ABSTRACT
Background:
The background of this study is to determine the awareness about health seeking behaviour (HSB) in parents of visually impaired children in a population-based study.
Methods:
The study was conducted in population <16 years in urban area of North India. A total of 20,955 (97.3%) children underwent visual acuity examination. Of these, 789 children were referred to the centrally based clinic with unaided visual acuity <6/12 in any eye for undergoing detailed ophthalmic examination.
Results:
Along with ocular examination, the parents of these 789 referred children, were interviewed for the questions related to HSB, the most common ocular symptom known to them was redness of eyes followed by watering and diminution of vision, 249 (34.6%) denied for any ocular problem in their children previously, amongst the remaining 469 parents/care takers with any ocular problem, a total of 367 (51.1%) referred children wore glasses and the proportion of parents wearing glasses was similar amongst these children (11.7% fathers and 11% mothers). Amongst the 118 respondents of visually impaired children (presenting visual acuity less than 6/18 in better eye with available correction), 56 (47.5%) denied for any ocular problem in their children previously, of the remaining 62 (52.5%), parents, 58 (93.5%) had consulted various healthcare agencies, 45.8% of the respondents reported not said that their children wore glasses prescribed to them. Only 24 (20.3%) respondents were aware that Vitamin A is good for eye health.
Discussion:
Diminution of vision, watering and redness of eyes were the most common ocular symptoms known to parents of referred children. HSB can be further improved via primary healthcare physicians by primary healthcare creating awareness about importance of wearing glasses and healthy diet in parents of visually impaired children.
Keywords: Caregiver, children, health seeking behaviour, refractive error, visual impairment
Introduction
Control of childhood blindness and visual impairment (VI) have been a priority under World Health Organization (WHO).[1,2,3] As children with VI pose an emotional and socioeconomic challenge for their families, they may less likely be able to complete their education and hence make a living for themselves. Early and regular eye examination in children is very important tool for ensuring normal visual development by facilitating timely detection and treatment of any ocular abnormality including refractive error and referral whenever necessary through the primary care physicians as most of these children visit the primary healthcare centres in the initial phase of treatment.
Health education of parents and guardians on the need for frequent eye examination and necessary treatment is an important strategy in developing countries where a significant number of people have poor knowledge of the importance of eye examination and treatment, hence neglecting eye care for their children.[4,5,6] It has been observed that the health seeking behaviour (HSB) for childhood blindness and visual improvement is often sub-optimal. Though there are studies done on barriers in seeking services for various areas of healthcare, only a few studies are available on barriers related to ocular causes or visual impairment. Hence, the current study aimed to determine the HSB in parents/caretakers of children with visual impairment to emphasise the important role of primary healthcare physicians in referring these children to ophthalmic service providers.
Materials and Methods
This population-based cross-sectional study was conducted during January 2015 to August 2018 in East Delhi district of North India. The study was initiated after taking due permission from District Blindness Control Programme officer of East Delhi District and approval by ethics committee of All India Institute of Medical Sciences, New Delhi. All children aged <16 years at the time of visit and staying in East-Delhi district for six months or more were included for the study. All children with unaided visual acuity <6/12 in any eye, children wearing glasses, and children who did not fix and follow were referred to a centrally located clinic for detailed ophthalmic examination.
Statistical analysis
The analysis was done after entry of the data in a specifically designed database in Epi data. The entered data was exported and final data analysis was done using Stata 14. The distribution of participants with respect to age, gender, residence type, education status, income, etc., was tabulated. A P value of <0.05 was considered statistically significant. Here along with detailed ophthalmic examination by an ophthalmologist, a HSB questionnaire was also filled by the medical social worker.
Designing of the questionnaire
In absence of any standard questionnaire for this objective, we developed our own set of questionnaire in consultation with eye care professionals and community ophthalmologists. The tool was pre-tested and standardised in a non-study cluster. The corrected tool was translated to Hindi and back-translated to English followed by comparison of original and back-translated into English versions. Following this, piloting of the study was conducted in a cluster using the finalised questionnaire. All the questions were asked from parents/caretakers of all the available referred children as per guidelines of the study.
The questionnaire had following sections
Knowledge of the eye problems. If the parents were aware that their child is having any eye problem and they perceived severity of the eye problem.
