Niger J Paediatr 2016; 43 (3):215 – 220
ORIGINAL
Amiebenomo OM
Parental knowledge and attitude to
Achugwo DC
Abah I
children's eye care services
DOI:http://dx.doi.org/10.4314/njp.v43i3.11
Accepted: 17th December 2015
Abstract :
Background: The
early
attitude to eye care and age, educa-
years of life is very significant in
tional status and number of chil-
Onyekachukwu MA
(
)
the development of the eyes and
dren for both fathers and mothers.
Abah I
vision, any disruption at this stage
Majority (60%of fathers and
Department of optometry,
Faculty of Life Sciences
may lead to severe visual impair-
66.7% of mothers) would seek eye
University of Benin, Benin-City
ment or even blindness. Eye ex-
examination for their children only
Email:
amination and treatment of chil-
when the child has an eye com-
maryanne.amiebenomo@uniben.edu.ng
dren is not just a right of the child,
plain or eye problem. The belief
but
also a necessity to properly
that
routine eye exam is not neces-
Achugwo DC
monitor and evaluate the eyes and
sary
was reported as the major
Asmara college of Health Sciences,
visual structure. The responsibil-
barrier in seeking eye examination
Asmara, Eritrea.
ity to make decisions as regards
for their children (60% of fathers
eye care of a child lies on the par-
and 57% of mothers). Other barri-
ents or guardian.
ers include funds, time, the use of
Purpose:
To
find out parents
traditional medicine, and distance
knowledge and attitude towards
to
eye clinic. Over 65% of parents
eye examination and treatment for
would allow their children use any
their children and the effect of
eye treatment at any age as long as
demographic factors such as gen-
the
doctor states the necessity.
der, age, educational status and
Although, few parents would re-
number of children.
strict their children from the use of
Method: A
total of
468 parents
glasses, eye surgery and eye train-
including fathers and mothers (not
ing
until the child is 10 years. Fa-
necessarily couples) in Benin City
thers were significantly (p=0.008)
participated in this cross-sectional
better educated about the eyes than
observational study. A semi-
mothers although, less than 30% of
structured questionnaire seeking
respondents has had education
parents’ demographic characteris-
about
eye care. Less than 1% of
tics, attitude towards eye exami-
respondents know that a child is
nation and treatment, factors af-
old enough to have a comprehen-
fecting the need for routine eye
sive eye examination at 6 months.
checkup for their children and
Conclusion: Proper
parent educa-
parents’ knowledge about the eyes
tion and enlightenment strategies
was used. The data was analyzed
should be put in place by profes-
using SPSS. The test of signifi-
sional bodies and the government
cance was performed using Chi
to
make better parents attitude
square and significance was taken
towards eye examination for the
at
p < 0.05.
sake of an improved eye health for
Results: Only
gender affected
children.
parents’ attitude towards eye ex-
amination
for
their
children
Keywords: Parents,
Eye examina-
(p=0.003). There were no signifi-
tion, Eye treatment, Children
cant associations between parents’
Introduction
result in reduced vision which may be difficult to cor-
rect.
1
The visual system of children is immature when born.
For normal vision development to occur, images trans-
Blindness in children can be avoidable with preventive
mitted to the higher centers must be clear and properly
measures and when eye examination and treatment is
focused. A failure in vision development may occur
early and frequent. In the developed world, children are
unnoticed unless there is an eye examination. This could
required to undergo eye examination at birth and as
216
early as six months. By six months an average child has
pediatric vision examination necessary at different ages
attained a number of developmental milestones and so
in
Nigeria. Hence, we sought to find out parents’ knowl-
can
undergo a full eye examination. Afterwards, a com-
edge
and attitude towards children eye examination and
prehensive eye examination is necessary at the preschool
treatment and the effect of demographic factors such as
age and frequently during the school age. School visual
2
gender, age, educational status and number of children.
screening is not sufficient but regular comprehensive
This could serve as source of information guiding chil-
eye examination at intervals.
dren-oriented parent eye-health-education messages.
