1. Dr. Margaret W Njuguna Dr. Lucy Njambi Ombaba
PREVALENCE, KNOWLEDGE, ATTITUDE AND PRACTICES IN REFRACTIVE ERROR AMONG HIGH SCHOOL STUDENTS IN NAIROBI COUNTY
Dr. Margaret W Njuguna
Dr. Lucy Njambi Ombaba

2. Review of research literature
Uncorrected refractive error(RE)
Global magnitude of uncorrected RE- leading cause of visual impairment and blindness
43% of visual impairment due to Uncorrected RE
80% of visual impairment worldwide can be avoided or cured
In children it may hinder school performance and lead to development of amblyopia.
Among the causes of blindness, refractive error ranks second to cataracts as a cause of blindness.
Uncorrected refractive error accounts for visual impairment in 153 million people.
Eighty percent of all visual impairment worldwide can be avoided or cured. About 90% of the world’s visually impaired live in developing countries1. Uncorrected refractive errors have a huge socioeconomic and psychological impact. In children it may hinder school performance and lead to development of amblyopia
1.Resnikoff S, Pascolini D, Mariotti SP, et al. Global Magnitude of visual impairment caused by uncorrected refractive errors in Bull world health Organ 2008; 86
2.WHO fact sheet on RE 2014

3. Review of research literature
Knowledge, attitude and practices(KAP) of refractive error
Lack of knowledge and stigmas plays a major role in uptake of refractive services in different continents
the lack of knowledge and awareness of RE are important risk factors for uncorrected RE 2,3,4
2.Congdon N., Z. m. (2008). prevalence and determinants of spectacle non-wear among rural Chinese secondary school children. Arch Ophthalmol.,
3.Ebeigbe, J. (2013). attitude and beliefs of Nigerian undergraduates to spectacle wear. Ghana Medical Journal.
4.Rosman M, W. T. (2009). Knowledge and beliefs associated with refractive errors and undercorrection: the Singapore Malay Eye Study. Br J Ophthalmol.

4. Study justification Uncorrected RE -public health concern.
Uncorrected RE hampers performance at school, reduces productivity and impairs quality of life.
Lack of knowledge, stigma and erroneous beliefs towards RE plays a major role in uptake of refractive services .2,3,4
Hardly any studies address KAP in refractive error
Assessing KAP gaps will justify intervention programmes
1.H.Nzuki. (2004). 2. Helen Significant refractive errors as seen in standard eight pupils attending public schools in langata Division, Nairobi, K
2.Congdon N., Z. m. (2008). prevalence and determinants of spectacle non-wear among rural Chinese secondary school children. Arch Ophthalmol.,
3.Ebeigbe, J. (2013). attitude and beliefs of Nigerian undergraduates to spectacle wear. Ghana Medical Journal.
4.Rosman M, W. T. (2009). Knowledge and beliefs associated with refractive errors and undercorrection: the Singapore Malay Eye Study. Br J Ophthalmol enya 2004

5. Study Objectives Broad objective
To determine the prevalence, knowledge, attitude and practice in refractive errors among high school students in Nairobi county.
Specific objectives
To determine the prevalence of refractive error among high school students
To assess the knowledge of refractive error among high school students
To determine the attitude of high school students towards refractive errors
To determine the practice in refractive error of high school students

6. Methodology Study design
Cross sectional school based study with a qualitative component
Study population
Form 3 high school students in public high schools in Nairobi County
Study area
Nairobi county-80 public high schools in 10 divisions

7. Methodology Sample size calculation and Sampling Method Parameters
Estimate of the expected proportion (p)
Desired level of absolute precision (d)
Estimated design effect (DEFF)
Confidence limit (usually 95% and Z score

8. Methodology Sample size calculation and Sampling Method
n = x 0.1 x 0.9 (1.5)
n = 1297
To estimate the assumed prevalence of refractive error 10% with 95% CI (8% - 12%) among high school students, adjusting for the design effect of 1.5 and confidence limit (usually 95% and Z score = 1.96), the final minimal sample size will be 1297
Factor 10% to end up with 1500
Total number 37580

9. Methodology Sampling the Procedure
Stratification/Categories of schools- National schools, County schools and District schools
Sub-stratified into boy, girl & mixed
Schools from each category will be randomly selected using spreadsheet program
Participants will be form 3 students
Participants will be allocated a study number

10. Study area- Nairobi County
starehe
westlands
dagoretti

11. Sampling frame of high school students in Nairobi County
News letter of high school performance
in National schools, in County schools and in the District schools

12. Data collection procedure
Presenting VA-Log MAR chart 3m
VA better than 6/12 in better eye. Record VA
Spectacles-VA sc&cc RE&LE
VA worse or equal to 6/12 in the better eye
Power of spectacle - Lensometer
Objective refraction & subjective refraction
Plano/ 0.25 DS/DC
RE ≥0.50 DS/DC
VA doesn’t improve by 2 lines
VA improves 2 lines or more=RE
Anterior and posterior segment examination- recordyytyffcnhhg
KAP=FGD or IDI
KAP FGD or IDI

13. Data management
Data analysis -SPSS and Computer Assisted/Aided Qualitative Data Analysis Software (CAQDAS).
Double data entry to ensure accuracy.
Proportions will be used to estimate the prevalence of R.E and proportion of students knowledgeable in refractive errors.
Responses to the KAP questions will be scored.
Participants with RE will be assessed in terms of KAP towards RE and access to ophthalmic services.
Results will be presented using ratio, proportion, rates, tables and diagrams wherever appropriate.

14. Ethical considerations
Approval -Ethical Committee of University of Nairobi – Kenyatta National Hospital.
Permission -Permanent Secretary, Ministry of Education and Head teachers of schools
Assent- Participants.
Confidentially of participants records.
Spectacle prescription and follow up for participants with RE.
Students with other ocular disease will be referred to eye centers.

15. Tentative Timetable Ethical Approval by April 2014
Collection of data May- June 2014
Data Analysis July-August 31st 2014
Presentation of results September 2nd 2014
Hand in bound book by January 1st 2015