Health seeking: The first and subsequent healthcare providers and eye care providers who were visited by the parents for the treatment of the eye problems and also the problems faced in reaching them at appropriate time in the form of financial constraints, distance, lack of awareness about the facility available.
Knowledge about eye care services: Whether the parents were aware of the available services for eye care in their area.
In case no treatment was sought: The reasons were asked why treatment was not sought. These included reasons such as lack of awareness about severity, ability to see adequately, non-awareness of available treatment or providers, costs of treatment.
The parents were also asked about the knowledge of nutrients essential for good ocular health and in which food ingredients vitamin A is present.
Results
Overall, 21,532 children were enumerated from 40 different clusters that covered a total of 9,859 households. Of these enumerated children, 20,955 (97.3%) underwent screening for visual acuity from 9176 (95.7%) households. A total of 20166 (96.2%) children had unaided visual acuity either normal or >6/12 in both eyes or were able to fix and follow (<3 years). The remaining 789 (3.8%) children aged 0-15 years were having unaided visual acuity less than 6/12 in any eye and referred by optometrists for detailed ophthalmic examination to the central clinic.
Of these 789 children, 68 (8.6%) were in preschool, 295 (37.4%) were studying in primary school, 278 (35.2%) in middle school and 148 (18.8%) were studying in class 9th or above. A total of 351 (48.9%) referred children wore glasses and the proportion of parents wearing glasses was similar amongst these children (11.7% fathers and 11% mothers). [Table 1]
Table 1.
Demographic distribution of referred children
| Characteristics | Screened in house to house visit (n=20955) | Referred (%) (n=789) |
|---|---|---|
| Age | ||
| <3 yrs | 3376 (16.1) | 4 (0.5) |
| 3-5 yrs | 3946 (18.8) | 46 (5.8) |
| 6-10 yrs | 7085 (33.8) | 286 (36.3) |
| 11-15 yrs | 6548 (31.2) | 453 (57.4) |
| Gender | ||
| Male | 11032 (32.6) | 405 (51.3) |
| Female | 9923 (47.4) | 384 (48.7) |
| Education of children | ||
| Pre-school | 7663 (36.6) | 68 (8.6) |
| Primary school | 7500 (35.8) | 295 (37.4) |
| Middle school | 4054 (19.3) | 278 (35.2) |
| ≥9th standard | 1738 (8.3) | 148 (18.8) |
| Child wearing glasses | ||
| No | 20088 (95.9) | 367 (51.1) |
| Yes | 867 (4.1) | 351 (48.9) |
| Education of father | ||
| Illiterate and primary school | 3968 (19.0) | 97 (12.3) |
| Middle school | 3717 (17.7) | 122 (15.5) |
| High school | 6394 (30.5) | 237 (30.0) |
| Intermediate | 4273 (20.4) | 190 (24.1) |
| Graduate and above | 2603 (12.4) | 143 (18.1) |
| Father wearing glasses | ||
| No | 19422 (92.7) | 687 (88.3) |
| Yes | 1201 (5.7) | 91 (11.7) |
| Education of mother | ||
| Illiterate and primary school | 7400 (35.3) | 214 (27.1) |
| Middle school | 4191 (20.4) | 161 (20.4) |
| High school | 5127 (24.5) | 225 (28.5) |
| Intermediate | 2621 | 108 (13.7) |
| Graduate and above | 1616 (7.7) | 81 (10.3) |
| Mother wearing glasses | ||
| No | 19843 (94.7) | 697 (89.0) |
| Yes | 1018 (4.8) | 86 (11.0) |
| Socio-economic status | ||
| Upper middle (II) | 2526 (12.1) | 119 (15.1) |
| Lower middle (III) | 6959 (33.2) | 323 (40.9) |
| Upper lower (IV)/lower (V) | 11470 (54.7) | 347 (44.0) |
When analysing the data for VI and blindness, the overall visual impairment according to the standard ICD 10 classification with the criteria of (presenting visual acuity less than 6/18 in better eye with available correction to absence of perception of light). A total of 124 children out of 20,955 examined children (5.92 per thousand, 95% CI: 4.96-7.05) had visual impairment. Amongst these 124 visually impaired children, a total of 110 parents were interviewed for HSB questionnaire. Of these, 118 children; 61 (50.8%) were in the age group of 11 to 15 years followed by 50 (41.7%) in the age group of 6 to 10 years followed by 9 (7.5%) in age group of 3 to 5 years and 4 (3.2%) in the age group less than 3 years. A total of 67 (55.9%) were males and 53 (44.1%) were females. Amongst these, 27 (22.5%) wore wearing glasses. Most of these children 62 (50%) belonged to upper middle (IV) or lower (V) class. [Table 2]
Table 2.
