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ORIGINAL ARTICLE
Year : 2018  |  Volume : 10  |  Issue : 2  |  Page : 64-67

Distribution of xerophthalmia among children in the traditional quranic schools in Al-Gezira State of Sudan


1 Department of Pediatric Optometry, Faculty of Optometry and Visual Sciences, Al-Neelain University, Khartoum, Sudan
2 Department of Binocular Vision, Faculty of Optometry and Visual Sciences, Al-Neelain University, Khartoum, Sudan

Date of Web Publication7-Mar-2019

Correspondence Address:
Dr. Zoelfigar Dafalla Mohamed
Department of Pediatric Optometry, Faculty of Optometry and Visual Sciences, Al-Neelain University, Khartoum
Sudan
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DOI: 10.4103/sjopthal.sjopthal_23_18

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  Abstract 


Background: Vitamin A deficiency is considered a serious public health issue in poor nations, which leads to corneal opacity and results in childhood blindness in most of the low-income countries. Aim: To determine the prevalence of xerophthalmia among children at traditional Quranic schools in Al-Gezira state of Sudan. Materials and Methods: This was a quantitative cross-sectional study conducted on 822 children aged from 5 to 15 years, living in traditional Quranic schools. The clinical examinations for all children in this study include the demographics of patients (name, gender, age, and duration of students in schools), symptoms (vision during the day and night), and then outer eye checked for all children by lope and magnifier and visual acuity using Snellen's chart. Results: The prevalence of night blindness, conjunctival xerosis, corneal xerosis, and Bitot's spots was 17.3%, 20.3%, 0.2%, and 0.7%, respectively. There was a significant association between the duration of staying the children at the schools and the development of night blindness (P ≤ 0.02). Conclusion: Children of this community are susceptible to xerophthalmia because food is inadequate of Vitamin A. The governmental and nongovernmental organization should supply this community by the diet rich of Vitamin A and Vitamin A supplementation orally for affected children as well as annually comprehensive eye examinations.

Keywords: Bitot's spots, conjunctival xerosis, corneal xerosis, night blindness, traditional Quran boarding schools, xerophthalmia


How to cite this article:
Mohamed ZD, Alrasheed SH. Distribution of xerophthalmia among children in the traditional quranic schools in Al-Gezira State of Sudan. Sudanese J Ophthalmol 2018;10:64-7

How to cite this URL:
Mohamed ZD, Alrasheed SH. Distribution of xerophthalmia among children in the traditional quranic schools in Al-Gezira State of Sudan. Sudanese J Ophthalmol [serial online] 2018 [cited 2019 Nov 18];10:64-7. Available from: http://www.sjopthal.net/text.asp?2018/10/2/64/253680




  Introduction Top


Xerophthalmia defined as the group of ocular signs and symptoms due to Vitamin A deficiency (VAD). The signs and symptoms of xerophthalmia include night blindness, conjunctival xerosis, Bitot's spots, corneal xerosis, and keratomalacia.[1] Night blindness is a condition in which the children cannot see at darkness, it classified as the earliest clinical sign of VAD.[2] Vitamin A is important for the eyes to protect the cornea; it is available as a fat-soluble vitamin absorbed in two patterns: retinol itself from animal sources or provitamin carotene from plant sources.[3]

VAD is one of the essential etiologies of avoidable visual impairment among children in low- and middle-income countries; further, VAD increases the risk of childhood morbidity and mortality.[4] Xerophthalmia can be investigated clinically by the night blindness and xerosis of the conjunctiva and the cornea followed by formation of Bitot's spot. VAD affects the retina, conjunctiva, and cornea, and the signs and symptoms tend to occur in a reliable sequence.[5] The World Health Organization (WHO) classification of VAD is as follows:[6]

XN - Night blindness

X1A - Conjunctival xerosis

XIB - Bitot's spot

X2 - Corneal xerosis

X3A - Corneal ulceration involving one-third or less of the cornea

X3B - Corneal ulceration involving one-half or more of the cornea

XS - Corneal scar

Kheir et al. in 2012 reported that the prevalence of xerophthalmia among children in traditional boarding school in Sudan as follows: night blindness, conjunctival xerosis, and Bitot's spots being 24%, 12.5%, and 1%, respectively.[7] The prevalence of xerophthalmia in a study conducted in India was 9.1% among children in Aligarh district.[8] In Ethiopia, the prevalence of xerophthalmia among preschool children was 8.6%.[9] The traditional boarding school is schools for teaching the Quran and the basics of reading and writing. They are popular in all Sudan. Children spent considerable time in these schools away from their home.[7] Therefore, the aim of this study was to determine the prevalence of xerophthalmia among children stay in the traditional boarding schools in Al-Gezira state of Sudan.


