Sudanese Journal of Ophthalmology

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 12  |  Issue : 1  |  Page : 1--6

Study of Glaucoma s prevalence in Atbara locality, Sudan, from 2009 to 2016


Mussa Atif Mohammed1, Hakim Maha Hamdi Haj2,  
1 Nile Valley University-College of Medicine, Atbara, Sudan
2 Infection Control Department, ENT Hospital, Khartoum, Sudan

Correspondence Address:
Dr Mussa Atif Mohammed
Nile Valley University-College of Medicine, Atbara
Sudan

Abstract

Context: Sudan is one of the largest countries in Africa with about 40 million people. Glaucoma is the second cause of blindness, responsible for 15% of blindness in Africa. Black-skinned peoples have the greatest prevalence of glaucoma. Aims: To reflect the prevalence and epidemiology of glaucoma to help decision-makers to develop the appropriate ophthalmic health strategic plan. Settings and Design: Retrospective study of the recorded data about glaucoma in Atbara Locality, Sudan, from 2009 to 2016. Subjects and Methods: Electronic and hard copy records of the Ministry of Health and its facilities, in Atbara locality, were collected and entered into SPSS version 23 (IBM SPSS Corporation., NY, USA) and were analyzed and interpreted. Statistical Analysis Used: The statistical tools that were used to analysis and interpret the data are the prevalence, ratio, percentages, and cross tabulation and the Chi-square statistics (P value used to indicate the significant of the different results). Results: The total number of glaucoma patients per year ranges from 717 to 2696 with a mean ± standard deviation of 1878 ± 643.39. The percentage of all glaucoma patients among the total population in Atbara locality per year ranges from 0.49% to 1.97% with an average of 1.34%. However, in those who aged 45 years and more, the percentage ranges from 3.58% to 17.13% with an average of 10.89%, which is higher than many population-based studies. The prevalence of glaucoma is increasing with age and more females were affected than males. Conclusions: Glaucoma was found to be more in Atbara locality than many other regions worldwide, so it needs more awareness, care, and a high priority in any sight-saving programs.



How to cite this article:
Mohammed MA, Haj HM. Study of Glaucoma s prevalence in Atbara locality, Sudan, from 2009 to 2016.Sudanese J Ophthalmol 2020;12:1-6


How to cite this URL:
Mohammed MA, Haj HM. Study of Glaucoma s prevalence in Atbara locality, Sudan, from 2009 to 2016. Sudanese J Ophthalmol [serial online] 2020 [cited 2020 Sep 21 ];12:1-6
Available from: http://www.sjopthal.net/text.asp?2020/12/1/1/293633


Full Text

 Introduction



Although Sudan began primary health-care (PHC) program in the seventies of the last century and it has a lot of public primaries, secondary, and tertiary health-care facilities, there is no collection, analysis, and interpretation of the data especially about the number, prevalence, and incidence of ophthalmic diseases and more specific for glaucoma which is the second cause of blindness worldwide. So that these shortages in data collections leaded to the development of many questions about the epidemiology of glaucoma.

Literature review

Sudan is the largest African country[1] and even after the separation of South Sudan, it has an area of about 1.9 million km.[2] The population is more than 39 million people in 2016;[3],[4] about 67% of them live in rural areas.[2],[4] Sudan is a low-to-middle-income country, with 47% of its population living under the poverty line.[4] The population below 5 years of age constitutes to 15% and those between 5 and 14 years of age are about 30% of the total estimated population, while those aged 65 years and over represent 4%.[1] About 17.0% is between the ages of 15 and 24 years (2015).[4]

This study was conducted in River Nile State (RNS), Atbara locality, which is the center of the Sudan cement factories and railway industry. The locality is 3.8 thousand square kilometer with a population of more than 131 thousands person in 2008[5] and more than 139 in 2012.[6] Atbara city has a population of about 107,930, making it the biggest metropolitan city in RNS.[7],[8] The population growth annual rate (PGNR) varies from year to year; it is 2.15% in 2010, 2.36% in 2015, and 2.41 in 2016.[7] This made the average PGNR of 2.31%.

