A Study Done by Rajesh Kumar Et.Al. on Ocular Morbidity Among Primary School Children In

Rajiv Gandhi University Of Health Sciences, Karnataka
Bangalore.
Annexure- II
Proforma For Registration Of Subjects For Dissertation
1. / Name of the candidate and address
(in block letters) / DR. PRATHVIMRAJ . B. U.
POST GRADUATE STUDENT,
DEPARTMENT OF COMMUNITY MEDICINE,
S.D.M COLLEGE OF MEDICAL SCIENCES & HOSPITAL,
MANJUSHREE NAGAR, SATTUR,
DHARWAD– 580009.
2. / Name of the Institution / S.D.M COLLEGE OF MEDICAL SCIENCES AND HOSPITAL,
MANJUSHREE NAGAR, SATTUR,
DHARWAD- 580009.
3. / Course of study and subject / M.D (COMMUNITY MEDICINE)
4. / Date of admission to the course / 30 – 05 - 2012
5. / Title of the Topic / A STUDY ON OCULAR MORBIDITY AMONG SCHOOL GOING CHILDREN in urban and rural field practice area of sdmcms&h,dharwad
6.
7. / BRIEF RESUME OF THE INTENDED WORK:
6.1Need for the study:
According to world health statistics 2012 , children under 15 age group constitute 31% of Indian population with a primary school enrolment percentage of 98% in boys and 94% in girls from 2005 – 20101. School going population forms an important section of the population with regard to development of the country butthis section of the population suffer many physical and mental problems with ocular morbidity being one among them.
Ocular morbidities include refractive errors, vitamin A deficiency, conjunctivitis,trachoma, ocular trauma, blepharitis, stye, colour blindness , cataract, pterygium.Majority of these causesare either preventable or curable. According to World Health Organization (WHO) statistics , in the year 2000 itself there were around 0.7 million blind children living in South-East Asia region alone2and as per rapid survey
on avoidable blindness conducted under NPCB, in India in the year 2006-07, thenational prevalence of childhood blindness /low vision was 0.80 per thousand.3. Considering the fact that 30% of Indian children lose their sight before the age of 20years4; early detection and treatment of ocular morbidity in young children is very important. VISION2020 The Right to Sight is a global initiative launched by WHO in 1999 to eliminate avoidable blindness like cataract, xerophthalmia, refractive error, trachoma and other causes of childhood blindness by year 20205.
A study of the pattern of ocular diseases in children is important because some eye conditions cause only ocular morbidity, some lead to blindness, some conditions are treatable like refractive errors, cataract and some conditions are largely preventable like measles and vitamin A deficiency.Refractive error is the most common cause of visual impairment around the world and second leading cause of treatable blindness. Most children with uncorrected refractive error are asymptomatic, hence periodic visual screening and primary eye care reduces the prevalence of refractive error. Early detection through regular surveys helps in ensuring prompt treatment and prevention of serious complications.
6.2 Review of the literature:

1. A study done by Rajesh Kumar et.al. on ocular morbidity among primary school children in Delhi in 2007noted that out of 775 subjects, 22.7 per cent had ocular morbidity of which refractive errors were 5.4%, conjunctivitis 4.6%, trachoma 4.3%, xerophthalmia 4.1% and stye 1.3% . Majority of these morbidities were preventable and deserved early attention6.
2. A study done by Gupta et.al. on ocular morbidity prevalence among school children in Shimla noted that the prevalence of ocular morbidity was 31.6% of which refractive errors were 22% , squint 2.5%, color blindness 2.3% , vitamin A deficiency 1.8 % and conjunctivitis 0.8%7.
3. A comparative clinical survey done by Uzma et.al. on the prevalence of refractive errors and eye diseases in urban and rural school children in 2009 noted that the prevalence of refractive error was 25% in the urban compared to 8% in rural group with increased literacy rate, duration of study hours, and older age of the child contributing more to the prevalence of myopia in the urban group. He also noticed that night blindness was reported in 3.2% of children in the rural group and 0.33% in the urban group withvitamin A deficiency, low socio-economic status, poor personal and environmental hygienic practice contributing more to the prevalence of ocular morbidity among rural group children8.
4. A study done by Hirendra Kumar Choudhury,Haimanti Choudhury, Himadri Choudhury, A. Datta on ocular survey of primary school going children in South Assam noted that the prevalence of defective visual acuity was 7.09% of whichrefractive error was the commonest cause of defective vision contributing 69.25% , followed byvitamin A deficiency contributing 28.17%,inflammatory and infective condition contributing 8.44% of total cases9.