  Materials and Methods Top


Study design

This was a quantitative cross-sectional study among children attended traditional Quranic boarding schools in Al-Gezira state of Sudan; their age ranged from 5 and 15 years.

Study sample

A total of 822 of children were selected randomly from eight Quranic schools in Al-Gezira state of Sudan, to find out the real situation of VAD among Sudanese children, and therefore, the study sample in this study was considered as Quranic school children studying in Gezira state from school to school; their ages ranged from 5 to 15 years.

Inclusion criteria of students

  • All children who are staying in Quranic schools
  • Age from 5 to 15 years
  • Agree to participate in the study.


Exclusion criteria of students

  • Those whose age did not correspond to the defined age group
  • Unwillingness to participate in the study.


Data collection

Examinations for all children in this study include the demographics of patients (name, gender, age, and duration of students in schools), symptoms (vision during the day and night), and the outer eye (cornea, conjunctiva, and ocular adnexa) examined for all children by loupe and magnifier. The teachers of Quranic schools were interviewed in structured interviews that consist of a series of predetermined questions that all interviewees answer in the same order to get information about the children nutrition to know the diet regimen in this community. The examiners used the local language to cooperate with children, and then, we ask the child about any problem of seeing during the daytime and any problem of seeing at night time according to the WHO xerophthalmia checklist.[10] Xerophthalmia was diagnosed using definitions provided by the WHO.[2]

Data analysis

Data analysis was performed using SPSS version 22 software for Windows 10 (Armonk, NY: IBM Corp). The data were revised for data entry errors and missing values inserted before starting the data analysis. The data for each subject were analyzed descriptively using mean, standard deviation, mode, frequency, and percentages. The relationship between measures was detected using correlation, cross-tabulations which is one of the most useful analytical tools, and a Chi-square test with a P < 0.05 being taken as the threshold of significance.


  Results Top


Study population

A total of 822 children who live in the boarding of traditional eight Quranic schools were examined. The age of the students ranged from 5 to 15 years with a mean and standard deviation of 12.41 ± 1.994 years and a median of 13 years. The duration of the children staying in boarding schools ranged from <1 year to 6 years with mean 1.68 ± 0.673 years while the median was 2.00 years [Table 1].
Table 1: The duration of staying the children in Quranic schools (Maseed)

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Ocular complaints among children

The majority of the children (580 [70.6%]) did not complain of any ocular symptoms, while 143 (17.4%) complained from night blindness, followed by 48 (5.8%) itching, 31 (3.8%) blurring of vision, 12 (1.5%) ocular pain, and 8 (1.00%) complained from tearing, redness, and headache as shown in [Table 2].
Table 2: The distribution of ocular symptoms among children

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Visual acuity of children

The study revealed that the most of children (789 [96%]) have a normal binocular visual acuity while 11 (1.3%) of the children their vision 6/9 and 22 (2.7%) visual impairment as shown in [Table 3].
Table 3: Visual acuity among children

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Outer eye diseases among the participants

[Figure 1] shows outer eye diseases among the children which revealed a total of 566 (68.9%) and 569 (69%) of children free from ocular abnormalities in the right and left eye, respectively, while VAD signs (conjunctival xerosis, Bitot's spots, and corneal xerosis) appeared in 175 (21.3%) and 176 (21.4%) in the right and left eye, respectively. The bacterial and allergic conjunctivitis appeared in 6 (0.7%) and 39 (4.7%) in the right eye, however, in the left eye appeared in 4 (0.5%) and 38 (4.6%) for bacterial and allergic one.
Figure 1: Outer eye examinations results of children

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Distribution of xerophthalmia among children

The results showed that 143 (17.3%) of children complained from night blindness; the current study revealed that there is a significant relationship between night blindness and the period of the staying the children in the boarding of schools according to cross-tabulation and Chi-square tests (P ≥ 0.02). The conjunctival xerosis and dryness appeared in 167 (20.3%), Bitot's spot 6 (0.7%), and corneal xerosis 2 (0.2%) [Table 1] and [Table 4].
Table 4: The prevalence of xerophthalmia among children

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  Discussion Top


VAD has a serious effect on the childhood eye, which leads to corneal opacity and results in childhood blindness in most of the low-income countries. In the current study, we aimed to determine the prevalence of xerophthalmia among children at traditional Quranic schools in Al-Gezira state of Sudan. The findings of this study indicate a high rate of night blindness and other xerophthalmia signs because of the children exposed to stable diet system scarce for Vitamin A.