A
variety of factors can cause severe visual impairment
and blindness in children, the leading source has been
Materials and method
linked to corneal scarring, caused by vitamin A defi-
3
ciency and measles followed by cataract and retinopathy
This cross-sectional observational survey was carried
of
prematurity. In addition to the correction of signifi-
out in Benin City. Benin city, the capital of Edo state
cant refractive errors and provision of low vision ser-
has 2 major hospitals which run an eye clinic, the Uni-
vices, the vision 2020 program has given priority to the
versity of Benin optometry department eye clinic at 2
control of these conditions mentioned above.
1
campuses, and about 20 Private eye clinics/hospitals.
Asemi-structured questionnaire was distributed using
Childhood blindness accounts for 3.2% of the burden of
convenience sampling technique to 600 parents (not
global blindness. Though the number of cases of blind-
4
necessarily couples) with at least a child less than 16
ness and visual impairment in children is lower than in
years of age. The questionnaire was pretested amongst 4
adults, Childhood blindness and visual impairment con-
fathers - 2 educated and 2 uneducated and 4 mothers - 2
trol have been prioritized by the World Health Organiza-
educated and two uneducated in Benin city, restructured
tion (WHO) for some reasons. Firstly, most causes of
for easy understanding and thereafter shared at social
blindness in children are avoidable and elimination will
5
meetings, church gatherings and work places around
greatly reduce the prevalence of blindness in countries
Benin city. Distribution of the final questionnaires was
of
low income like sub-Saharan Africa and Asia. Sec-
1
by
hand. The questionnaires were self-administered for
ondly, childhood blindness is closely related to mortality
most educated parents but interview administered for
rate
1,6
and 60% of children who go blind from condi-
those who requested.
tions like premature birth, measles, congenital rubella
Four hundred and sixty eight (78%) properly filled ques-
syndrome, vitamin A deficiency and meningitis die
tionnaires were retrieved for this study. Each question-
within a year of going blind. Thirdly, Even if a blind
naire had three major sections: section one assessed the
child survives, his number of blind years ahead is very
parents’ attitude towards eye examination and barriers to
high,
1,
7
causing blindness to have more devastating ef-
seeking routine eye care for their children, section two
fect
in children. These children may pose an emotional
assessed parents’ attitude towards eye treatment for their
and
socio economic challenge for their families, they
child and section three assessed parents’ knowledge on
may
be less likely to complete their education and hence
eye
care.
make a living for themselves.
Parents attitude were judged based on their response to
To
actualize this priority, early and regular eye examina-
either of the following as regards seeking eye examina-
tion in children is a very important tool for ensuring
tion for their children; routine eye examination, referral
normal visual development and reduce the risk of vision
by
a general medical practitioner or pediatrician, pres-
loss, facilitating early detection and treatment, consulta-
ence of eye complain or problem and other reasons such
tion by another eye care practitioner or referral where
as
accidents or ocular emergencies. They were further
necessary. Health education of parents and guardians on
asked a question to elicit barriers faced by them to rou-
the
need for frequent eye examination and necessary
tine
eye examination and in addition eye conditions that
treatment is an important WHO strategy in developing
would require them to seek eye examination. Parents
countries where a good number of people have poor
were
also made to indicate at what ages they can allow
knowledge of the importance of eye examination and
their child to use these form of eye treatment; eye drop,
treatment, hence neglecting eye care for their children.
8
eye
ointment, glasses, eye surgery and eye training.
As
regards how much they know about eye care, parents
Ntsoane and Oduntan, (2010) enumerated a number of
9
were
asked to pick from the following options where
demographic factors that could affect the utilization of
they
have had information about care of the eyes; radio,
eye
care facilities these include age, gender, level of
television, personal studies, seminars and lectures, hos-
education, race, socio economic factors, knowledge of
pital, personal studies, journals. They were also asked if
eye
diseases and eye care services. Furthermore, barriers
they
know that a child should have his first comprehen-
to
parents seeking eye examination for their children
sive
eye examination by 6 months.
may
include the belief that eye examination is not neces-
sary,
10
lack
of funds,
11,
12
distance from eye clinic, time,
Statistical package for social sciences (SPSS version 22)
reliance on pediatricians, general practitioners and visual
was
used to represent the data in tables and figures and
screenings and the availability of traditional medicine as
2
the
test of significance was performed at p<0.05 using
a
cheaper alternative.
