Resource-limited Economy Research Articles

Pattern and Outcome of Pediatric Cardiac Surgery in University of Nigeria Teaching Hospital, Enugu: A Setting of West African Sub-region

Abstract Background: Paediatric cardiac surgery is highly challenging, especially in resource-limited economy like ours. The burden of heart diseases in children is huge and increasing thus, the need to audit the bold step resumed by our center in the last 5 years. Objective: To determine the pattern and outcome of Paediatric open heart surgeries done in a tertiary hospital of West African sub-region. Methodology: Descriptive, cross-sectional study where medical records of all Paediatric Open Heart Surgeries done in our centre from March 2013 to July 2018 (five year period) were reviewed. We looked at pre-operative and post-operative outcome measures and compared our outcome variables with international best practices outcome. Results: A total of 73 children had open heart surgery within the above period. Age group Ranged from infants to adolescents with almost equal sex distribution. The mean parental age was 37 years. About 20 different procedures were done with more of ventricular septal defect closure and total correction of tetralogy of Fallot. Combined two or three procedures in a patient were done in 33 (45.21%) patients. The mean bypass time was 70.98 min, mean duration on ventilator 2.4 days, mean duration on inotropes 5.5 days, and mean duration of intensive care unit stay was 7.53 days. Blood transfusion was given in 38 (52.08%) patients. Discharge in good condition in 89.04% patients, whereas 6.9% had mortality. Conclusion: Despite the efforts of our foreign collaborators, there is still a yearning need for intersectoral involvement to enshrine routine open heart surgery and cardiac intervention services by training and retraining of local capacity.

The role of clinical and sonographic assessments in pre-operative evaluation of patients with splenic injuries in a resource-limited economy.

Splenic trauma has been recognized as the most common cause of preventable deaths amongst trauma patients. Due to paucity of modern diagnostic imaging facilities in our setting, determination of the error rates and role of the simple, available diagnostic approaches are worthwhile and relevant to the practice of general surgery. The aim was to determine the role and diagnostic accuracy of clinical and sonographic assessments of splenic injuries. This was a prospective study of the value of pre-operative clinical and sonographic assessments of patients with splenic injuries in our setting. A total of 111 patients with abdominal trauma were evaluated. Of these, splenic injuries were confirmed in 75 patients intra-operatively, mainly from blunt trauma. Of the 97 cases diagnosed by clinical method, 66(68.0%) were confirmed by intraoperative findings. Similarly, of 86 sonographic diagnoses of splenic injuries, 61 (70.9%) truly had splenic trauma. Sensitivity for sonographic and clinical assessments was 84.7% and 78.9% respectively. False positive and negative rates for clinical (27.3% versus 44.1%) and ultrasonographic (29.1% versus 40.0%) assessments were high. Majority of splenic injuries were due to blunt abdominal trauma. The two diagnostic methods showed high sensitivity, but performed poorly for other validity tests.

A real-world prospective study on dialysis-requiring acute kidney injury.

BackgroundCurrent information about acute kidney injury (AKI) epidemiology in developing nations derives mainly from isolated centers, with few quality multicentric epidemiological studies. Our objective was to describe a large cohort of patients with dialysis-requiring AKI derived from ordinary clinical practice within a large metropolitan area of an emerging country, assessing the impact of age and several clinical predictors on patient survival across the spectrum of human life.MethodsWe analyzed registries drawn from 170 hospitals and medical facilities in Rio de Janeiro, Brazil, in an eleven-year period (2002–2012). The study cohort was comprised of 17,158 pediatric and adult patients. Data were analyzed through hierarchical logistic regression models and mixed-effects Cox regression for survival comparison across age strata.ResultsSevere AKI was mainly hospital-acquired (72.6%), occurred predominantly in the intensive care unit (ICU) (84.9%), and was associated with multiple organ failure (median SOFA score, 11; IQR, 6–13). The median age was 75 years (IQR, 59–83; range, 0–106 years). Community-acquired pneumonia was the most frequent admission diagnosis (23.8%), and sepsis was the overwhelming precipitating cause (72.1%). Mortality was 71.6% and was higher at the age extremes. Poor outcomes were driven by age, mechanical ventilation, vasopressor support, liver dysfunction, type 1 cardiorenal syndrome, the number of failing organs, sepsis at admission, later sepsis, the Charlson score, and ICU admission. Community-acquired AKI, male gender, and pre-existing chronic kidney disease were associated with better outcomes.ConclusionsOur study adds robust information about the real-world epidemiology of dialysis-requiring AKI with considerable clinical detail. AKI is a heterogeneous syndrome with variable clinical presentations and outcomes, including differences in the age of presentation, comorbidities, frailty state, precipitation causes, and associated diseases. In the cohort studied, AKI characteristics bore more similarities to upper-income countries as opposed to the pattern traditionally associated with resource-limited economies.

