|Year : 1966 | Volume
| Issue : 4 | Page : 165-170
Incidence of trachoma among the school children in Madurai city
Madurai Medical College, Madurai., India
|Date of Web Publication||17-Jan-2008|
Madurai Medical College, Madurai.
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Krishnamoorthy R. Incidence of trachoma among the school children in Madurai city. Indian J Ophthalmol 1966;14:165-70
|How to cite this URL:|
Krishnamoorthy R. Incidence of trachoma among the school children in Madurai city. Indian J Ophthalmol [serial online] 1966 [cited 2020 Jun 1];14:165-70. Available from: http://www.ijo.in/text.asp?1966/14/4/165/38637
Trachoma pilot project, undertaken by the Indian Council of Medical Research conducted a survey of incidence of Trachoma in all the States of our country in the year 1959. As Medical Officer-in-charge of the Trachoma pilot project in the State of Madras, I had an opportunity to tour the state and examine 2298 persons in 740 households of 35 villages in 5 districts. That survey work was confined to rural population and the incidence of Trachoma was found to be 4.6 per cent. In the year 1965-66 a survey of ocular diseases among the school children of Madurai city was done by the Department of Ophthalmology with the assistance of the Census Department.
1. Pilot Survey:
At the outset a pilot survey of 123 children in three schools, was done in the month of November 1965, to study the incidence of diseases of the eye. This pilot survey helped us to assess the incidence of diseases of the eye and thereby calculate the number of children to be examined in Madurai for sample survey. The pilot survey also helped us in understanding the difficulties of examination of children and recording and analysing the details. We found the incidence of trachoma in the pilot survey to be 4.9 per cent.
2. Selection of Schools and children:
In Madurai city there are 179 schools within the Municipal limits and 116,770 children were studying in these schools in the year 1965-66.
A list of all the 179 schools was prepared in the alphabetical order. The list contained information about the number of standards in each school and the number of sections in each standard and the number of children in each section. The Census department with the help of the result of the pilot survey found that about 2000 children should be examined in the random sample survey. Every 50th student in each school was selected for examination.
By this method of random sampling, the survey covered all the schools in Madurai city, all age groups of either sex, all communities, all income groups and all residential areas.
The Census department selected 2008 children for examination in this survey work. With the co-operation of the Education Department and teachers we were able to examine 1923 children, only 85 children (4%) being absent. Among the children examined 1051 were boys and 872 were girls.
3. Mode of examination:
All children selected were brought to the Erskine Hospital, Madurai for examination in the Eye department. In the Eye department a team of two Assistant Medical Officers, four House surgeons, one social worker, one technician, two clerks and two opticians and an Orthoptist examined these children and entered the details in the proforma. Everyday 20 to 40 students from different schools were examined. The whole survey work lasted for two months, from February to April 1966. In this paper only the incidence of trachoma among the school children of Madurai, has been analysed.
4. Incidence of ocular disorders:
[Table - 2] illustrates the relative incidence of ocular disorders among the children examined. It shows that the general health was not satisfactory in a number of children, angular stomatitis was found in 309 children and xerosis in 115 children, out of 1923 examined. Defective vision, sufficient to be a handicap for the children in the class room was found in 290 children.
5. Incidence of Trachoma:
Among the 1923 children examined, it may be noted that 98 children (5.1%) had trachoma. Madurai city has a population of 424,975: among them 116,770 (27.46%) was school going children. This survey covered nearly 27.46% of the total population of the Madurai city, and so approximately gives the true incidence of trachoma in the urban population. The incidence of 5.1 per cent in the urban population is comparable to 4.6 per cent incidence of trachoma in the rural population of Madras State, as estimated by the Trachoma Pilot project in the year 1959.
6. Age and Sex incidence of trachoma :
Because more children were selected and examined in the younger age groups more cases of trachoma were likely to be seen in these age groups. To overcome this snag, the percentage of children with trachoma to the total number of children examined in each sex and age group was also calculated. Such an analysis clearly showed
(1) that trachoma was more common in the younger children (S to 11 years) of the
Elementary schools than the older children (11 to 16 years) of the higher Elementary schools and high schools,
(2) that girls were more frequently affected than boys in all ages.
It shows that trachoma is primarily a disease of the young and immunity getting established with age, the incidence decreases. Consequently it was observed that trachoma was less prevalent in the higher standards in high schools.