Demographic distribution of referred and visually impaired children
| Visual impairment (%) | No visual impairment (%) | Total (%) | |
|---|---|---|---|
| Age | |||
| 3-5 yrs | 9 (7.5) | 31 (5.2) | 40 (5.6) |
| 6-10 yrs | 50 (41.7) | 211 (35.3) | 261 (36.4) |
| 11-15 yrs | 61 (50.8) | 356 (59.5) | 417 (58.08) |
| Gender | |||
| Male | 67 (55.9) | 303 (50.7) | 370 (51.5) |
| Female | 53 (44.1) | 295 (49.3) | 348 (48.5) |
| Education of children | |||
| Prep/play school | 13 (10.8) | 44 (7.4) | 57 (7.9) |
| Primary school | 56 (46.7) | 215 (36) | 271 (37.8) |
| Middle | 36 (30) | 218 (36.5) | 254 (35.4) |
| ≥9th | 15 (12.5) | 121 (20.2) | 136 (18.9) |
| Child wearing glass | |||
| No | 93 (77.5) | 274 (45.8) | 367 (51.1) |
| Yes | 27 (22.5) | 324 (54.2) | 351 (48.9) |
| Education of father | |||
| Primary school | 18 (15) | 72 (12) | 90 (12.5) |
| Middle | 18 (15) | 93 (15.6) | 111 (15.5) |
| High school | 39 (32.5) | 180 (30.1) | 219 (30.5) |
| Intermediate | 31 (25.83) | 146 (24.4) | 177 (24.6) |
| Graduate and above | 14 (11.67) | 107 (17.9) | 121 (16.9) |
| Father wearing glasses | |||
| No | 105 (87.5) | 518 (88) | 623 (87.8) |
| Yes | 15 (12.5) | 71 (12.1) | 86 (12.2) |
| Education of mother | |||
| Primary school | 37 (30.83) | 162 (27.1) | 199 (27.7) |
| Middle | 30 (25) | 118 (19.7) | 148 (20.6) |
| High school | 33 (27.5) | 166 (27.8) | 199 (27.7) |
| Intermediate | 12 (10) | 89 (14.9) | 101 (14.1) |
| Graduate and above | 8 (6.67) | 63 (10.5) | 71 (9.9) |
| Mother wearing glasses | |||
| No | 111 (93.28) | 524 (88.2) | 635 (89.1) |
| Yes | 8 (6.72) | 70 (11.8) | 78 (10.9) |
| Socio-economic | |||
| Upper middle (II) | 12 (10) | 91 (15.2) | 103 (14.4) |
| Lower middle (III) | 48 (40) | 245 (41) | 293 (40.7) |
| Upper lower (IV) | 60 (50) | 262 (43.8) | 322 (44.9) |
| Total | 110 (100) | 598 (100) | 718 (100) |
Amongst 789 referred children, a total of 718 parents or care takers were administered questionnaire related to assessment of their knowledge about healthcare services along with knowledge and perception for ocular health in their child. The most common ocular symptom known to them was redness of eyes followed by watering and diminution of vision, 249 (34.6%) denied for any ocular problem in their children previously, amongst the remaining 469 parents/care takers with any ocular problem, 462 (98.5%) had consulted healthcare agencies for ocular problems, amongst these a maximum consulted eye specialist 307 (66.5%), 128 (27.7%) visited opticians at spectacle shop and remaining 27 (5.8%) visited others. Amongst those visiting an eye specialist, 135 (44%) visited government hospital and remaining 172 (56%) visited eye specialist at private hospital [Figure 1, Table 3].
Figure 1.
Comparison of health seeking behaviour reported among parents for ocular problem amongst referred and visually impaired children
Table 3.