Psycho-economic impact of COVID-19 pandemic on otorhinolaryngology practice in India

<p class="abstract"><strong>Background:</strong> COVID-19 pandemic has exposed the soft underbelly of healthcare systems across the world wherein resource limited economies seemed to have taken a greater hit. Present questionnaire-based study was done to determine the perceived threats, psychological stress and economic concerns among practicing otolaryngologists in India, facing COVID-19 pandemic.</p><p class="abstract"><strong>Methods:</strong> A cross-sectional, anonymous, self-reported questionnaire-based study was carried out among otolaryngologists in India over 3 week’s period, during the first countrywide lock-down. An online questionnaire was hosted and publicized using social media. A total of 178 participants landed on the page, 73 were excluded at the first question, 105 otolaryngologists, who were allowed to proceed, completed the questionnaire. </p><p class="abstract"><strong>Results:</strong> Out of 105 otolaryngologists, 57 (52.8%) worked in private-sector. Significantly (p=0.001) higher number of private doctors (66.7%) were afraid of escalated cost of running out-patient clinics compared to government doctors (33.3%). Majority (80.8%) were against performing routine surgeries during pandemic with no significant difference between private and government doctors (p=0.765). Increased stress, during this pandemic was perceived by 73.1%.</p><p class="abstract"><strong>Conclusions:</strong> There were clear indications of psychological stress among the practicing otolaryngologists. Main reasons; anxiety about risk of infection for self, staff members and family, economic impact of the increased protective measures needed. It can be safely concluded based on the study that to alleviate fears of otolaryngologists in India; a comprehensive policy intervention is needed urgently, which is all the more important with the threat of a resurgence looming large over the country.</p>

A 'parallel pandemic': The psychosocial burden of COVID-19 in children and adolescents.

The widespread restrictive measures used to control the transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection include but are not limited to social distancing and temporary shutdown of schools, companies, and recreational facilities. These dramatic shifts in lifestyle implemented in a short time-frame, have inadvertently exposed a darker social scenery that challenges the well-being and development of a generation of children and adolescents globally. The pandemic has stretched the capacity of healthcare providers and home caregivers in resource-rich and resource-limited economies, leaving many children in circumstances that offer limited physical, infrastructural, emotional, and social support.

Re-thinking breast and cervical cancer preventive campaigns in developing countries: the case for interventions at high schools

BackgroundThe negative impact of cervical and breast cancers in low and lower-middle income countries are worsening, and, along with other non-communicable diseases, occur disproportionately in these resource-limited economies. Most preventive approaches to these cancers require government funding, but few countries with the most at-risk population can afford government-sponsored universal vaccination, screening, diagnostic and treatment programmes, which, along with socioeconomic issues, contribute to the poor outcomes in these mostly developing countries. An urgent need exists, therefore, to find an effective, affordable, cost-effective, culturally-acceptable and sustainable way of reducing these cancers. This paper advocates a re-thinking in the current preventive campaigns.Main bodyUsing evidence provided by recently-published papers, a case is made for enlightenment campaigns to primarily target teenagers (boys and girls) in high schools of developing countries. Inclusions into the schools’ academic curricula are the recommended approach, given that both cancers take hold on populations within that age bracket.This approach, if adopted, may be the only accessible, affordable and realistic approach that gives millions of women in low and lower-middle income countries the chance at survival. Empowering them early instils the self-awareness and confidence necessary for young adults to take charge of their own health. The acquired knowledge, in turn, helps them adopt positive attitudes and preventive behaviours that will, ultimately, prolong their lives.ConclusionThe recommended approach offers governments and concerned stakeholders an evidence-based option that allows them to deliver cost-effective and sustainable life-saving interventions, while hoping to get around the bottlenecks that limit the large scale implementation of other effective but capital-intensive strategies.