1. A study done by Marasini et.al. on Refractive errors and visual anomalies in schoolchildren in the Kavrepalanchowk District in Nepal in 2010 showed that among 1,802 school children examined, prevalence of ocular abnormality was 11.7% of whichlid abnormalities3.55%, refractive errors (3%), convergence insufficiency 2.49%, conjunctival abnormalities 1.10%, strabismus 0.88% and amblyopia0.33% were the common findings 10.
2. A study done by Prakash Prajapati et.al. on prevalence of ocular morbidity among school adolescents of Gandhinagar District, Gujarat showed that prevalence of ocular morbidity among school adolescents was 13% of which refractive error was 40% and vitamin A deficiency was 30% in various forms of xerophthalmia11.

6.3 Objectives of the study:

1. To study the prevalence of ocular morbidity among the school children in urban and rural field practice area of SDMCMS&H, Dharwad
2. To study the factors affecting ocular morbiditiesamong the school children in urban and rural field practice area of SDMCMS&H, Dharwad
3. Early diagnosis of ocular morbidity and referral of the cases.

Materials and Methods:
7.1Source of data:
Study subjects:
The study subjects are school children aged 6 to 15 years, who are studying from standardsI to X in the schools of the urban and rural field practice areas of SDM College of Medical Sciences and Hospital, Dharwad.
Inclusion criteria :
1.School children from 6 to 15 years age, who are studying from standards I to X
Exclusion criteria:
1. School children below 6 years and above 15years of age.
2. Those not willing to give consent for the study.
Study Area:
The study will be conducted in the schools of thefield practice area ofSDM College of Medical Sciences and Hospital, Dharwad.
Study Period:
The study will be carried out over a period of one year from November2012 toOctober 2013.
7.2Methods of collection of data:
Study Design:
This study is a cross sectionalstudy.
Sample Size:
The sample size is estimated by using the formula n= 4pq/L2. The prevalence ‘p’ of ocular morbidityamong schoolchildren is taken as 22.7%6. The permissible error in the estimate of p: “L”, was set at 10%.Using the above mentioned formula which considers 95% confidence limits, the sample size is estimated to be1362.
Sampling Procedure:
The study will be conducted in the schools of the field practice area of SDM College of Medical Sciences and Hospital, Dharwad. After reaching the concerned school, the subjects will be selected from each class by systematic random sampling, till the desired sample is met.
Study Instruments:

1. A pre testedpredesigned semi-structured proforma.
2. Weighing machine, stadiometer to procure the anthropometric measurements.
3. Ishihara's isochromatic chart will be used to identify the cases of red-green color blindness.
4. Snellen’s chart will be used to test far vision , keeping it at six meters distance from the subjects
5. Near vision will be tested with the help of Jaeger’s chart keeping the distance of 25-30cm from the eyes of the subjects.
6. A pinhole vision will be taken to differentiate refractive errors from organic pathology in cases of poor visual acuity (<6/9),
7. A pen torch will be used for examination of the anterior segment.
8. Cover – uncover test will be used to diagnose squint.
9. Stethoscope