Comparison of health seeking behaviour (HSB) between parents/caretakers of referred and visual impaired children
| Referred n=718 (%) | Visually impaired | ||
|---|---|---|---|
|
| |||
| n=118 (%) | P | ||
| What do you think are symptoms of eye diseases in children?* | |||
| Diminution of vision | 271 (37.8) | 48 (40.7) | 0.496 |
| Watering | 208 (28.9) | 36 (30.5) | 0.711 |
| Redness | 174 (24.2) | 29 (24.6) | 0.947 |
| Itching | 73 (10.1) | 7 (5.9) | 0.093 |
| Photophobia | 24 (3.3) | 2 (1.7) | 0.273 |
| Purulent discharge | 24 (3.3) | 3 (2.5) | 0.591 |
| Headache | 20 (2.7) | 4 (3.4) | 0.430 |
| Don’t know | 214 (29.8) | 30 (25.4) | 0.242 |
| Has your child ever suffered from an eye problem? | (n=718) (%) | (n=118) (%) | |
| Yes | 349 (48.7) | 56 (47.5) | 0.748 |
| No | 369 (51.3) | 62 (52.5) | |
| If yes, in case of any eye problem, whom do you usually consult first? | (n=349) (%) | (n=56) (%) | |
| Eye specialist in government hospital | 172 (49.3) | 30 (53.6) | 0.484 |
| Eye specialist in a private setup | 135 (38.7) | 15 (26.8) | 0.046 |
| Spectacle shop-keeper | 8 (2.3) | 1 (1.8) | 0.782 |
| School screening | 8 (2.3) | 0 (0.0) | 0.211 |
| General physician (MBBS) | 7 (2.0) | 3 (5.4) | 0.051 |
| Do not consult | 7 (2.0) | 4 (7.1) | 0.003 |
| Local practitioner in the slum area | 6 (1.7) | 0 (0.0) | 0.280 |
| Govt. Dispensary | 5 (1.4) | 3 (5.4) | 0.007 |
| Any other | 1 (0.3) | 0 (0.0) | 0.662 |
| In case you do not consult eye specialist for child’s eye problems, what are the reasons? | (n=42) (%) | (n=11) (%) | |
| Financial problem | 11 (26.2) | 4 (36.4) | 0.841 |
| Not aware about availability | 19 (45.2) | 3 (27.3) | |
| Too far | 8 (19.0) | 3 (27.3) | |
| Local healers/doctors are better | 2 (4.8) | 0 (0.0) | |
| Family reasons | 2 (4.8) | 1 (9.1) | |
| In case of trauma to your child’s eye, when do you think you should seek advice? | (n=718) (%) | (n=118) (%) | |
| Immediately | 694 (96.6) | 114 (96.6) | 0.136 |
| Within one day | 9 (1.2) | 0 (0.0) | |
| Anytime | 7 (1.0) | 2 (1.7) | |
| When child faces difficulty | 3 (0.4) | 1 (0.8) | |
| Few days | 1 (0.1) | 1 (0.8) | |
| Don’t know | 4 (0.7) | 0 (0.0) | |
| Do you use eye medicines prescribed by family members/pharmacist/local healers/non-Ophthalmologists/chemist shop for any eye problem in your family members? | (n=718) (%) | (n=118) (%) | |
| Yes | 59 (8.2) | 9 (7.6) | 0.928 |
| No | 659 (91.8) | 109 (92.4) | |
| For which eye problems do you use self-medication for your child? | (n=59) (%) | (n=9) (%) | |
| Redness | 31 (52.5) | 5 (55.6) | 0.990 |
| Watering | 15 (25.4) | 3 (33.3) | 0.832 |
| Eye flu | 8 (13.6) | 1 (11.1) | 0.348 |
| Foreign body sensation | 3 (5.1) | 1 (11.1) | 0.966 |
| Decreased vision | 1 (1.7) | 0 (0.0) | 0.529 |
| Any other | 1 (1.7) | 0 (0.0) | 0.529 |
*Multiple responses
When these questions were asked from the parents/caretakers of visually impaired children (with PVA <6/18 in better eye with available correction), it was found that out of 124 children with visual impairment, questions could be asked from parents of 118 (95.2%) children.
The most common ocular symptom known to them was diminution of vision 48 (40.7%) followed by watering of eyes 36 (30.5%) followed by redness of eyes 29 (24.6%). Amongst the 118 respondents of visually impaired children, 56 (47.5%) denied for any ocular problem in their children previously, of the remaining 62 (52.5%), parents, 58 (93.5%) had consulted various healthcare agencies, that consisted of 45 (77.6%) visiting an ophthalmologist for ocular problem in their children [Figure 1, Table 3].