Tackling breast cancer in developing countries: insights from the knowledge, attitudes and practices on breast cancer and its prevention among Nigerian teenagers in secondary schools.

SummaryBackgroundBreast cancer occurrences in developing countries are gradually matching caucasian levels. Since early detection is linked to reductions in morbidities and mortality, affordable screening techniques like breast self-examination (BSE) becomes imperative in these resource-limited economies. Ascertaining the Knowledge, Attitudes, and Practices (KAP) of breast cancers and BSE among young adult females will help provide baseline information for early and targeted interventions.MethodA cross sectional survey involving 432 female senior secondary school students in Otuocha Educational Zone of Anambra State, Nigeria.ResultsA total of 321 (74.3%) valid questionnaires were returned. Mean age was 16.79 ± 1.48 years. Even though 84.6% and 55.2% had respectively heard about breast cancer and BSE, and the ‘General Knowledge’ of breast cancer was high (75.2%), specifics on ‘Risk Factors’ (41.5%) and ‘Symptoms’ (46.1%) were poor.Knowledge on correct BSE ‘Techniques’ was 52.9%, but few know when to commence (43.1%), the right frequency (31.5%), or the right timing (24.6%). A large majority (73.6%) had positive attitudes, but only 6.1% practice it monthly, while 55.3% had never done it at all. No significant predictors of Knowledge and Practice of BSE was identified.ConclusionHealth campaigns on BSE and breast cancers should provide specific details on techniques, risk factors and symptoms, while emphasizing on the right methods, timing and frequency. The positive attitudes identified raise optimism that health interventions would be effective and can have long term benefits. If possible, BSE and breast cancer teachings should be included in the secondary school academic curricula of resource-limited countries.

Targeting cervical cancer campaigns on teenage high schoolers in resource-limited economies: lessons from an intervention study of Nigerian senior secondary school girls

Given the dearth of government-sponsored programmes, preventive lifestyles and practices are the realistic hopes for millions of women in developing countries against cervical cancer. Early interventions for teenage high school girls have been advocated recently, but evidence-base for sustainable activities at this demographic is lacking. This article reduces this gap by determining the impact of two cervical cancer education techniques. This is a 6-month interventional cohort study of 432 female high school students in South-eastern Nigeria. A total of 317 (73.4%) and 301 (69.7%) valid responses were received from the pre-intervention (16.8 ± 1.5 years) and post-intervention (17.2 ± 1.6 years) surveys, respectively. About 213 (70.8%) were fully engaged with the interventions. Logistic regression revealed that participants who were 'engaged' with the interventions, either through symposium attendance or by reading of the printed handouts, showed significant improvements across multiple cervical cancer parameters regarding knowledge on 'pap smears' (analysed with four items), 'HPV vaccine' (two items) and 'risk factors' (two items). Improvements in Knowledge of 'early symptoms' were not improved, with 'post-coital bleeding' [odds ratio (OR) = 0.95; P = 0.87] and 'being asymptomatic' (OR = 0.69; P = 0.32) remaining statistically similar between the engaged and the unengaged. If 'engagement' with either intervention was disregarded, a chi-square analysis identified no significant improvement in knowledge on any parameter. Ensuring 'engagement' with intervention campaigns is vital to achieving effective and sustainable cervical cancer knowledge. Engagement may be achieved by repeating the education activities across all the years/classes that make up high school in each developing country, along with formal examinations at each level.

Lead sorption characteristics of various chicken bone part-derived chars.