Data Collection:
Permission will be obtained from the school authorities who would have notified theconcerned parents/guardians tocollect data by the questionnaire and to do the required examination. Date of birth of each student will be obtained from the school authorities.A pilot study will be done to collect the appropriate data and test the feasibility.Apredesigned, pre tested, semi - structured proforma will be used to collect the appropriate data.Anthropometric measurements like weight, height will be measured. General physical examination will be done. Ophthalmological and systemic examinations will be done using study instruments.
Study Analysis:
Appropriate statistical tests will be used to analyze the data like rates, ratios and Chi square test with P value < 0.05.
7.3Does the study require any investigations or interventions to be conducted on patients or other humans or animals?If so, please describe briefly.
No.
7.4 Has ethical clearance been obtained from ethical committee of your institution in case of 7.3?
Yes. (Annexure III)
8. / List of References:

1. World health statistics report 2012. Geneva: World Health Organization (Switzerland); 2012. 160-1.

1. Health situation in the South-East Asia Region 1998-2000. New Delhi: World Health Organization regional office for South East Asia (INDIA); 2002.147.

1. Annual Report2010-11.New Delhi: Ministry of Health & Family Welfare, Government of India. 109.

1. Dandona R, Dandona L, Srinivas M, Sahare P, Narsaiah S, Muñoz SR, et al. Refractive error in children in a rural population in India. Invest Ophthalmol Vis Sci. 2002;43:615–22.

1. Park K.Epidemiology of chronic non-communicable diseases. In, Park K (ed). Park’s Textbook of Preventive and Social Medicine, 21st edition. Jabalpur,M/s Banarsidas Bhanot Publishers, 2011;374

1. Kumar R, Dabas P, Mehra M, Ingle GK, Saha R, Kamlesh. Ocular morbidity amongst primary school children in Delhi. Health and Population Perspectives and issues. 2007; 30 (3): 222-9.

1. Gupta M, Gupta BG ,Chauhan A ,Bharadwaj A. Ocular morbidity prevalence among school children in Shimla, Himachal, North India. Indian J ophthalmol. 2009; 57(2): 133–8.

1. Uzma N, Kumar BS, Khaja Mohinuddin Salar BM , Zafar MA, Reddy VD .A comparative clinical survey of the prevalence of refractive errors and eye diseases in urban and rural school children. Can J Ophthalmol. 2009; 44(3):328-33.

1. Bhattacharya D, editor. Ocular Survey of Primary School Going Children in South Assam.Proceedings of the 68thAll India ophthalmological society conference; 2010 Jan 21-24; Kolkata, India. Mumbai: Medknow.

1. Marasini S , Sharma R , Sthapit PR , Sharma D , Koju U, Thapa G ,Nepal BP.Refractive Errors and Visual Anomalies in Schoolchildren in the Kavrepalanchowk District. Kathmandu Univ Med J 2010 ; 8(4): 362-6

1. Prajapati P, Oza J, Prajapati J, Kedia G, Chudasama RK. Prevalence of Ocular Morbidity among School Adolescents ofGandhinagar District, Gujarat. Online J Health Allied Scs. 2010;9(4):5

9. / Signature of the candidate / Dr. PRATHVIMRAJ. B. U.
10. / Remarks of the guide / Approved
11. / Name and Designation
11.1 Guide / Dr.J . V . CHOWTI ,
PRINCIPAL,
PROFESSOR,
DEPARTMENT OF COMMUNITY MEDICINE,
S.d.m. COLLEGE OF MEDICAL SCIENCES AND HOSPITAL,
SATTUR,
DHARWAD-580009.
11.2 Signature
11.3 Co-Guide / DR. MRIDULA PRABHU,
ASSISTANT PROFESSOR,
DEPARTMENT OF OPHTHALMOLOGY,
S.d.m. COLLEGE OF MEDICAL SCIENCES AND HOSPITAL,
SATTUR,
DHARWAD-580009.
11.4 Signature
11.5 Head of the Department / Dr. G.N. PRABHAKARA,
PROFESSOR AND HEAD,
DEPARTMENT OF COMMUNITY MEDICINE
S.D.M COLLEGE OF MEDICAL SCIENCES AND HOSPITAL, SATTUR,
dHARWAD-580009.
11.6 Signature
12. / 12.1 Remarks of the Principal and Chairman
12.2 Signature