Amongst the 45 parents consulting eye specialist, a total of 15 (33.3%) visited private hospital and 30 (66.7%) visited government hospital and dispensaries for seeking eye care in case of any ocular problem in their children. Amongst six parents/caretakers not consulting ophthalmologist, the other healthcare agency sought was general physicians in three (50%), each in government dispensaries and spectacle shop. The most common reason for not visiting ophthalmologist was financial problem and distant location in three each. [Table 4, Figure 1]
Table 4.
Attitude of parents towards wearing glasses for their children
| (n=597) (%) | (n=118) (%) | ||
|---|---|---|---|
| Has your child ever been prescribed spectacles? | |||
| Yes | 367 (51.1) | 48 (40.7) | <0.001 |
| No | 351 (48.9) | 70 (59.3) | |
| Who (place/person) prescribed the spectacles? | (n=367) (%) | (n=48) (%) | |
| Private eye specialist | 175 (47.7) | 17 (35.4) | 0.004 |
| Eye specialist in govt. hospital | 131 (35.7) | 21 (43.8) | |
| Spectacle shop-keeper | 20 (5.5) | 3 (6.3) | |
| Local practitioner in the slum area | 13 (3.5) | 1 (2.1) | |
| School screening | 16 (4.4) | 0 (0.0) | |
| Govt. dispensary | 5 (1.4) | 5 (10.4) | |
| PEC/PHC | 5 (1.4) | 0 (0.0) | |
| Any other | 2 (0.5) | 1 (2.1) | |
| Is he/she wearing them at present? | (n=367) (%) | (n=48) (%) | |
| Yes | 317 (86.4) | 26 (54.2) | 0.001 |
| No | 50 (13.6) | 22 (45.8) | |
| What was the reason for not wearing the spectacles? | (n=50) (%) | (n=22) (%) | |
| Broken/lost | 14 (28.0) | 5 (22.7) | 0.802 |
| Uncomfortable with glasses | 11 (22.0) | 7 (31.8) | |
| Manage without spectacles | 12 (24.0) | 5 (22.7) | |
| Economic reason | 7 (14.0) | 4 (18.2) | |
| Family reasons | 4 (8.0) | 0 (0.0) | |
| Social reasons | 2 (4.0) | 1 (4.6) |
Attitude for ocular care during trauma and self-medication
On asking about self-medication for ocular disease, 659 (91.8%) of the parents of the referred children did not use any self-medication for their children, in the remaining 59 (8.2%) doing self-medication the most common reason was redness of eyes 31 (52.5%) for which they took medicine from local pharmacy/chemist shop.
Amongst the VI children, most of the parents 109 (92.4%) denied of adopting self-medication, in the remaining 9 (7.6%) the most common symptom for which self-medication was done was redness in eyes 5 (4.2%) followed by watering 3 (2.5%) and eye flu 2 (1.1%). Nearly 114 (96.6%) parents visited an ophthalmologist immediately and 4 (3.4%) visited at the time when child complains of some ocular symptom after injury. [Table 3]
Attitude and compliance for wearing glasses
A total of 48 (40.7%) children wore glasses amongst these visually impaired children. Of these 48, 22 (45.8%) were prescribed glasses in private hospital, 26 (54.2%) were prescribed glasses in government hospital. Amongst these 48 children prescribed with glasses only 26 (45.8%) wore glasses [Table 4]. The current usage of glass amongst the visually impaired children had no significant association with demographic characteristics. Amongst the 367 (51.1%) children prescribed with glasses, the education of parents had a positive significant association with place where glasses were prescribed (P < 0.05) and also socio-economic status had a positive association with the place of prescription of glasses. People belonging to the lower socio-economic class prefer visiting government sector for getting prescription of glasses for their children.
Amongst 22 (45.8%) not wearing glasses but were prescribed with glasses, the most common cause for not wearing glasses was glasses were broken or lost in 5 (22.7%), could manage without glasses in 5 (22.7%) and were uncomfortable with glasses in 7 (31.8%) [Table 4].
Knowledge about essential ocular nutrient
Only 171 (23.7%) of the respondents of referred children had knowledge about role of vitamin A in eye health, 382 (53.2%) knew about its presence in green leafy vegetables, 167 (23.2%) reported its presence in milk followed by 90 (12.5%) responding for its presence in yellow fruits. Amongst VI children, 63 (53.4%) of the parents knew about its presence in green leafy vegetables, 29 (24.6%) reported its presence in milk followed by 7 (5.9%) responding for its presence in yellow fruits [Table 5].