The health system in RNS provides health care through different outlets including Atbara Teaching Hospital (ATH) which is the largest hospital in the state, PHC units, dressing stations, dispensaries, and health centers.[1] Noncommunicable diseases account for about 33.9% of the total burden of disease, whereas communicable diseases account for 52.7% and injuries 13.4% (2012).[4]

Glaucoma was defined as a group of optic neuropathy that characterized by and associated with loss of visual function, with or without increased intraocular pressure.[9],[10] It has been estimated that glaucoma will affect about 76 million people worldwide by 2020.[11] Glaucoma is the second cause of blindness worldwide as it is responsible for 8% of the blindness and account for 15% of blindness in Africa.[12]

Black-skinned peoples have the greatest prevalence of open-angle glaucoma (OAG),[13],[14],[15],[16],[17] for example, the Caribbean black populations,[18],[19] the African,[13],[20],[21],[22] and the black American,[13],[15] all have a high prevalence. The black-skinned populations have different glaucoma prevalence in different regions and areas, for example, the prevalence is different in the Caribbean islands and inside different regions of Africa[13] that may reflect the diversity of genetic and environmental and the socioeconomic factors in these areas.[23],[24] This diversity pattern is different from that observed in Caucasian populations as they have nearly the same prevalence of glaucoma in the different regions of the world, for example, Europe,[13] USA,[13],[25] and Australia,[26],[27] all have nearly the same prevalence of glaucoma.

Objective

The study aims to explore and describe the annular pattern and prevalence of glaucoma among patients attended ATH and the PHC facilities in Atbara locality from 2009 to 2016 that amount to help in designing and planning the future glaucoma management programs in Sudan and especially in Atbara locality.

 Subjects and Methods



The study was a retrospective study depended on the records of the confirmed diagnosed glaucoma patients in the Ministry of Health, ATH, and other PHC facilities in Atbara locality in RNS through 2009–2016. The ATH is the biggest in the locality and covers the city and its surrounded rural areas.

The data were taken from the Ministry of Health in Nile Valley State through 2009–2016 and compared it to the records of the ATH and other health facilities to ensure the accuracy of both the resources and the process of transferring of the data from the periphery (ATH and the PHC facilities) to the center (Ministry of Health). The study depended mainly on the Ministry of Health records and the RNS government records and its official website. The gaps in these records were filled from the peripheral center's records (when there are gaps and when the data for these gaps were available from the peripheral centers).

The data were collected, organized, and ordered as the total number of the glaucoma patients attended ATH and others PHC facilities in Atbara's locality per year from 2009 to 2016 according to the age and gender; then, these values were compared with the total numbers of the glaucoma patients and to the total population of the Atbara locality during the same period. The numbers of the populations for some years were not found, so they have been calculated using the mean annual population growth rate and the known population numbers. The ratio of the female population to the male is nearly equal during 2009–2016.[28],[29] The data were entered and analyzed using version 23 of IBM SPSS Corporation. IBM SPSS, NY, USA.

 Results



The total number of glaucoma patients (triglycerides [TG]) per year ranges from 717 to 2696 with a mean ± standard deviation of 1878 ± 643.39 [Table 1].{Table 1}

The patients' age was divided into five groups according to the method used by the ministry of health to record the data. Each of these groups was divided into two subgroups according to the gender [Table 1].

The prevalence and ratios of the glaucoma patients were calculated according to their gender groups within the age's groups among the TG patients attended ophthalmic clinics (ATH and PHC facilities) in Atbara locality per year [Table 2] and among the total population of the Atbara locality [Table 3].{Table 2}{Table 3}

The result includes the percentages of the gender of glaucoma patients in the different age groups [Table 2] and [Table 3].