7. Trachoma and School:
Trachoma was seen in children from 58 schools out of 179 schools covered in this survey. Out of these 58 schools 25 were Municipal Elementary schools, 26 were aided elementary schools and remaining seven were high schools. Trachoma was found more frequently in the Municipal Elementary schools of both the south and the north range, (7.3 and 8.9 respectively) then the 'aided' elementary schools (5.8 and 4.8). The high schools had a still lower incidence (2.5 and 1.5).
8. Trachoma and Visual Loss:
In a survey of trachoma it is necessary to know not only the incidence but also its severity. Severity can be judged by the visual incapacity caused. Determining the visual acuity in these 98 children with trachoma it was found that 20% had vision between 6/18 and 6/9, 3% between 6/60 and 6/24 and none below 6/60. Even these were due to refractive errors and in none of them it was due to involvement of cornea. Thus with an incidence as low as 5.1 the severity of trachoma in this survey may be considered extremely low.
9. Trachoma and Community:
Trachoma was found in children of all communities. But they were found unexpectedly in fair numbers even in some communities (Pillai, Brahmin, Naidu, vellalar, chettiar and Sourashtra) who have healthy and hygienic habits. Fifty children with trachoma were found in the communities mentioned above.
10. Trachoma and income:
Per capita income was obtained by dividing the total monthly income of the family by the total number of members of the family (adults and children). Most of the children with trachoma were found to be having low per capita income. 61 children had per capita income of Rs. 19/- and less. It can be seen from the table that there is a sudden drop from the income-group Rs. 20/- and up which appears to be the critical level.
For the same reason it was found that trachoma was more prevalent in the free Municipal Elementary schools than in the "aided" elementary schools. The incidence was even less in public high-schools.
11. Trachoma and Malnutrition
Angular stomatitis was found in 16 per cent of the entire group of school children whereas 24 per cent of the children with trachoma had angular stomatitis. Trachoma was found only in 5.1 per cent of all the 1923 school children, whereas 7.7 per cent of the children with angular stomatitis had trachoma. Though angular stomatitis like trachoma was more common in younger children it was commoner in males whereas trachoma was more common in females.
Xerosis was noted in 115 children (5.9%). Only two children had trachoma and xerosis together in this survey.
Trachoma and malnutrition diseases may occur in the low income groups and this relationship appears to be only casual. In the lower income groups overcrowding and unhealthy dwellings may be a predisposing factor for trachoma. In the same low groups are also seen malnutrition and their effects on the eye. In fact, malnutrition appears to be a greater problem in Madras than trachoma.
12. Trachoma and diet
A detailed analysis has been made regarding the nature of the diet-(1) vegetarian or non-vegetarian, (2) type of rice, (3) milk consumed or not and (4) vegetables consumed or not. There were no peculiar features to point out relationship of any diet factor to trachoma in this series.
13. Summary and conclusion
Incidence of trachoma in the school children of Madurai city was found to be 4.9 per cent in the pilot project and 5.1 per cent in the random sample survey. This incidence in urban population is comparable to the 4.6 per cent incidence of trachoma in rural population of Madras State. (Trachoma Pilot Project, 1959).
Trachoma was (1) more common in the younger children (5 to 10 years) than older children (I l to 16 years), (2) more in the first five standards than the higher standards of the schools, (3) more in girls than boys, (4) more in Municipal elementary schools than aided elementary schools and high schools, (5) more in the Pillai, Brahmin, Chettiar, Vellalar and Sourashtra communities than the others, (6) more in the lower income groups.
There was no definite relationship of trachoma to nature of diet. Though students with angular stomatitis (B2 deficiency had higher incidence of trachoma (7.2%) those with xerosis had only 2g, trachoma. Thus malnutrition is a greater problem than trachoma in Madras.
Madurai city had a school children population of 116,770 in 1965-66. As the incidence of trachoma was 5.1 per cent it may be estimated that 5951 school children had trachoma. The severity of trachoma as judged by visual impairment due to corneal involvement, was very low.
| Acknowledgement|| |
I thank Dr. G. Venkataswamy, Prof. of Ophthalmology, Madurai Medical College and the Census department for their valuable guidance in preparing this article.
My thanks are due to my colleagues. House-surgeons, Opticians and Steno-typist, who helped me in this survey and in analysis.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]