Table 5.
Knowledge about any essential nutrient for ocular health amongst parents/caretakers (n=118)
| Referred (n=718) (%) | Visually impaired | ||
|---|---|---|---|
|
| |||
| (n=118) (%) | P | ||
| Do you know which vitamin is good for eye health? | |||
| Vitamin A | 171 (23.7) | 24 (20.3) | 0.315 |
| Others | 6 (0.8) | 0 (0.0) | |
| Don’t know | 541 (75.5) | 94 (79.7) | |
| Do you know the common sources of Vitamin A in our diet?* | (n=718) (%) | (n=118) (%) | |
| Green leafy vegetables | 382 (53.2) | 63 (53.4) | 0.993 |
| Don’t know | 242 (33.7) | 39 (33.0) | 0.842 |
| Milk | 167 (23.2) | 29 (24.6) | 0.732 |
| Yellow/orange fruit like papaya, mango, pumpkin | 90 (12.5) | 7 (5.9) | 0.017 |
| Mother’s milk for infants | 9 (1.3) | 1 (0.9) | 0.661 |
| All of the above | 4 (0.5) | 0 (0.0) | 0.656 |
*Multiple responses
Discussion
HSB in parents amongst children with VI was evaluated as in all societies children are being raised in a way that is generally compatible with the demands of their physical environment, socio-economic condition, demographic characteristics and the belief system that has been adopted in their society, the implication of parents belief about a particular disease is integral to the place and kind of care that would be sought when their child falls sick. Most of these parents have a tendency to visit primary healthcare providers at primary healthcare centres in the beginning as they are located in there vicinities. So, these family physicians can real play a very important role in the timely referral of these children with various ocular ailments including refractive error. There are very few studies related to HSB in children in ophthalmology,[4,5] most of the studies conducted have evaluated the compliance for wearing glasses.[6,7,8,9,10,11,12,13,14,15,16]
Diminution of vision, watering and redness of eyes were the most common ocular symptoms known to parents of referred children. Amongst the visually impaired children a total of 48 (40.7%) parents reported diminution of distant vision as the major ocular complaint. Among them, 30 (53.6%) consulted eye specialist in a government setup for any ocular problem [Table 4]. If in case they did not consult any eye specialist for ocular problem, the main reason was financial constraints and unawareness about the availability of eye healthcare services in their nearby area. This is similar to a study conducted by Bala Balasubramaniam et al.[4] on HSB in Chennai in South India. This is also similar to the finding reported by Amiebenomo et al.[5] in Benin city in Nigeria, they did a study on eliciting the attitude of parents for seeking eye care in children and reported the similar barriers like funds, time, use of traditional medicine, and distance to eye clinic that affected the healthcare in their children.
In the current study, most of the parents of the referred children (91.8%) denied of adopting self-medication, in the remaining 8.2% the most common symptom for which self-medication was done was redness in eyes (52.4%) followed by watering (28.8%) and eye flu (22%). [Table 3] There are many studies related to self-medication in different age groups.[17,18,19,20,21,22] In a study conducted by Carvalho et al.[20] in adults, the patients treated the ophthalmologic emergency care by self-medicating with homemade or manufactured products. The most widely used products in their study included boric acid, normal saline, leaf infusions and breast milk, they also reported that 25.6% of people reported self-medicating, many patients cited their lack of understanding of healthcare and their difficulty in obtaining medical care as reasons for these practices. In a study conducted by Gupta et al.[21] in Gurugram, Haryana on self-medication, of the 2160 adult participants interviewed, 396 (18.2%) reported using ophthalmic medications without consulting an ophthalmologist, mainly for symptoms like watering (37.1%), redness (27.7%), itching (19.2%) and infection (13.6%). Similarly in a study conducted by Kagashe et al.[19] in Tanzania, amongst 358 participants, 59.8% admitted to have used eye medicines before coming to hospital. 88.6% used modern medicines, 3.4% used traditional medicines and 7% used both modern and traditional medicines. Traditional eye medicines used were in liquid form, of which 68% were from plant sources, 16% salty water and 16% honey. The major sources of the eye medicines used were from pharmacies (41.6%) and hospitals (33%).[7]
Besides this, attitude of parents towards wearing glasses in their children was also a concern as refractive error is the most easily treatable cause of visual impairment in children, 45.8% of the visually impaired children wore glasses. [Table 4], Of them, nearly 45% were not compliant for wearing them, the main reason for noncompliance was that either the glasses were broken or lost. There are numerous studies conducted on behaviour towards wearing glasses but all these are school-based studies, on comparing these studies with the current population-based study,[8,9,10,11,12,13,14,15,16,23,24] it was observed that compliance for wearing glasses in the current study was better than the 28% acceptance as reported by Bhandari et al.[7] but less than Youmoto et al.[16] who reported 71.1% acceptance after one year of wearing spectacles. The most important reason for not wearing glasses in our study was either that glasses were broken or uncomfortable with glasses [Figure 1], this is similar to the study conducted by Bhandari et al.,[7] Yabumoto et al.[6] and Pavithra et al.[9]
In the current study, spectacle wear was associated positively to the magnitude of refractive error and father’s education (P = 0.008), this is similar to the study conducted by Gogate et al.[8] who also reported the similar positive association to the magnitude of refractive error (P < 0.001), father’s education (P = 0.016).