Recycling food waste for beneficial use is becoming increasingly important in resource-limited economy. In this study, waste chicken bones of different parts from restaurant industry were pyrolyzed at 600°C and evaluated for char physicochemical properties and Pb sorption characteristics. Lead adsorption isotherms by different chicken bone chars were carried out with initial Pb concentration range of 1-1000mgL-1 at pH 5. The Pb adsorption data were better described by the Langmuir model (R2=0.9289-0.9937; ARE=22.7-29.3%) than the Freundlich model (R2=0.8684-0.9544; ARE=35.4-72.0%). Among the chars derived from different chicken bone parts, the tibia bone char exhibited the highest maximum Pb adsorption capacity of 263mgg-1 followed by the pelvis (222mgg-1), ribs (208mgg-1), clavicle (179mgg-1), vertebrae (159mgg-1), and humerus (135mgg-1). The Pb adsorption capacities were significantly and positively correlated with the surface area, phosphate release amount, and total phosphorus content of chicken bone chars (r≥0.9711). On the other hand, approximately 75-88% of the adsorbed Pb on the chicken bone chars was desorbable with 0.1M HCl, indicating their recyclability for reuse. Results demonstrated that chicken bone char could be used as an effective adsorbent for Pb removal in wastewater.

Retinal imaging with smartphone.

The use of smartphones for various purposes among health professionals is increasing, especially with the availability of different applications. On account of cost, fundus cameras are not readily available in ophthalmic practice in developing countries. Since smartphones are readily available, easy to use and portable, they may present a cheap alternative in a resource-limited economy. to explore the use of smartphone (Blackberry Z-10) for retinal imaging in a resource-limited economy. A smartphone (Blackberry Z-10) was used to acquire retinal images with the use of +20D lens in patients with dilated pupils by activating the video mode of the camera. Clear retinal images were obtained in different clinical conditions in adults and children including branch retinal vein occlusion with fibrovascular proliferation, chorioretinal scarring from laser photocoagulation, presumed ocular toxoplasmosis, diabetic retinopathy, retinoblastoma, ocular albinism with fundus hypopigmentation. The ability to have low cost fundus imaging from readily available smartphones in an eye clinic in Nigeria presents a major boost to patient care and also offers an innovative role in research, education, and information sharing.

Monitoring transfusion practice

Blood transfusion has become an integral part of modern health care. When it is required, it is an essential element of therapy. However, it is not without risk. Being of human tissue origin, this risk is related to its source as well as the process involved in its provision. To ensure that blood transfusion is safe and does not cause harm to patients, these risks have to be monitored, evaluated and managed appropriately. Therefore, it is essential to develop quality management system to ensure processes and procedures are controlled to prevent deviations and errors. Quality systems should be developed covering the whole transfusion chain. Policies, standards and guidelines are important tools. To ensure that the system is effective, there are various mechanisms to monitor, evaluate and analyse to bring about improvement. These include developing indicators, quality and clinical/transfusion audits, quality assessment programmes and haemovigilance programme. Guidelines whether national or international are required against which practices and performance are gauged. Haemovigilance sometimes lead to focused audits to understand deviations that occurred and to institute corrective actions. In resource limited economies, monitoring can be used effectively when a stepwise approach is adopted. The aim is to create a culture of professionalism in delivering quality of care to patient with efficient use of available resources. The benefit can be extended to influence change and improvement in health care in general. The Hospital Transfusion Committee plays an important role in implementing change.

Multivariate regression analysis of prime variables affecting ophthalmic patients’ satisfaction in a resource limited economy

The aim of the present study was to appraise prime dependent variables of ophthalmic patients’ satisfaction in a Nigerian public eye care facility with a view to boosting service uptake. It was a cross sectional study conducted between March and May 2012 in our centre. Consecutive clinic patients (n=251) that met study’s criteria were recruited. The patients filled interviewer-administered structured questionnaires. A total of 251 patients were analyzed comprising 139 males (55.4%) and 112 females (44.6%). Male:female ratio=1:0.8. The ages of the patients studied ranged from 17 to 92 years with a mean of 37.2 years±15.57. Bivariate analysis, validated by multiple logistic regression, showed P values of 0.021, 0.008, 0.036, 0.008 and 0.004 for privacy, comfort during eye exam, fairness (non-partiality), thoroughness of examination and expectation, respectively. Satisfaction with overall quality of services was 80.1%. The services of any eye facility should be patient-driven to attain desired goals; therefore the identified areas of patients’ dissatisfaction should be addressed for effective service uptake.