13
Chi
square test. This study faced limitations due to recall
bias
as with a typical questionnaire study.
There is no operational government protocol that makes
217
Results
and 66.7% of mothers) would seek eye examination for
their children only when the child has an eye complain
Of
the 468 respondents, 196(41.88%) were males and
or
eye problem. Twenty-six percent of fathers would
272 (58.12%) were females, within the ages 21-65
seek eye examination for their child if a general medical
years; majority were aged between 31-50 years, 359
practitioner or pediatrician refers their children to see an
(76.71%). Out of the 260 females who indicated their
eye care practitioner for a comprehensive eye examina-
educational status, majority (125) 48% had Secondary
tion. Other reasons why parents would seek eye exami-
School leaving certificate as their highest level of educa-
nation for their children includes accidents and ocular
tion while,61 (33%) out of the 186 males indicated they
emergencies. This difference amongst the response from
had
been to one higher institution or the other. Most
fathers and mothers was seen to be significant
parents, (60% females and 67% males) in Benin City
(p=0.003).
have 1-3 children, while few parents (4% females and
6%
males) have greater than 6 children. There were no
Fig 1: Reasons
why parents
seek eye
examination for
their
significant associations between parents’ attitude to eye
children
examination and age (p=0.920 for fathers, and p=0.890
for mothers), educational status (p=0.309 for fathers,
p=0.949 for mothers), and number of children (p=0.0787
for fathers and p=0.544 for mothers).
Few parents (6% of fathers, and 4.1% of mothers) recog-
nize routine eye examination as a reason to seek eye
examination for their children, majority (60%of fathers
Table 1: Demographic
characteristics of
parents as
it relates
to attitude
towards eye
examination for
their children
Routine eye examination
Doctor’s referral
Eye
complaint
Others
P -
value
Frequency (%)
Frequency (%)
Frequency (%)
Frequency (%)
Age (fathers)
21-25
0
(0)
0
(0)
0
(0)
0
(0)
26-30
0
(0)
2
(33)
4(66)
0
(0)
31-35
3
(8)
7(19)
24(65)
3
(8)
36-40
2(9)
7(32)
12(55)
1(4.5)
41-45
3(6)
10
(21)
30(61)
6
(12)
0.9020
46-50
2(5)
14(36)
19(49)
4(10)
51-55
1(4)
6(24)
18(72)
0(0)
56-60
1(7)
4(29)
9(64)
0(0)
61-65
0(0)
1(25)
3(75)
0(0)
Total
12(6)
51(26)
119(60)
14(8)
Age (mothers)
21-25
0
(0)
3
(37.5)
5(62.5)
0(0)
26-30
1(3.7)
8(29.6)
16(59.2)
2(7.4)
31-35
2(4.9)
7(17.1)
28(68.2)
4(9.8)
36-40
4(4.9)
14(17.1)
56(68.2)
8(9.8)
41-45
1(2.4)
10(24.4)
30(73.1)
0(0)
0.890
46-50
2(4.3)
8(19.5)
30(65.2)
6(13)
51-55
1(4.5)
6(27.3)
13(59.1)
2(9.1)
56-60
0
(0)
0(0)
0(0)
0(0)
61-65
0(0)
0(0)
0(0)
0(0)
Total
11(4.1)
56(21.0)
178(66.7)
22(8.2)
Number of children (fathers)
1 –
3
10
(7.9)
28
(22)
82
(64.6)
7
(5.5)
4 –
6
7
(12.3)
17
(29.8)
31
(54.4)
2
(3.5)
0.787
> 6
0
(0)
2
(33.3)
4
(66.7)
0
(0)
Total
17
(9.0)
47
(24.7)
117
(61.6)
9
(4.7)
Number of children (mothers)
1 –
3
8
(4.9)
30
(18.4)
115
(70.6)
10
(6.1)
4 –
6
10(10.2)
18
(18.4)
66
(67.3)
4
(4.1)
0.544
> 6
1
(9.1)
3
(27.3)
6
(54.5)
1
(9.1)
Total
19
(6.9)
51
(18.8)
187
(68.8)
15
(5.5)
Educational status (fathers)