CONSENT FROM THE SCHOOL AUTHORITIES

Investigator: Guide:
Dr.PRATHVIMRAJ B.U.. Dr. J.V. CHOWTI
Post Graduate Student, Professor and Head ,
Department of Community Medicine, Department of Community Medicine,
S.D.M College of Medical Sciences S.D.M College of Medical Sciences and Hospital, Sattur, Hospital, Sattur,
Dharwad-580009. Dharwad-580009.
TITLE OF THE STUDY: A STUDY ON OCULAR MORBIDITY AMONG SCHOOL GOING CHILDREN in urban and rural field practice area of sdmcms&h,dharwad

The study has been explained to me in detail. I understand that the information regarding my students that is collected during the course of this study will remain confidential. I understand that my students’ participation in this study is voluntary and that I have the right to withdraw from the study at any time without giving any reason. I understand that the records maintained will be used only for research purpose.

I hereby grant permission to conduct this study in my school and agree to my students’ participation in this study.

Name and signature of the Principal/Headmaster………………………………………………

Name of the school ……………………………………………………………………………..

and address …………………………………………………………………………….

……………………………………………………………………………..

Date……………………..

Signature of the investigator……………………………………………………………….

Name of the investigator……………………………………………………………………

Date………………………………

PROFORMA

General information

1. Serial number: Age: Sex : M / F
2. Class:
3. Name of the school and address:

1. Type of school: a) Government: b) Private:
2. Religion : a) Hindu: b) Muslim: c) Christian: d)others :
3. Fathers education:

a) Illiterate / b) Primary / c) High school /d) PUC

e) Diploma / f) Graduate / g) Post graduate:

1. Fathers occupation:

a) Unemployed / b) Agriculturist / c) Shopkeeper / d) Bank employee:

e) Doctors / Engineers / Computer software / f) Businessman:

g) Others specify:

1. Mothers education:

a) Illiterate / b) Primary / c) High school / d) PUC

e) Diploma / f) Graduate / g) Post graduate:

1. Mothers occupation:

a) Housewife / b) Agriculturist / c) Shopkeeper / Business women:

d) Doctors/ Engineers / computer software / e) Teacher

f) Others specify:

Family data:

1. Type of family: a) Nuclear b) Joint c) Third generation
2. Family composition :

1. Socioeconomic status: as per modified B.G.Prasads classification as per updated CPI index

Class 1 / 2 / 3 /4 /5

Ocular history:

1) History of any congenital anomaly: a) Yes b) No

If yes specify:

2) History of difficulty in seeing the words written in black board: a) Yes b) No

If yes - Onset:

- Duration:

- More during: a) Day b) Night c) Constant:

- Are you aware it is not normal: a) Yes: b) No:

- Are you aware that it can be treated: a) Yes:

- If aware why haven’t you shown to the doctor:

3) History of difficulty,blurring, crowding of words while reading books: a) Yes b) No

If yes - Duration:

- Are you aware it is not normal: a) Yes b) No

- Are you aware that it can be treated: a) Yes b) No

- If yes why haven’t you showed to the doctor:

4) History of difficulty in differentiating colours: a) Yes b) No

5) History of double vision: a) Yes If yes: Unilateral / Bilateral b) No

6) History of wearing spectacles / contact lenses: a) Yes b) No

7) Reason for wearing spectacles / contact lenses

a) Near vision / b) far vision / c) Astigmatism / d) Others

8) History of not wearing spectacles even though prescribed: a) Yes b) No

If yes reason - a) Cosmetic / b) Can read without glasses / c) Cannot read properly even with specs.