 Discussion



The study showed that the percentage of the glaucoma patients who are <5 years old (congenital, developmental, juvenile, and acquired glaucoma) ranges from 0.04% to 0.98% of the total glaucoma patients with an average of 0.613%, which is very low when compared to percentage of glaucoma in the same age group in Blue Nile province, which is 3.5% for congenital glaucoma and 3.6% for the juvenile glaucoma.[30]

The prevalence of glaucoma in this age group among the total population of the same age in Atbara locality ranges from 0.005% to 0.110% and average of 0.052%; this result is very high when compared to a prevalence of childhood glaucoma according to the pieces of literature in which it is about 1–2 in 10000 of children.[31],[32] This means that the prevalence of childhood glaucoma in the study is significantly higher than 2–3 times more than what was found in literature (P = 0.001). The result confirms what is known about the prevalence of glaucoma in the Middle East; it is high.[32]

The males were (52%) affected more than females (48%); this result is lower than that found in the USA, in which about (66.67%) of the childhood glaucoma patients were male.[31]

The same observations occurred in the age groups of 5–14 years, in which the prevalence is high and is more than three times the prevalence of glaucoma in the literature, in which glaucoma affects approximately 1 in 2000 children.[33] This result is low when compared to the result found by de Espinosa et al., in which the prevalence of glaucoma is 3.5%.[34]

In this group of age, the females were affected (52%) more than males (48%); this result is higher than that found in the USA, in which about (33.37%) of the childhood glaucoma patients are female.[31] This result is near to the result found by Montero de Espinosa et al., in which they found the prevalence of glaucoma in those who aged 5–14 years is equal in both sexes.[34]

Concerning the ratios of the glaucoma patients who are 15–24 years old to the total glaucoma patients, it is found to be from 0.52% to 8.62% with an average of 5.08%, while the prevalence of the glaucoma of this age group among the total population of the same age ranges from 0.07% to 1.83% and average of 0.86%. The study showed that the prevalence is significantly higher in females (76%) than males (24%) (P = 0.000). The researchers did find any study about this age group to compare between the two studies.

The age group of 25–44 years has a ratio of the glaucoma patients to the total glaucoma patients ranges from 5.64% to 32.40% with an average of 24.14%, while its prevalence among the total population of the same age ranges from 0.48% to 4.76% and average of 3.0%. This result is low when compared to the prevalence of glaucoma in the Black residents of Temba aged ≥40 years, South Africa, which was 5.3%.[35] However, it is high when compared to the study about primary OAG (POAG) which stated that the prevalence is about 1% of the population aged ≥40 years worldwide.[32] However, the comparison is not an ideal one because it included only the last 5 years of the study age group while an opened age for the second comparison group. The researchers did find any others study about this age group to compare between the two studies.

Again, the study showed that the prevalence is significantly higher among females (64%) than males (36%) (P = 0.000).

The study showed that the ratio of glaucoma patients who are above 44 years old to the total glaucoma patient ranges from 57.37% to 88.98% and an average of 68.27%. The prevalence of the glaucoma patients in this age group among the same aged population ranges from 3.58% to 17.13% and the average of 10.89%, which is higher than many population-based studies, for example, one of these studies found the prevalence among white –skinned people aged 40 years and more ranges from 1.1% to 2.1% throughout the world.[10] The result is high when compared to the percentage of glaucoma in American and European population, in which it affects 1%–3% of those who are 40 years and more.[36] Furthermore, this result is higher than the result of the Barbados Eye Study, which found a prevalence of 7% in individuals older than 40 years.[10],[28] However, the result is considered very high and significantly different from the result of the Rotterdam Study, which found a prevalence of 0.8%.[10]

Considering that the study occurred in African-Arab population, this result is considered high even when compared to African people who are known to have the highest prevalence of glaucoma that equal to 3–4-fold of the other region.[10]

This result is higher than a lot of other studies, for example, in Bangladesh, the study among people aged 40 years and older showed the prevalence of definite glaucoma was 2.1%.[24] Even after adding the prevalence of probable glaucoma to definite glaucoma, the prevalence was 3.1% (95% confidence interval: 2.4–4.0; 58 people).[24] In the Vellore Eye Survey, the prevalence of POAG in the 30–60-year age group is equal to 0.41%.[37] The prevalence of POAG in the Andhra Pradesh Eye Diseases Study is 2.56% in those aged 40 years and older.[38] The result of the study in the South Indian urban population was 3.51%.[21]

