Year : 1978 | Volume
: 26 | Issue : 2 | Page : 9--12
Ocular morbidity in school children in rural coastal area of Karnataka
James Kuruvilla, PN Srinivasa Rao
Department of Ophthalmology, K.M.C., Manipal, India
P N Srinivasa Rao
Department of Ophthalmology, K.M.C., Manipal
|How to cite this article:|
Kuruvilla J, Srinivasa Rao P N. Ocular morbidity in school children in rural coastal area of Karnataka.Indian J Ophthalmol 1978;26:9-12
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Kuruvilla J, Srinivasa Rao P N. Ocular morbidity in school children in rural coastal area of Karnataka. Indian J Ophthalmol [serial online] 1978 [cited 2020 Jul 9 ];26:9-12
Available from: http://www.ijo.in/text.asp?1978/26/2/9/31464
The Kasturba Medical College Hospital maintains a Mobile Eye Unit, which conducts regular eye camps, eye clinics, glaucoma detection clinics and eye check-up of school children in rural areas. This project was partly financed by Operation Eye Sight Universal, Canada and partly by the Academy of General Education, Manipal. An analysis of ocular morbidity in school children must yield useful information as the field of work is purely rural and from an area which is not investigated hitherto.
Materials and Methods
One Taluk (Udupi) of the district of South Kanara, in coastal Karnataka is selected. An intimation is sent to all the schools of the area, about our intention of school check-up program. A team of one postgraduate degree holder in Ophthalmology, one diploma holder, one post-graduate student and one optometrist were sent in a van to each school which was interested in this project. Medical treatment or glasses were prescribed wherever necessary. Rarely the student was requested to attend the base hospital, and on the whole, the follow up of these referred cases were unsatisfactory. Bulk of the school examination was done in 1975, but some of the schools were checked in 1974 and 1976. Proforma for entering the details of individual pupil were sent earlier, and the teachers were requested to fill the non-technical part of it earlier. Work of each school was done in one day as far as possible, sending more departmental staff if necessary. Occasionally more than one visit was necessary.
Observations are shown in. [Table 1][Table 2][Table 3][Table 4][Table 5][Table 6][Table 7][Table 8].
Total population of the Udupi Taluk is 3,84,913. The population of the age group 5-12 years is 81,405. Number of school going children is 75,799 (93.1%). The number of primary school children examined is 8,496 more than 10% of the student population of the primary school and so becomes statistically significant. Total number of schools are 506, and the schools examined are 44, further strengthens the statistical significance.
Though the incidence of abnormality is 12.5, many of them are insignificant, such as congenital abnormalities of no importance.. The actual morbidity will be around 10%.
The morbidity in any survey depends a lot on the surveyed areas and. calculations based on such surveys may not be applicable to another area. However, such local surveys are useful in assessing the overall disease pattern of the country.
The incidence of acute infections must be markedly less than 1.1% stated here, since the bulk of the check up program was conducted during the 1975 epidemic of acute conjunctivitis.
Singh found 11% of conjunctivitis (both acute and chronic) and one case of stye among 11,813 children examined at Patiala. Venkataswamy reported 2% incidence of conjunctivitis, chalazion and stye among the school children of Madurai.
Among chronic infection the incidence of trachoma is only 0.24%. Our criteria for diagnosis of trachoma is purely clinical (Duke Elder (the typical description of the trachoma follicles and the vascular pattern with or without corneal involvement.) A search for inclusion bodies was made only in few cases. Even making an allowance for that the incidence of trachoma is one of the lowest among the reported series in this country. There was no case of trachoma stage IV and even IIIrd stage.