Only (20.3%) of the parents of the visually impaired children had knowledge for vitamin A as an essential ocular nutrient. Similar to the study conducted by Akhtar et al.,[22] they also emphasised the need to generate knowledge amongst mother of infants to prevent vitamin A deficiency-related visual impairment.
Conclusion
One of the positive finding in the study was that most of the parents/caretakers are avoiding self-medication and seeking treatment immediately in case of ocular trauma. Also as refractive error is the most common cause of VI, so it is important that health talks should be encouraged and arranged at PHC level for making parents aware of importance of glasses. The attitude of caregivers of children should be changed towards usage of glasses and health education programmes related to importance of timely correction of refractive errors, avoiding self-medication and importance of ocular nutrient should be motivated by the primary healthcare providers.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- 1.Gilbert C, Bowman R, Malik ANJ. The epidemiology of blindness in children:Changing priorities. Community Eye Health. 2017;30:74–7. [PMC free article] [PubMed] [Google Scholar]
- 2.Wadhwani M, Vashist P, Singh SS, Gupta V, Gupta N, Saxena R. Prevalence and causes of childhood blindness in India:A systematic review. Indian J Ophthalmol. 2020;68:311–5. doi: 10.4103/ijo.IJO_2076_18. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Wadhwani M, Vashist P, Senjam SS, Gupta V, Saxena R, Tandon R. A population-based study on the prevalence and causes of childhood blindness and visual impairment in North India. Indian J Ophthalmol. 2021;69:1381–7. doi: 10.4103/ijo.IJO_2408_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Balasubramaniam SM, Kumar DS, Kumaran SE, Ramani KK. Factors affecting eye care-seeking behavior of parents for their children. Optom Vis Sci. 2013;90:1138–42. doi: 10.1097/OPX.0000000000000010. [DOI] [PubMed] [Google Scholar]
- 5.Amiebenomo OM, Achugwo DC, Abah I. Parental knowledge and attitude to children's eye care services. Niger J Paediatr. 2016;43:215–20. [Google Scholar]
- 6.Yabumoto C, Hopker LM, Daguano CR, Basilio FMA, Robl R, Rodrigues DB, et al. Factors associated with spectacle use compliance in a visual screening program for children from Southern Brazil. Invest ophthalmol Vis Sci. 2009;50:2439. [Google Scholar]
- 7.Bhandari G, Pradhan S, Shrestha M, Bassett K. Eye glasses compliance among children undergoing school visual acuity screening in Nepal. Adv Ophthalmol Vis Syst. 2016;5:286–90. [Google Scholar]
- 8.Gogate P, Mukhopadhaya D, Mahadik A, Naduvilath TJ, Sane S, Shinde A, et al. Spectacle compliance amongst rural secondary school children in Pune district, India. Indian J Ophthalmol. 2013;61:8–12. doi: 10.4103/0301-4738.99996. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Pavithra MB, Hamsa L, Madhukumar S. Factors associated with spectacle-wear compliance among school children of 7-15 years in South India. Int J Med Public Health. 2014;4:146–50. [Google Scholar]
- 10.Congdon NG, Patel N, Esteso P, Chikwembani F, Webber F, Msithini RB, et al. The association between refractive cutoffs for spectacle provision and visual improvement among school-aged children in South Africa. Br J Ophthalmol. 2008;92:13–8. doi: 10.1136/bjo.2007.122028. [DOI] [PubMed] [Google Scholar]