Presbyopia: Prevalence, distribution and determinants in Owerri, Nigeria

Background: Presbyopia causes blurring and impairment of vision at near. It is the most common physiologic change in the adult eye with advancing age. Good near vision is a necessity for domestic activities, office work and near vision tasks other than reading and writing, especially among adults in a resource-limited economy. The study determined the prevalence, distribution and determinants of presbyopia; presbyopic spectacle coverage; and provided data for ready-made near vision spectacles in Imo State, Nigeria. Materials and Methods: A total of three thousand, four hundred and fifty-one adults consisting of 2606 persons as study group and 845 persons as controls were randomly selected for the study. Structured questionnaire was administered to the subjects. Their visual acuity at far and near including tonometry, ophthalmoscopy, perimetry, retinoscopy and subjective refraction were done. Subjects who could not read N6 and emmetropes, who are 40 years and above were considered as presbyopic. Results: The prevalence of presbyopia was 70.9% and 75.0% of study and control groups respectively. Females aged 40-49 were in the majority (57.1% and 51.9% of females in the study and control groups respectively). Subjects requiring additions at near of ˃+1.50DS to 2.00DS were in the majority (39.0% and 46.4% of study and control groups respectively). Amongst the presbyopes 61.3% and 78.7% of study and control groups respectively did not have presbyopic correction. The subjects were also ignorant of corneal inlay technology in treatment of presbyopia. A higher prevalence exists among rural dwellers and the contributory factors were environmental influences, poor nutrition and irrational use of chloroquine for treatment of malaria. Conclusion: Over seventy-percent of presbyopia was found in this study. The determinants were age, gender, nutrition and drug use. Majority of the presbyopes were domicile in the rural area and did not have corrective spectacles. We recommend visual health education, regular vision screening and intervention to achieve the targets of vision 2020 in low-and-medium-income countries.

Outcome of Late Presentation of Posterior Urethral Valves in a Resource-Limited Economy: Challenges in Management

Delayed presentation of patients with posterior urethral valve with complications like severe urosepsis, uremia, and anemia are seen in our setting. Renal replacement therapy which should have been offered to these patients is not readily available for children in our country. The aim of this study is to determine the pattern of late presentation and outcome of management of posterior urethral valve in a resource-limited setting. A descriptive retrospective study (1997–2009) was conducted. Data including pattern of presentation, duration of symptoms, complications, and outcome of initial management were analyzed. Twenty-one patients were seen. The median age was 3 years (2 days–13 years). The mean duration of symptoms before presentation was 2.6 years. Nineteen patients (91%) presented with urosepsis while 8 patients (36%) presented with significant renal insufficiency. Laboratory findings varied from-mild-to marked elevation in serum creatinine. Radiological findings confirmed the diagnosis of posterior urethral valve. We concluded that late presentation is common in our setting. This is associated with high morbidity and mortality rates. Efforts at improving awareness and early diagnosis among the health team should be made to stem the tide.