This result is also higher than a lot of other studies, for example, the result of study occurred in Malay people in Singapore who are 40 years and older (3.4%), and the results of a study among ethnic Chinese people in Singapore and other racial/ethnic groups in Asia.[23]

The prevalence is higher in females (52%) than males (48%); this is different from the results of the Barbados Eye Study, which found that the prevalence is higher in men than in women with an age-adjusted male–female ratio of 1.4.[28]

The prevalence of all glaucoma through 2009–2016 varies from year to year; it is low as 0.49% in 2014 and high as 1.97% in 2011 and with an average of 1.34%. This result is slightly lower to the overall prevalence of POAG in the population of rural southern India, which was 1.62%.[20] However, it is very low when compared to the Singapore Malay Eye Study, in which the prevalence of all glaucoma is 3.4%,[22] and it is also low when compared to study done on African population, in which they found that the prevalence is 8.4%.[39]

The prevalence of all-female glaucoma patients through 2009–2016 varies from 46% to 76%, which is nearly similar to the study done by Quigley and Broman, in which they found that the prevalence of females affected by glaucoma is 59.1% of all people with glaucoma.[40] This result is similar to the Blue Mountains Eye Study which reported a higher prevalence of glaucoma in women.[17] While the result is different from many other studies stating that the prevalence of glaucoma is higher in men than women.[14],[41] Also, the result is different from another group of studies stating that the prevalence of glaucoma is the same in men and women.[16],[18],[19],[39]

The study showed that glaucoma accounted for a big proportion of the total consultations in the ATH and other PHC facilities in Atbara locality. This is reflected by the percentage of the glaucoma patients attended to ophthalmology clinics which ranges between 6.6% and 19.63% of the total ophthalmic patients with the average percentage of 14.02% which is slightly higher than the result found by Samy et al., in which they found the percentage of 13.3%.[42] The standardized age-specific prevalence was 7.7% for ages 30 years and above and 8.5% for ages 40 years and above.[39]