If others specify:

9) History of eye pain: a) Yes b) No

If yes - Onset: Sudden / Gradual

- Site: Left eye / Right eye

- Continuous / intermittent

- Does it increase with movement of eye: a) Yes b) No

10) History of headache associated with eye pain: a) Yes b) No

If yes - Site: a) Frontal / occipital / others b) Unilateral / Bilateral

- Severity: mild / moderate / severe

- Associated with nausea or vomiting: a) Yes b) No

- Aggravates on bending forward: a) Yes b) No

- Aggravates on reading: a) Yes b) No

11) History of watering of eyes: a) Yes b) No

If yes - Duration: a) Acute / chronic b) Continuous / intermittent

- Increases on getting up on early morning: a) Yes b) No

- Associated with swelling below medial side of eye: a) Yes b) No

- Aggravated on straining: a) Yes b) No

- Aggravated during eye pain: a) Yes b)No

12) History of itching, burning, foreign body sensation in the eye: a) Yes b) No

13) History of discharge from eye: a) Yes b) No

If yes – serous / mucoid / purulent / mucopurulent / serosanguinous-ropy

14) History of allergy: a) Yes b) No

15) History of running nose, cough with expectoration: a) Yes b) No

16) History of itching of scalp: a) Yes b) No

If yes - associated with white scaly flakes / Dandruff: a) Yes b) No

- associated with louse: a) Yes b) No

17) History of recurrent swelling of eyelid: a) Yes b) No

If yes: Painful / Painless

18) History of matting of eyelid early morning: a) Yes b) No

19) History of floaters: a) Yes b) No

If yes - present most part of the day: a) Yes b) No

- does it move with movement of eyes: a) Yes b) No

20) History of flashes of light in front of eyes: a) Yes b) No

21) History of photophobia: a) Yes b) No

If yes - onset: sudden / gradual

- Continuous / intermittent

- Aggravating factors (specify)

- Relieving factors (specify)

22) History of trauma to eye: a) Yes b) No

If yes - Site: Left eye / Right eye

- Type: Blunt / Penetrating / Acid / Alkali

23) History of deviation of eyes: a) Yes b) No

If yes - who noticed it first: Participant / Others

24) History of watching TV: a) Yes b) No

If yes - Hours in a day: a) >1 hours b) 1 to 4 hours c) more than 4 hours

- Distance of sitting from TV: a) 2 meters b) 2-6 meters c) > 6 meters

25) History of working / playing in a Computer / Laptop: a) Yes b) No

If yes - Hours in a day: a)1 hours b) 1 to 4 hours c) more than 4 hours

- Distance of sitting from Computer: : a) 2 meters b) 2-6 hours c) > 6 meters

26) History of difficulty in watching in dim light: a) Yes b) No

27) History of dryness of eye: a) Yes b) No

28) History of persistent diarrhea / vomiting: a) Yes b) No

29) History of immunization: a) Yes b) No c) c) Ifyes: Partial / Complete

30) History of Vitamin A prophylaxis: a) Yes b) No

31) History of hours of sleep: a) <4 hours b) 4 to 10 hours c) >10 hours

32) History of ocular surgeries in the past: a) Yes b) No

33) History of other complaints: a) Yes b) No If yes specify:

34) History of taking any medications: a) Yes If yes specify: b) No

Dietary history

1) Type of diet: a) Vegetarian b) Mixed

2) Dietary intake:

Morning

Afternoon

Evening

Night

Anthropometric measurements:

Height: Weight: BMI:

General Physical Examination:

Pallor: Yes / No Icterus: Yes / No Cyanosis: Yes / No Clubbing: Yes /No

Lymphadenopathy: Yes / No Edema: Yes / No

Head to toe examination ( positive findings):

Ophthalmic examination:

1. Head posture

1. Facial symmetry

1. Ocular posture

Right eye Left eye

1. Vision

1. Distant vision
2. Pinhole
3. Near vision
4. Colour vision

1. Ocular adnexa:
2. Lids and adnexa
3. Conjuctiva
4. Sclera
5. Cornea
6. Anterior chamber
7. Iris
8. Pupil
9. Lens

1. Ocular movement:

1. Systemic examination:
2. CVS:
3. RS:
4. P/A:
5. CNS: