Factors Influencing The Incidence Of Glaucoma Among Adult Patients In General Hospitals

Factors Influencing The Incidence Of Glaucoma Among Adult Patients In General Hospitals
Abstract
To achieve the state of complete physical, mental and social well-being of the population there is need to create awareness and stimulate actions from the community to achieve health. However, there seems to be no relationship between health practices and the information available on people’s health in Anambra State. The central issue of this study is to identify the factors responsible for the spread of glaucoma in Anambra State by studying the records of adult patients in the three general hospitals in Anambra State with functional eye clinics for the period between 2002 and 2006 with appropriate research questions and hypothesis formulated tot obtain data for the solution. The literature on past studies on the factors influencing the incidence of glaucoma and its management in Nigeria is reviewed. The Social Learning Theory and the Health Belief Model (HBM) are used as the theoretical framework. The study is designed as both a descriptive and a Cohort Survey seeking to describe the distribution and incidence of glaucoma within Anambra state of persons who experienced the same life event within 2002 to 2006. The random sampling technique was used with the multi-stage sampling procedure and the use of tables and percentages in data presentation. The Chi squared (X2) was used in testing the hypotheses proposed. Factors influencing the incidence of glaucoma among adult patients in general hospitals in Anambra state between 2002 and 2006 based on 1446 patients and 200 questionnaires administered on general hospitals staff included family history, increased 10P and others with a variable incidence rate and an increased level of public awareness. The increase in health education and eye examination centers are recommended and the level of awareness of the glaucoma disease and its control is recommended for more intense studies.
Chapter One
Introduction
1.1 Background to the Study
Millions of people living in Nigeria are cut off from the mainstream of economic and social development due to heavy burden of diseases. Among these diseases is glaucoma which is the result of too much pressure in the eye. It is usually believed to begin after the age of 40 (forty) years and is a common cause of blindness (Mohammed, 2001).
Responsibility for health care in Nigeria is shared among the constitutional tiers of government: federal, state and local. The local governments are supposed to take care of the primary level (emphasizing preventive Medicare), while state governments are responsible for the secondary level (emphasizing curative Medicare), and the federal government is in charge of the tertiary level of care (emphasizing referral Medicare) to which teaching and specialist hospitals belong. This implies that there are basically three health care levels in Nigeria: primary, secondary and tertiary health care levels. (Anyanwu, Oyefusi, Oaikhegn, & Dimowo 1997: 608).
In Nigeria, glaucoma constitutes a medical, public health and socio- economic problem. This is because Nigeria is found to be one of the most endemic countries in the world, accounting for a sizeable proportion of the global cases, with about 6.7 million patients with glaucoma worldwide (WHO, 1992). The damaging and insidious nature of glaucoma make it spread gradually without being noticed but causes serious harm.
The Basic Health Service (BHS) scheme formed an important health programme of the Third Development Plan (1975-1980) and Fourth Development Plan (1981-1985) of the Federal Government. Under the BHS the government intended to significantly improve the modern health care system of the country within the framework of a three-tier national comprehensive health care delivery system mentioned earlier. Record achievement from the implementation of the BHS shows increases in personnel and institutions. For example, the number of registered medical practitioners in Nigeria rose from 10,399 in 1981 to 16,145 in 1987 (Mbanefo, Soyibo & Anyanwu) 1996.
However, the unsuccessful implementation of the BHS programme made the federal government to embark on a new direction health care delivery which makes Primary Health Care (PHC) the focus. There was need for close involvement of the local governments, local communities, and individuals in the implementation of the PHC in collaboration with the other two tiers of government. Activities that formed part of the PHC include: National Programme on Immunization (NPI), Campaign against River blindness, Oral Rehydration Therapy (ORT), among others (FMH, 1988).
The incidence of glaucoma among adult patients refers to the rate of occurrence of this disease. In epidemiology the interest is in the number of new cases arising in a given period of time in a specified group of people.
The American Academy of ophthalmology (1983) notes that an estimated 2 million people have been identified as having glaucoma. Of these 889,000 are visually impaired, 67,150 are legally blind and each year an additional 5,500 people become blind from glaucoma. Equally, in 1997 glaucoma caused 36,000 hospital admission in America, 25 million office visits and more than $440 million spent on direct health cost on glaucoma.
