A POPULATION STUDY IN THE AKWAPIM SOUTH DISTRICT OF GHANA

ABSTRACT

Modem Eye care in Ghana is making progress in prevention of blindness from

cataract, onchocerciasis and trachoma, but stuck with glaucoma that remains the

leading cause of permanent blindness in Ghana. This project addresses issues

on the epidemiology of glaucoma by determining the magnitude of the burden of

Primary Open Angle Glaucoma by a prevalence study in the Akwapim South

district of Ghana.

It looks at the factors related to advanced damaging effect on vision,

socio-cultural and alternate eye care factors that influence eye care.

A total of 1.843 people aged 30 years and above were screened in a crosssectional

population survey. A prevalence of 6.6% with a 95% confidence

interval of 5.46 to 7.76 and an exponential trend line for prevalence/age

relationship was found in the 30-64year age group.

A case- control study recruiting 123 patients with early features of glaucoma

(control) and 93 patients with advanced glaucoma (cases) was aiso carried out

for risk-factor analysis. Highest level of intra ocular pressure before treatment

was the single most important factor associated with advanced visual loss and

this was overwhelmingly significant. Adjusted Odd’s ratio of glaucoma by

multiple logistic regression model showed that intraocular pressure> 3tmmHg in

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a patient was nearly 3 times more likely to present with advanced glaucoma (OR

2.66, 95% confidence interval 1.45, 4.91, p value 0.0017). Other factors which

were tested but showed weak associations that did not reach significant level

were age, sex, family history of glaucoma, occupation, and ethnicity.

Data was collected in the population by questionnaire on demographic data and

awareness, knowledge and health seeking behaviour related to eye care. The

details of the questionnaire included age, gender, and occupation, the

respondent's definition/understanding of blindness, causes of blindness known,

or cause of action taken in face of an eye disease, past history of eye disease

and the individual's knowledge and attitudes to glaucoma Cataract ranked as

the most common cause of blindness respondents were aware of (77.2% of

respondents) followed closely by eye injuries (71.9%). More than half the

respondents were also aware of “kooko” (55.7%) and old age related (54.7%).

Only 3.6% were aware that glaucoma causes blindness and 1% (23/1785) of

the population knew it may be hereditary. About 3.6% (64/1785) were aware of

glaucoma as an eye disease but only 0.8% (15/1785) knew that the disease

glaucoma is related to optic nerve damage and, or intraocular pressure. A person

in the higher occupational levels was 9 times more likely to understand glaucoma

than the lower levels (OR 0.11, 95% Cl 0.04-0.3, Pvalue 0.0001). “Kooko" is the

indigenous name for piles however it turned out to be an ubiquitous disease that

can affect any part of the body including the eye. Nearly half (47%) of

respondents used hospital/clinic services while the other half (49%) used

chemical stores1, herbalists, or self prescribed medication from the last 2 service

providers. This data confirms the view that significant eye care services are also

provided by chemical sellers and herbalists. It also indicates that the people

patronised the services of these alternate service providers as much as they

patronised the hospitals and clinics using chi square test (P value 0.78).

Information was collected independently by questionnaire and interviews from 21

chemical sellers and 60 herbalists identified by informants. The chemists sold

only antibiotic eye drops that were used as first line treatment for all cases they

saw. The herbalists claimed they treat cataract 82%, eye injuries 82%, kooko

75%, and Apollo 28%2 of respondents. None of them were aware of or treated

glaucoma. The routes of administration of the herbal medicine for eye disease

were instillation into the eye and nose 50%, instillation into the eye 25%, oral and

eye 10%, oral and nasal, and ocular 10% and only oral only 5% of respondents.

Although glaucoma prevalence is high in the Akwapim South district the level of

awareness is low in the population, chemical sellers, and herbalists who provide

about half of eye care services in the district. The level of the initial intra ocular

pressure is the most important factor in determining extent of visual damage.