- 11.Messer DH, Mitchell GL, Twelker JD, Crescioni M, CLEERE Study Group. Spectacle wear in children given spectacles through a school-based program. Optom Vis Sci. 2012;89:19–26. doi: 10.1097/OPX.0b013e3182357f8c. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Congdon N, Zheng M, Sharma S, Choi K, Song Y, Zhang M, et al. Prevalence and determinants of spectacle nonwear among rural Chinese secondary schoolchildren:the Xichang Pediatric Refractive Error Study Report 3. Arch Ophthalmol. 2008;126:1717–23. doi: 10.1001/archopht.126.12.1717. [DOI] [PubMed] [Google Scholar]
- 13.Aldebasi YH. A descriptive study on compliance of spectacle-wear in children of primary schools at Qassim Province, Saudi Arabia. Int J Health Sci (Qassim) 2013;7:291–9. doi: 10.12816/0006057. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Wedner S, Masanja H, Bowman R, Todd J, Gilbert C, Gilbert C. Two strategies for correcting refractive errors in school students in Tanzania:Randomised comparison, with implications for screening programmes. Br J Ophthalmol. 2008;92:19–24. doi: 10.1136/bjo.2007.119198. [DOI] [PubMed] [Google Scholar]
- 15.Li L, Song Y, Liu X, Lu B, Choi K, Lam DSC, et al. Spectacle acceptance among secondary school students in rural China:The Xichang pediatric refractive error study (X-PRES)--report 5. Invest Ophthalmol Vis Sci. 2008;49:2895–902. doi: 10.1167/iovs.07-1531. [DOI] [PubMed] [Google Scholar]
- 16.Khandekar R, Sudhan A, Jain BK, Tripathy R, Singh V. Compliance with spectacle wear and its determinants in school students in Central India. Asian J Ophthalmol. 2008;10:174–7. [Google Scholar]
- 17.Eze BI, Chuka-Okosa CM, Uche JN. Traditional eye medicine use by newly presenting ophthalmic patients to a teaching hospital in South-Eastern Nigeria:Socio-demographic and clinical correlates. BMC Complement Altern Med. 2009;9:40. doi: 10.1186/1472-6882-9-40. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Ukponmwan CU, Momoh N. Incidence and complications of traditional eye medications in Nigeria in a teaching hospital. Middle East Afr J Ophthalmol. 2010;17:315–9. doi: 10.4103/0974-9233.71596. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Kagashe GAB, Msela B. Self medication among patients seen at ophthalmology clinics at four hospitals in dar es salaam Tanzania. J Pharm. 2012;2:21–5. [Google Scholar]
- 20.Carvalho RS, Kara-José N, Temporini ER, Kara-Junior N, Noma-Campos R. Self-medication:Initial treatments used by patients seen in an ophthalmologic emergency room. Clinics (Sao Paulo) 2009;64:735–41. doi: 10.1590/S1807-59322009000800005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Gupta N, Vashist P, Tandon R, Gupta SK, Kalaivani M, Dwivedi SN. Use of traditional eye medicine and self-medication in rural India:A population-based study. PLoS One. 2017;12:e0183461. doi: 10.1371/journal.pone.0183461. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Akhtar S, Ahmed A, Randhawa MA, Atukorala S, Arlappa N, Ismail T, et al. Prevalence of vitamin A deficiency in South Asia:Causes, outcomes, and possible remedies. J Health Popul Nutr. 2013;31:413–23. doi: 10.3329/jhpn.v31i4.19975. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Wadhwani M, Vashist P, Singh SS, Gupta V, Gupta N, Saxena R. Myopia prevalence in a population-based childhood visual impairment study in North India-CHVI-2. Indian J Ophthalmol. 2022;70:939–43. doi: 10.4103/ijo.IJO_974_21. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.World Health Organization. Cumulative official updates to ICD –Feb 2009. [[Last accessed on 2015 Jul]]. Available from: http://www.Who.int/clasification/icd/Official updates Combined 1996-2008 VOLUME1.pdf .