No
Education
0(0)
2(33.3)
4(66.6)
0(0)
Primary
0(0)
5(29.4)
11(64.7)
1(5.9)
WAEC
2(3.8)
10(19.2)
40(76.9)
0(0)
0.309
Vocation
2(4)
15(30)
28(56)
5(10)
Higher institution
6(8.5)
12(16.9)
50(70.4)
3(4.2)
Total
10(5)
45(22.8)
133(67.5)
9(4.6)
Educational status (mothers)
No
Education
0(0)
1(20)
4(80)
0(0)
Primary
1(3.2)
8(25.8)
20(64.5)
2(6.5)
WAEC
2(1.6)
25(20)
88(70.4)
10(8)
0.949
Vocation
1(1.9)
15(28.9)
34(65.4)
2(3.8)
Higher institution
2(4.3)
10(21.3)
30(63.8)
5(10.6)
Total
6(2.3)
59(22.7)
176(67.7)
19(7.3)
218
Barriers to seeking routine eye care
Eye treatment
The
belief that routine eye exam is not necessary was
Over
65% of parents would allow their children use any
reported as the major barrier in seeking routine eye ex-
eye
treatment at any age as long as the doctor states the
amination for their children (60% of fathers and 57% of
necessity. Figures 3 and 4 show Parents’ attitude to-
mothers).
Other barriers include funds, time, the use of
wards eye treatments for their children. This difference
traditional medicine, and distance to eye clinic (Fig 2).
was found to be statistically significant (p=0.00).
Fig 2: Barriers
reported by
parents to
routine eye
examination
Fig 5: The
use of
various eye
treatments for
children reported
of
their children
by
fathers
Fig 6: The
use of
various eye
treatments for
children reported
by
mothers
Conditions causing parents to seek eye exam for their
children
Over 60% of fathers will seek eye examination for their
children if the eye complaint is squint or eye pain and
discomfort. No father agreed to frequent headaches as a
possible vision problem necessitating them to seek eye
examination for their children.
Other than squint, eye pain and discomfort, 19% of
mothers will seek eye examination for their children for
Knowledge about the eyes
other reasons such as ocular emergencies.
The
question on parents’ acquisition of knowledge about
Fig 3: Reasons
why fathers
seek an
eye exam
for their
children
the
eye was answered by 426 parents (240 mothers and
186 fathers). From the result, less than one third claim to
have had knowledge about eye care.
Fathers were significantly (P=0.008) better educated
about the eyes than mothers, 48 (25.8%) fathers claim
they have had education about the eyes from various
sources compared to only 37 (15.4%) mothers. This in-
formation is shown in Table 3
below.
Table 3: Parents’
sources of
knowledge about
the eyes
Fathers
Mothers
Radio
4
7
TV
28
16
Hearsay
-
3
Fig 4: Reasons
why mothers
seek an
eye exam
for their
Personal studies
11
4
children
Journals
3
2
Others
2
(seminars and
5
(Hospitals)
lectures)
Total
48
37
When
asked if they are aware that a child should have
his
first comprehensive eye examination at 6 months,
only
3 (0.64%) indicated ‘Yes’ while the rest reported
‘No’.
219
Table 2: Demographic
characteristics of
parents as
it relates
to
health information about their children from there, but in
knowledge about the eye
a
society where the health sector does not do much to
Have you had any
Yes
No
P -
value
educate parents about routine eye checkup for children,
form
of education
mothers are deprived of such information.
about the eyes?