The prevalence of glaucoma through 2009–2016 is increasing with increased age of the population; this result is the same as in many studies, for example, American Academy series,[10] Varma et al.,[19] Vijaya et al.,[21] Raychaudhuri et al.,[22] Rudnicka et al.,[41] and Kosoko-Lasaki et al.[43]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Country Cooperation Strategy for WHO and Sudan; 2008-2013. Available from: https://apps.who.int/iris/bitstream/handle/10665/113233/CCS_Sudan_2010_EN_14477.pdf;sequence=1. [Last accessed on 2020 May 30].
2A-Rahman NH, Jacquet GA. The state of emergency care in the republic of Sudan. Afr J Emer Med 2014;4:55-60.
3World Health Organization. Countries - Sudan. Statistics. Available from: http://www.who.int/countr ies/sdn/en/. [Last accessed on 2020 May 30].
4World Health Organization. Country Cooperation Strategy at a Glance - Sudan. Available from: https://apps.who.int/iris/bitstream/handle/10665/136885/ccsbrief_sdn_en.pdf?sequence=1. [Last accessed on 2020 May 30].
5The Republic of Sudan. River Nile State - Government. Official Website. Available from: http://www.rivernilestate.gov.sd/. [Last accessed on 2020 May 30].
6Yusra J, Rawan A. Atbara: The Cradle of the Sudan Uprising. 500 Words Magazine; 2019. Available from: http://500wordsmag.com/miscellaneous/atbara-the-cradle-of-the-sudan-uprising/. [Last accessed on 2020 Jul 21].
7World Population Review. Countries. Sudan; 2019. Available from: http://worldpopulationreview.com/countries/sudan-population/. [Last accessed on 2020 May 30].
8World Atlas. World Map. Africa. The Sudan. Where is Atbara. Available from: https://www.worldatlas.com/af/sd/nr/where-is-atbara.html. [Last accessed on 2020 May 30].
9Central Bureau of Statistics. Statistical Year Book for the Year 2009. Khartoum. Sudan 2009. Available from: http://cbs.gov.sd/resources/uploads/files/%D8%A7%D9%84%D9%83%D8%AA%D8%A8%20%D8%A7%D9%84%D8%A7%D8%AD%D8%B5%D8%A7%D8%A6%D9%8A%202009.pdf. [Last accessed on 2020 May 31].
10American academy of ophthalmology. Basic science series course, Section10. Glaucoma. San Francisco. USA. 2016.
11Foster A, Resnikoff S. The impact of Vision 2020 on global blindness. Eye (Lond) 2005;19:1133-5.
12Kyari F, Abdull MM, Bastawrous A, Gilbert CE, Faal H. Epidemiology of glaucoma in sub-Saharan Africa: Prevalence, incidence and risk factors. Middle East Afr J Ophthalmol 2013;20:111-25.
13Racette L, Wilson MR, Zangwill LM, Weinreb RN, Sample PA. Primary open-angle glaucoma in blacks: A review. Surv Ophthalmol 2003;48:295-313.
14Dielemans I, Vingerling JR, Wolfs RC, Hofman A, Grobbee DE, de Jong PT. The prevalence of primary open-angle glaucoma in a population-based study in The Netherlands. The rotterdam Study. Ophthalmology 1994;101:1851-5.
15Tielsch JM, Sommer A, Katz J, Royall RM, Quigley HA, Javitt J. Racial variations in the prevalence of primary open-angle glaucoma. The Baltimore eye Survey. JAMA 1991;266:369-74.
16Klein BE, Klein R, Sponsel WE, Franke T, Cantor LB, Martone J, et al. Prevalence of glaucoma. The Beaver Dam Eye Study. Ophthalmology 1992;99:1499-504.
17Mitchell P, Smith W, Attebo K, Healey PR. Prevalence of open-angle glaucoma in Australia. The Blue Mountains eye study. Ophthalmology 1996;103:1661-9.
18Weih LM, Nanjan M, McCarty CA, Taylor HR. Prevalence and predictors of open-angle glaucoma: Results from the visual impairment project. Ophthalmology 2001;108:1966-72.
19Varma R, Ying-Lai M, Francis BA, Nguyen BB, Deneen J, Wilson MR, et al. Prevalence of open-angle glaucoma and ocular hypertension in Latinos: The Los Angeles Latino Eye Study. Ophthalmology 2004;111:1439-48.
20Vijaya L, George R, Paul PG, Baskaran M, Arvind H, Raju P, et al. Prevalence of open-angle glaucoma in a rural south Indian population. Invest Ophthalmol Vis Sci 2005;46:4461-7.
21Vijaya L, George R, Baskaran M, Arvind H, Raju P, Ramesh SV, et al. Prevalence of primary open-angle glaucoma in an urban south Indian population and comparison with a rural population. The Chennai Glaucoma Study. Ophthalmology 2008;115:648-540.