This study revealed that almost 17.3% of children had night blindness this lower than that reported by Kheir et al., in traditional Quranic boarding schools in Khartoum (2012), which indicated that the prevalence of night blindness was 24%. The current study indicated that the prevalence of conjunctival xerosis was 20.3% which was higher than that found by Kheir et al., in Khartoum which was 12.5% and comparable in other signs.[7] The prevalence of xerophthalmia among children in traditional Quranic boarding schools in Al-Gezira of Sudan is higher than a study conducted in India to determine determinants of VAD which was 9.1%,[8] and in Ethiopia, the prevalence among preschool children was 8.6%.[9]

The current study revealed that there is a significant relationship between night blindness and the period of staying the children in the boarding of schools; similar to results found by Kheir et al. in Khartoum state of Sudan, they reported that xerophthalmia is common outer eye condition among children live at the hostel of traditional Quranic boarding school because their diet is deficient from Vitamin A. Their consciousness about importance of Vitamin A and xerophthalmia prevention should be delivered for the community of Quranic schools.


  Conclusion Top


The study concluded that VAD is common among children staying in traditional Quranic boarding schools in the Al-Gezira state of Sudan. Children of this community are susceptible to xerophthalmia due to the food is inadequate of Vitamin A. The governmental and nongovernmental organization should supply this community by the diet rich of Vitamin A and Vitamin A supplementation orally for affected children as well as annually comprehensive eye examinations.

Acknowledgment

We would like to express our sincere thanks and gratitude to all teachers, students, and staffs for their great help in data collection and completing this study. We would also like to thanks all the people who participated in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Vitamin A Deficiency and Xerophthalmia. Report of a Joint WHO/USAID Meeting. WHO Technical Report Series, No. 590. Geneva: World Health Organization; 1976. Available from: http://www.whqlibdoc.who.int/trs/WHO_TRS_590.pdf. [Last accessed on 2014 Jun 09].  Back to cited text no. 1
    
2.
Sommer A. Field Guide to the Detection and Control of Xerophthalmia. 2nd ed. Geneva: World Health Organization; 1982. Available from: http://www.apps.who.int/iris/bitstream/10665/40822/1/9241541628_eng.pdf. [Last accessed on 2014 Jun 09].  Back to cited text no. 2
    
3.
Janine S, Thomas S. Vitamin A deficiency and eye. Int Ophthalmol Clin 2000;40:83-91.  Back to cited text no. 3
    
4.
Stephenson LS, Latham MC, Ottesen EA. Global malnutrition. Parasitology 2000;121:S5-22.  Back to cited text no. 4
    
5.
Chander A, Chopra R, Batra N. Vitamin A deficiency: An eye sore. Med Nutr Nutraceut 2013;2:41. Available from: http://www.jmnn.org/text.asp?2013/2/1/41/105329. [Last accessed on 2018 Sep 07].  Back to cited text no. 5
    
6.
Ajaiyeoba AI, Samaila E. Use of Bitot's spot in the screening of Vitamin A deficiency in a Nigerian population. Afr J Biomed 2001;4:155-7.  Back to cited text no. 6
    
7.
Kheir AE, Dirar TO, Elhassan HO, Elshikh MA, Ahmed MB, Abbass MA, et al. Xerophthalmia in a traditional Quran boarding school in Sudan. Middle East Afr J Ophthalmol 2012;19:190-3.  Back to cited text no. 7
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8.
Sachdeva S, Alam S, Beig FK, Khan Z, Khalique N. Determinants of Vitamin A deficiency amongst children in Aligarh district, Uttar Pradesh. Indian Pediatr 2011;48:861-6.  Back to cited text no. 8
    
9.
Tariku A, Fekadu A, Ferede AT, Mekonnen Abebe S, Adane AA. Vitamin-A deficiency and its determinants among preschool children: A community based cross-sectional study in Ethiopia. BMC Res Notes 2016;9:323.  Back to cited text no. 9
    
10.
Dole K, Gilbert C, Deshpande M, Khandekar R. Prevalence and determinants of xerophthalmia in preschool children in urban slums, Pune, India – A preliminary assessment. Ophthalmic Epidemiol 2009;16:8-14.  Back to cited text no. 10
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
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