It is from the implication of the data as given above and the fact that glaucoma is one of the avoidable causes of blindness that the need to maintain adequate and effective health care delivery system becomes imperative. Therefore this study examines the factors responsible for the occurrence of glaucoma among adult patients in Anambra state (2002- 2006).
1.2 Statement of the Problem
For Nigeria to achieve the state of complete physical, mental and social well-being of the population there is need to create awareness and stimulate actions from the community to achieve health. This can be accomplished through an effective health education which according to Onukwubiri (1994), bridges the gap between health information and health practices. It is any combination of methods designed to facilitate voluntary change of behaviours of individuals or groups to promote health.
In Anambra state there seems to be no relationship between health practices and the information available on people’s health. The researcher observed during her clinical posting to Eye clinic at the General Hospital Enugwu-ukwu that most adult glaucoma patients reported to the clinic when their eye conditions had deteriorated. Furthermore, the adults suffering from the disease are not aware of the disease occurrence.
The central focus of this study therefore borders on identifying the factors responsible for the spread of glaucoma in Anambra State. In other words what are those constraints to effective primary health care delivery and health education in the state. This is done by studying the records of adult patients in the three General Hospitals in Anambra State with functional eye clinics for the period between 2002 – 2006.
1.3 Purpose of the Study
The broad purpose of the study is to examine the factors influencing the incidence of glaucoma among adult patients (in general hospitals) in Anambra state (2002 – 2006) and to highlight the problems resulting from lack of information on factors influencing the incidence of glaucoma.
The specific objectives of the study include:
- To determine the incidence of glaucoma among adult patients in Anambra state between 2002 – 2006.
- To verify the incidence of glaucoma in relation to family history in Anambra state between 2002 – 2006.
- To identify the incidence of glaucoma in relation to gender in Anambra state between 2002 to 2006.
- To identify other factors influencing the incidence of glaucoma in adult patients in Anambra state from 2002 – 2006.
- To ascertain the number of people affected by glaucoma in relation to age from 2002 – 2006.
- To determine the relation between health information and incidence of glaucoma in Anambra State, and
- To examine the level of awareness of the glaucoma in Anambra state.
1.4 Significance of the Study
The result of the study will be of immense benefit to health institutions, community members, researchers and government. The study on the factors influencing the incidence of glaucoma will give a preview of the level of incidence for intervention strategic planning.
Furthermore, this research will help to create awareness of the disease to the community members, as well as serve as related literature to other researchers by providing a fore-knowledge of what is obtainable and available on the ground as it concerns the area of study.
1.5 Scope of Study
The study is a determination of the factors influencing the incidence of glaucoma in adult patients in Anambra state between 2002 and 2006. This means that only available data on adult patients who visited the General Hospital in Awka, Enugwu-ukwu and Onitsha are used for the study. Another delimitation is that adults between the ages of 40 years and above and studied as our interest is mostly on open angle glaucoma.
1.6 Research questions
- What is the incidence of glaucoma among adult patients in Anambra state between 2002 and 2006?
- What is the incidence of glaucoma in relation to family history in Anambra state from 2002 – 2006?
- What is the incidence of glaucoma in relation to gender in Anambra state from 2002 – 2006?
- What other factors influence the incidence of glaucoma in adult patients in Anambra state from 2002 – 2006?
- What is the number of people affected by glaucoma in relation to age from 2002 – 2006?
- How does health information effect the incidence of glaucoma in Anambra state?
- What is the level of awareness of glaucoma in Anambra state?
1.7 Hypotheses of the Study
- Ho1: There is no significant relationship between the incidence of glaucoma disease among different age groups of the study from 2002 – 2006.
- Ho2: There is no significant difference in the incidence of glaucoma between males and females of the study group from 2002 – 2006.
- Ho3: There is no significant difference in the incidence of glaucoma and hereditary among the study group from 2002 – 2006.
- Ho4: There is no significant relationship between health information and the incidence of glaucoma in Anambra state.
Chapter Five
Discussions of Results, Conclusion and Recommendations
5.1 Discussions of Results
The need to create awareness and stimulate actions from the community to achieve health is imperative as there seems to be no relationship between health practices and the information available on people’s health. The study focused on identifying problems of lack of information on factors influencing the incidence of glaucoma in Anambra State.