22Raychaudhuri A, Lahiri SK, Bandyopadhyay M, Foster PJ, Reeves BC, Johnson GJ. A population based survey of the prevalence and types of glaucoma in rural West Bengal: The West Bengal Glaucoma Study. Br J Ophthalmol 2005;89:1559-64.
23Shen SY, Wong TY, Foster PJ, Loo JL, Rosman M, Loon SC, et al. The prevalence and types of glaucoma in Malay people: The Singapore Malay eye study. Invest Ophthalmol Vis Sci 2008;49:3846-51.
24Rahman MM, Rahman N, Foster PJ, Haque Z, Zaman AU, Dineen B, et al. The prevalence of glaucoma in Bangladesh: A population based survey in Dhaka division. Br J Ophthalmol 2004;88:1493-7.
25Bourne RR, Sukudom P, Foster PJ, Tantisevi V, Jitapunkul S, Lee PS, et al. Prevalence of glaucoma in Thailand: A population based survey in Rom Klao District, Bangkok. Br J Ophthalmol 2003;87:1069-74.
26Foster PJ, Oen FT, Machin D, Ng TP, Devereux JG, Johnson GJ, et al. The prevalence of glaucoma in Chinese residents of Singapore: A cross-sectional population survey of the Tanjong Pagar district. Arch Ophthalmol 2000;118:1105-11.
27Liang YB, Friedman DS, Zhou Q, Yang X, Sun LP, Guo LX, et al. Prevalence of primary open angle glaucoma in a rural adult Chinese population: The Handan eye study. Invest Ophthalmol Vis Sci 2011;52:8250-7.
28Leske MC, Connell AM, Schachat AP, Hyman L. The Barbados eye study. Prevalence of open angle glaucoma. Arch Ophthalmol 1994;112:821-9.
29Buhrmann RR, Quigley HA, Barron Y, West SK, Oliva MS, Mmbaga BB. Prevalence of glaucoma in a rural East African population. Invest Ophthalmol Vis Sci 2000;41:40-8.
30Beiram MM. Blindness in the Sudan: Prevalence and causes in Blue Nile province. Bull World Health Organ 1971;45:511.
31Glaucoma Research Foundation. Childhood Glaucoma. San Francisco: Glaucoma Research Foundation; 2016. Available from: https://www.glaucoma.org/glaucoma/childhood-glaucoma-1.php. [Last accessed on 2020 May 31].
32U.S. National Library of Medicine. Genetic Home Reference. Early – Onset Glaucoma; 2019. Available from: https://ghr.nlm.nih.gov/condition/early-onset-glaucoma#statistics. [Last accessed on 2020 May 31].
33Glaucoma Australia. Glaucoma in Older Children and Adolescents. Fact Sheet. Seen in 2019. Available from: https://www.glaucoma.org.au/about-glaucoma/types-of-glaucoma/glaucoma-in-older-children/. [Last accessed on 2020 May 31].
34de Espinosa MM, Pérez RP, Schiattino PM, Cossío MI, Ponce J. Juvenile glaucoma: Long-term development of ocular hypertension in children. New Front Ophthalmol 2017;3:1-4.
35Rotchford AP, Kirwan JF, Muller MA, Johnson GJ, Roux P. Temba glaucoma study: A population-based cross-sectional survey in urban South Africa. Ophthalmology 2003;110:376-82.
36David FE, Alicja RR. Glaucoma Identification and Co-Management. London: Elsevier; 2007.
37Jacob A, Thomas R, Koshi SP, Braganza A, Muliyil J. Prevalence of primary glaucoma in an urban south Indian population. Indian J Ophthalmol 1998;46:81-6.
38Dandona L, Dandona R, Srinivas M, Mandal P, John RK, McCarty CA, et al. Open-angle glaucoma in an urban population in southern India: The Andhra Pradesh eye disease study. Ophthalmology 2000;107:1702-9.
39Ntim-Amponsah CT, Amoaku WM, Ofosu-Amaah S, Ewusi RK, Idirisuriya-Khair R, Nyatepe-Coo E, et al. Prevalence of glaucoma in an African population. Eye (Lond) 2004;18:491-7.
40Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006;90:262-7.
41Rudnicka AR, Mt-Isa S, Owen CG, Cook DG, Ashby D. Variations in primary open-angle glaucoma prevalence by age, gender, and race: A Bayesian meta-analysis. Invest Ophthalmol Vis Sci 2006;47:4254-61.
42Samy El Gendy, N.M. and Abdel-Kader, A.A., 2018. Prevalence of selected eye diseases using data harvested from ophthalmic checkup examination of a cohort of two thousand Middle Eastern and North African subjects. Journal of ophthalmology, 2018. Available from: http://downloads.hindawi.com/journals/joph/2018/8049475.pdf. [Last accessed on 2020 May 31].
43Kosoko-Lasaki O, Gong G, Haynatzki G, Wilson MR. Race, ethnicity and prevalence of primary open-angle glaucoma. J Natl Med Assoc 2006;98:1626-9.