Singh found 8.79% of the students in the school suffering from one stage or other of the trachoma. Studies by Krishnamurthy in Madurai Municipal schools showed an incidence of 5.2%. In Singh's studies, the incidence of trachoma among school children in slum areas was 9.17% whereas the incidence among children of modern schools was 5.06%. This shows climate, dirt, dust and wind do have an influence on the prevalence of trachoma in a particular area. According to Gupta Punjab and Haryana reports about 79.1% of incidence of trachoma, while it is only 0 5% in West Bengal. Punjab and Haryana which are economically forward states in India should not have such high incidence of trachoma but for the climatic conditions. The reports from Madurai, (Krishnamurthy) is widely separated in time from the present reports of Udupi (1976). Nevertheless the clinical impression is that the incidence of trachoma is very much less in coastal areas of Karnataka, compared to Tamilnadu.
However, trachoma control pilot project, India (I.C.M.R. 1956-63) classified Mysore as moderate endemic region (22.6%), whereas Madras is considered as low endemic region (4.6% Gupta et al. Coastal areas of Karnataka is distinct geographically and climatically from the rest of Karnataka, and resembles very much like Kerala which is again considered as low endemic region by the trachoma control pilot project.
Another interesting feature is relatively high incidence of clinically obvious -spring catarrh 0.66%. Thus spring catarrh seems to be more important cause of ocular morbidity than trachoma and it may be worth investigating this morbidity.
Incidence of malnutrition seems to be markedly less than major part of South India. While there is no clinically detectable vitamin deficiency in the area, Bitot's spots were found only in 0.43% of the cases. No case of angular stomatitis, night blindness or xerophthalmia was seen. However, there are good number of cases of anaemias.
Venkataswamy noted that the general health was not satisfactory in large number of children in Madurai. Angular stomatitis characteristic of vitamin B_, deficiency was found in 14% of children, xerosis in 3.9% of children. Both xerosis and angular stomatitis was present in 2.08% of children.
The explanations for the relatively better nutrition of the school children of this locality are (1) the middle class children habitually take milk and vegetables and (2) fish being the cheapest food, forms an important part of the diet in coastal area among the poor.
The incidence of muscle imbalance is 2.02%. Singh et al have observed an incidence of 0.19% and Venkataswamy had observed the same in 1.14% of cases. 2.93% to 3.69% of school children Delhi Municipal Corporation, and 4.60% to 5.28% ,school children of New Delhi Municipal Corporation seem to have evidence of muscle imbalance Mohan et al The problem we observed here was that of getting these patients to the base hospital for further examination and treatment. The children were unwilling to forego classes. It may be worth detecting these cases at pre-school stage in a general paediatric clinics.
True partial sightedness not improving with glasses :-The figure shows that 28 (0.32%) out of 8496 children have vision less than 6/60 in both eyes and another 28 (0.32%) out of 8496 have got vision between 6/60 to 6/18. Projecting this figure to the whole Taluk about 250 to 500 students are visually handicapped in the area and this may affect their studies. It works out to 1 to 2 per school. This has to be reviewed in the background of 93.1% children going to the school in the area. No comparable figure is available in the country, but one can easily assume, such problem is existing in the rest of the country also. Chew, et al reported 0.06% of partial sightedness in Singapore. The authors recommend the creation of resource rooms in 5-6 centres in the island. While the children study in a normal school, they receive special training at one of these centres. To detect cases early, a screening of all primary children is suggested. Anyway with the introduction of compulsory primary education, the national attention must be drawn towards these partially sighted children.
An analysis of causes of loss of vision shows that majority of the cases are not under the control of Ophthalmologists. At least some of them, we believe by history, may be due to vitamin A deficiency at the pre-school level. This fact, together with incidence of 0.43% of xerosis, shows that vitamin A deficiency is very much in the background at the pre-school stage and no complacent attitude should be taken in that direction.
The area under investigation seems to be one of the least effected areas of the country as regard malnutrition and trachoma. But there are cases of trachoma, and some of the innocent looking folliculosis may of be viral in origin. Similarly the history of few bilateral corneal opacities, and persistent Bitot's spots suggested that Vitamin A deficiency is very much in the background and no complacent attitude must be taken. With the introduction of compulsory primary education, special arrangements must be made to train the visually handicapped who attend the normal schools.
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