Mandibular defect reconstruction with nonvascularized iliac crest bone graft

Reconstruction of mandibular defect is a challenge to the head and neck surgeon because of associated functional and esthetic problems. Our experience with the use of nonvascularized iliac crest bone graft is hereby reported. The aim was to report our experience with the use of nonvascularized iliac crest bone for mandibular defect reconstruction at University College Hospital, Ibadan. Nigeria. A retrospective descriptive study was performed. Cases of mandibular reconstruction with iliac crest bone graft between January 2001 and December 2007 were included in this study. Grafts were secured with either a stainless steel wire or a titanium plate. Preoperative diagnosis, postoperative follow-up records including investigations, diagnosis of graft infection and subsequent treatment modalities were extracted from the available records. Descriptive variables were analyzed with SPSS version 14. A total of 47 patients had mandibular defect reconstruction with nonvascularized iliac crest block bone during the study period. Thirty-eight patients had graft secured with transosseous wire [NVIBw] while 9 had a titanium plate [NVIBp]. The male:female ratio was 26:21 while the mean age of the patients was 24.6±4.25 years. Ten patients (21.3%) developed persistent graft infection during the postoperative period. All cases of infection occurred in patients who had transosseous wiring and analysis showed that 60% of the infected grafts revealed mixed microbial isolates containing Klebsiela spp, Pseudomonas Aeurogenosa, and E coli. Six (60%) of the infected grafts were removed as a result of unabated infection while 4 (40%) were successfully treated by exploration and pus drainage. Nonvascularized iliac crest bone graft provides an affordable and less technical choice for mandibular reconstruction with minimal complications in a resource-limited economy.

Aligned carbon nanotube based ultrasonic microtransducers for durability monitoring incivil engineering

Structural health monitoring of porous materials such as concrete is becoming a majorcomponent in our resource-limited economy, as it conditions durable exploitation ofexisting facilities. Durability in porous materials depends on nanoscale features which needto be monitored in situ with nanometric resolution. To address this problem, we putforward an approach based on the development of a new nanosensor, namely a capacitivemicrometric ultrasonic transducer whose vibrating membrane is made of alignedsingle-walled carbon nanotubes (SWNT). Such sensors are meant to be embedded in largenumbers within a porous material in order to provide information on its durability bymonitoring in situ neighboring individual micropores. In the present paper, we report onthe feasibility of the key building block of the proposed sensor: we have fabricatedwell-aligned, ultra-thin, dense SWNT membranes that show above-nanometer amplitudesof vibration over a large range of frequencies spanning from 100 kHz to 5 MHz.

Opinion of surgical eye patients on preoperative routine HIV screening in a resource-limited economy

Despite inherent benefits, routine (HIV) test is still controversial. A cross-sectional survey of 198 preoperative eye patients was carried out at a Nigerian hospital to determine their opinion on preoperative routine HIV screening. Participants comprised 121 (61%) males and 77 (39%) females, mean age 56 years SD 17. Most (77%) had at least primary education. Awareness of HIV/AIDS was high (96%) and radio was the commonest (73%) source of awareness. Just 18% previously had HIV screening, only 37% had positive attitudes towards routine HIV test. Many admitted stigmatization (47%), discrimination (48%) and lack of cure (44%) as challenges of HIV/AIDS. There were no associations (p > 0.05) between participants’ educational levels and awareness of HIV/AIDS, previous HIV test, consenting to preoperative HIV test. Also, there were no associations between participants’ gender and awareness of HIV/AIDS, previous HIV test, but male gender was associated with consenting to preoperative HIV test (p = 0.011). Continued support for HIV enlightenment (73%) and funding of research into cure for HIV/AIDS 59% were recommended. Discordance exists in participants’ awareness, education and attitudes to routine HIV test. Stigmatization, discrimination and lack of cure still lively HIV/AIDS challenges. Informed consent before preoperative HIV test and continued support for HIV/AIDS are underscored. Key words: Attitude, informed consent, patient right, preoperative eye patient, routine HIV test.

Refractive ocular conditions and reasons for spectacles renewal in a resource-limited economy