The plan of this study was to seek to describe the distribution and incidence of glaucoma in Anambra State within a specified period of time (2002-2006). The area of study was the entire functional eye clinics situated at the three general hospitals. A validated structured questionnaire were used for primary data and secondary data comprised the records of 1448 patients form 2002 – 2006. Seven-research question and four hypotheses guided the study.
1. Incidence of Glaucoma in Anambra
The rate of the incidence of glaucoma in Anambra state from 2002 to 2006 was variable. There was an increase of 12.8% in 2003 above the 2002 figure and a decrease of 60% the following year.
Factors responsible for glaucoma among the group include increase 10P, accounting for 92%; hereditary 5%; and eye injuries, diabetes and others accounting for 3%.
2. Age and Glaucoma in Anambra State
Having determine the incidence of glaucoma in Anambra State the next problem was to describe this incidence in term of the age groups. About 1.87% of the studied group fall blow 40 years – 40 years in so pronounced in the literature as the age of glaucoma.
3. Family and glaucoma in Anambra State
For determination was the incidence of glaucoma is relation to family history in Anambra State from 2002 to 2006. There are only 5% of the cases resulting from hereditary.
4. Awareness of glaucoma in Anambra State.
The influence of health information on the occurrence of glaucoma in Anambra state was determined by the respondents’ assessment of the relevance of health information on the disease. Also to determine the level of awareness of glaucoma in the state questions were posed in the stimulus – response mode following the application of the social learning theory and the Health Belief Model. 53% of the respondents have regular eye examination as against 46.7% who do not. Only 2.8% of the respondents know that they have a risk of glaucoma (including 19 with family history); and all those who have knowledge of the risk have a family history of the disease.
5.2 The Implications for the Study
Three of the hypotheses were rejected, as the calculated X2 were higher than the distribution values with only one hypothesis being accepted. The implications of the findings for the study are that:
- There is a significant relationship between the incidence of glaucoma among different age groups of the study from 2002 – 2006.
- There is a significant difference in the incidence of glaucoma between males and females for the period.
- There is also a significant difference in the incidence of glaucoma and hereditary among the study group for the relevant period, and
- The acceptance of the hypothesis that there is no significant relationship between health information and the incidence of glaucoma in Anambra state.
5.3 Conclusions
Millions of people living in Nigeria are cut off from the mainstream of economic and social development and this puts a lot of stress on the management of disease such as glaucoma which is one of the avoidable causes of blindness. This makes adequate and effective care delivery system imperative. It becomes necessary therefore to identify factors responsible for the spread of glaucoma in Anambra state.
Appropriate research questions and hypotheses are formulated to obtain data for the solution of the main objective. The aim therefore is to identify the factors influencing the incidence of glaucoma in order to give a preview of the level of occurrence for intervention strategic planning.
The literature on past studies on the factors influencing the incidence of glaucoma for the conceptual explication of glaucoma, the incidence of glaucoma, factors influencing the incidence, glaucoma in Nigeria and prevention and management of glaucoma. The Health Belief Model (HBM) was used as a theoretical framework with the Social Learning Theory.
The structure of the research is descriptive and a cohort survey as it seeks to describe the distribution and incidence of certain characteristics within Anambra state of persons who experienced the same significance life event within a specified period of time. Three general hospitals (Awka, Enugwu-ukwu and Onitsha) from the 34 in the state were used to represent the entire state. Data was collected through primary and secondary sources of folders and cards on 1448 patients. The random sampling technique with the multi-stage sampling procedure and the used of table and percentage in data presentation was used. The chi-squared (X2) was used in testing the hypotheses proposed.
Although the incidence rate of glaucoma is changeable in Anambra state, there is a significant relationship between the incidences among different age groups with ten years interval. Statistically, there is a significant difference in the incidence of glaucoma between males and females and hereditary among the study group as health information does not seen to influence glaucoma in Anambra state.
5.4 Recommendation
To stem the spread of this silent blinding disease there is need to increase the health education of the public to ensure greater awareness of the glaucoma disease in Anambra state.
5.5 Limitations of the Study
A major constraint during the study is the attitude of the hospital personnel in releasing the records and files for investigation.
5.6 Recommendation for the Further Studies
- It is recommended that the level of awareness of the glaucoma disease in the state be subjected to further and more intense study.
- It should be appreciated if there is a study on the role of national programmes on the control of the glaucoma disease.


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