Frequency (%)
Frequency(%)
From this study, routine children eye examination was
Age (fathers)
21-25
-
-
not
subscribed to by most parents, this was a similar
finding in a previous study. However, this contradicts
10
26-30
-
6
(100)
the
conclusion from Ayanniyi et al., (2010) that parents
8
31-35
21(56.8)
16
(43.2)
36-40
26(100)
-
had
the right perception to the eye care of their children.
41-45
48(100)
-
<0.0001
The
contradiction results from the study’s focus on
46-50
39(100)
-
guardians’ eye care seeking behavior when a child has
51-55
25(100)
-
an
eye problem or complain alone, which is different
56-60
14(100)
-
from
this study that assessed routine eye examination
61-65
4(100)
-
Total
213(90.6)
22(9.4)
and treatment among other reasons.
Age (mothers)
21-25
3(37.5)
5(62.5)
Funds were also a major barrier for both fathers and
26-30
9(33.3)
18(66.7)
mothers as expected from a low-income countries, this
has
been previously identified by other studies,
9,
11, 12, 14
31-35
-
37(100)
36-40
6(9.8)
55(90.2)
Although guardians/parents economic status and their
41-45
11(35.5)
20(64.5)
0.200
choices in managing children’s ocular condition was not
46-50
35(76.1)
11(23.9)
investigated. Time and traditional medicine availability
51-55
5(22.7)
17(77.3)
56-60
1(20)
4(80)
were
also barriers seen more amongst fathers, inade-
61-65
-
-
quate time reported may be because most fathers are the
Total
70(25.6)
203(74.4)
bread winners of the family hence they feel their role
Number of children (fathers)
ends with provision of money and they have less time to
1 –
3
95(81.9)
21(18.1)
seek eye examination for their children. Distance to eye
4 –
6
56(100)
-
--
clinic was the least reported, this may be because of the
> 6
5(100)
-
good
distribution of eye clinics in Benin metropolis or
Total
156(88.1)
21(11.9)
the notion that if a child has a need for eye examination
Number of children (mothers)
1 –
3
22(10.4)
189(89.6)
and the money is available then distance will not be a
4 –
6
42(47.2)
47(52.8)
0.054
hindrance.
> 6
3(20)
12(80)
Total
94(27.5)
248(72.5)
Majority of parents reported that their children could use
Educational status (fathers)
any
treatment for the eyes as long as a doctor has pre-
No
Education
6(100)
-
scribed it. This is good, as parents rely on doctor’s judg-
Primary
15(93.8)
1(6.2)
ment
more than their personal beliefs. Also few parents
WAEC
47(90.4)
5(9.6)
0.369
indicated restricting their children from the use of
Vocation
43(86)
7(14)
Higher institution
50(86.2)
8(13.8)
glasses, eye surgery and eye training until the child is 10
Total
161(88.5)
21(11.5)
years. Some parents, mostly mothers who claimed their
Educational status (mothers)
child will never have any form of eye treatment and
No
Education
3(75)
1(25)
nothing to do with eye clinic do this because of their
Primary
16(61.5)
10(38.5)
beliefs and misconceptions about eye conditions and
WAEC
48(35.6)
87(64.4)
0.002
treatments and probably as a result of religious bias. The
Vocation
2(3.8)
50(96.2)
few children who are allowed to go without eye treat-
Higher institution
11(22)
39(78)
ment due to restrictions from their parents could add
Total
80(30)
187(70)
significantly to the socioeconomic burden arising from
children who are visually impaired in our society.
Discussion
Authors’ contribution
The purpose of this work was to find out the knowledge
OMA: Study conception and design, manuscript
and attitude of parents in Benin City as regards eye ex-
preparation.
amination and treatment for their children. Of the four
DCA: Manuscript editing, ensured proper referencing
demographic factors assessed by this study, only gender
and
provided educational guidance and counseling.
significantly affected parents’ attitude toward eye ex-
IA:
Data collection and analysis
amination for children. This difference in response may
Conflict of interest: None
be
attributed to the significant difference in parents’
Funding: None
knowledge about the eyes. Although one will expect
mothers to have better education about the eyes than
fathers due to the fact that they visit the hospital with the
children more often than fathers and are likely to get
220
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