BackgroundAlthough a leading cause of visual impairment and a treatable cause of blindness globally, the pattern of refractive errors in many populations is unknown. This study determined the pattern of refractive ocular conditions, reasons for spectacles renewal and the effect of correction on refractive errors in a resource-limited community.MethodsA retrospective review of case records of 1,413 consecutive patients seen in a private optometry practice, Nigeria between January 2006 and July 2007.ResultsA total number of 1,216 (86.1%) patients comprising of (486, 40%) males and (730, 60%) females with a mean age of 41.02 years SD 14.19 were analyzed. The age distribution peaked at peri-adolescent and the middle age years. The main ocular complaints were spectacles loss and discomfort (412, 33.9%), blurred near vision (399, 32.8%) and asthenopia (255, 20.9%). The mean duration of ocular symptoms before consultation was 2.05 years SD 1.92. The most common refractive errors include presbyopia (431, 35.3%), hyperopic astigmatism (240, 19.7%) and presbyopia with hyperopia (276, 22.7%). Only (59, 4.9%) had myopia. Following correction, there were reductions in magnitudes of the blind (VA<3/60) and visually impaired (VA<6/18-3/60) patients by (18, 58.1%) and (89, 81.7%) respectively. The main reasons for renewal of spectacles were broken lenses/frame/scratched lenses/lenses' falling off (47, 63.4%).ConclusionsAdequate correction of refractive errors reduces visual impairment and avoidable blindness and to achieve optimal control of refractive errors in the community, services should be targeted at individuals in the peri-adolescent and the middle age years.

Awareness and knowledge of ocular cancers in a resource-limited economy

Aims:To determine awareness and knowledge of ocular cancers in a resource-limited setting.Material and Methods:A descriptive cross-sectional survey (2009) of 1,887 Nigerians using interviewer-administered questionnaire.Results:Respondents were 55.6% males, and mean age was 30 years, SD 9.5. Most respondents (77.8%) had at least secondary education. Fewer respondents were aware of eye cancers (57.1%) compared to cancers in general (73.7%) (P<.001). Despite the male preponderance there were no associations between gender and awareness of ocular cancers (P=0.07) and cancers in general (P=0.85). However, education was associated with awareness of ocular cancers (P<.001) and cancers in general (P<.001). Ocular cancers were thought to be caused by corrosives 33.2%, trauma 21.4%, witchcraft 18.6%, genetic transmission 15.7%, sunlight 8.0%, radiations 2.5% and infections 0.6% (n = 883). Of 280 respondents, 41.1% based their knowledge of patients having ocular cancers on sources other than hospital diagnosis. Of 148 respondents, 16.2% were related to ‘patients’ they knew had ocular cancers. There were 202 respondents who indicated challenges to accessing orthodox medical eye care services by ocular cancer patients as high cost 55.5%, long waiting period 23.3%, long distance 15.4% and poor attitude of health workers 5.9%.Conclusion:Awareness of ocular cancers compared to other cancers is low. Misconceptions on the causes of ocular cancers exist. Public ocular cancers health education can enhance awareness. The need to address barriers to accessing eye care is underscored.

Challenges, Attitudes and Practices of the Spectacle Wearers in a Resource-Limited Economy

Purpose:To evaluate challenges, attitudes and practices among spectacle wearers to effect positive change when necessary, and determine positive change in a resource-limited economy.Materials and Methods:A multi-hospital descriptive, cross sectional survey of spectacle wearers was conducted between May 2007 and December 2008 in Nigeria.Results:A total of 214 wearers comprising 43.5% males and 56.5% females aged 18-84 years were surveyed. The majority of subjects (92.6%) had at least secondary education. The wearers’ challenges included expensive spectacles (43.0%), falling/scratched/broken lenses (29.4%) and fear that spectacles would damage the eyes (23.8%). The wearers’ attitudes were comprised of consultations with ‘road side dispensers’ (7%) and permitting other individuals to select spectacle frames for them (26%). Care and maintaince practices included use of handkerchief, tissue paper, fingers and water to clean spectacles (49.5%) and placing spectacles inside spectacle cases (30.4%). There were no associations (P > 0.05) between gender or literacy levels and who selected the frames for the subjects, caregivers consulted for spectacles, and cleaning materials for spectacles. The placement of spectacles when not in use was significantly associated (P < 0.05) with the wearers’ gender and literacy levels but not with the length of spectacle wear.Conclusion:Attitudes and practices requiring positive change crossed gender and educational levels among spectacle wearers. The cost of spectacles should be regulated and availability of standard eye care practices would reduce challenges including lens-related defects and quackery. During consultation with a recognized eye care professional, counseling of wearers on positive attitudes/practices as well as allaying fear of spectacle wear is required.