survey of the general public. Ophthalmologica 2006;220:101-8.  Back to cited text no. 8
    
9.Livingston PM, Lee SE, De Paola C, Carson CA, Guest CS, Taylor HR. Knowledge of glaucoma and its relationship to self care practices in a population sample. Aust N Z J Ophthalmol 1995;23:37-41.  Back to cited text no. 9
    
10.Attebo K, Mitchell P, Cumming R, Smith W. Knowledge and beliefs about common eye diseases. Aust N Z J Ophthalmol 1997;25:283-7.  Back to cited text no. 10
    
11.Saw SM, Gazzard G, Friedman D, Foster PJ, Devereux JG, Wong ML, et al. Awareness of glaucoma and health beliefs of patients seffering primary angle closure. Br J Ophthalmol 2003;87:446-9.  Back to cited text no. 11
    
12.Gasch AT, Wang P, Pasquale LR. Determinant of glaucoma awareness in a general eye clinic. Ophthalmology 2000;107:303-8.  Back to cited text no. 12
    
13.Agbeja-Baiyeroju AM, Bekibele CO, Bamgboye EA, Omokhodion F, Oluleye TS. The Ibadan glaucoma study. Afr J Med Med Sci 2003;32:371-6.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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