african drylands institute for sustainability

To determine the magnitude and pattern of significant refractive errors in primary school children in Kilungu division of Makueni District, Kenya. Design: A cross – sectional primary school based study. Setting: Eight (8) Primary school in Kilungu division of Makueni District, Kenya. Target population: 1439 Primary school pupils aged between 12 and 15 years. Results: The prevalence of significant refractive error was 5.2%, 75/1439, (95% CI) being responsible for 92.6 % of all causes of poor eyesight. Hypermetropia accounted for 3.2% (95% CI), myopia 1.7% (95% CI) and astigmatism 0.3% (95% CI) of refractive errors. Myopia was more likely to be present in the pupils aged 14 to 15 years than those aged 12 to 13 years with OR 2.9 (0.1 – 9.2) which was statistically significant (p = 0.022). Conclusion: The overall prevalence of significant refractive errors in pupils aged 12 to 15 years in Makueni's Kilungu division at 5.2% (95% CI) was high enough to justify a regular school eye screening in primary schools in Kenya.

Trachoma is the leading cause of infectious blindness worldwide. Though trachoma can be treated with antibiotics (active trachoma) or surgery (trachomatous trichiasis), it is still endemic in most parts of Ethiopia. Despite the prevalence of this infectious disease in different parts of the country, district level data is lacking. This study was thus conducted to assess the prevalence estimate of trachoma and its risk factors in Kersa District, Southwest Ethiopia. METHODS: A community based cross sectional Rapid Assessment of Trachoma was conducted using a WHO guideline. Six sub-districts were selected from Kersa District based on primary high risk assessment and from each sub-district; 21-27 households were randomly selected. Active trachoma for children aged 1-9 years, trachomatous trichiasis for people above 15 years old and environmental risk factors for trachoma were assessed. Data were analyzed using SPSS version 16. RESULTS: The overall prevalence estimate of active trachoma was 25.2% (95% CI: 20.7-30.4%). Forty three percent of children had unclean faces, 11.5% of households had water source at more than half hour walking distance, 18.2% did not have functional latrine, and 95.3% of the households had solid waste disposal within a distance of 20 meters. Households with environmental risk factors were at an increased risk to active trachoma, but the association was not statistically significant (p>0.05). The prevalence estimate of trachomatous trichiasis inclusive of "trachoma suspects" was 4.5%. CONCLUSION: Trachoma is endemic in Kersa District with active trachoma being a public health problem in the studied sub-districts. Hence, SAFE strategy should be implemented.

PURPOSE: To determine possible differences in visual acuity, socio-demographic factors and vision-related Quality of Life (QoL) between people accepting and people refusing sponsored cataract surgery.

METHODS: Three hundred and fifty seven local residents with visually impairing cataract, presenting at screening sites in Kwale District, Kenya were clinically assessed and interviewed. The World Health Organization (WHO) QoL-questionnaire WHO/Prevention of Blindness and Deafness Visual Functioning Questionnaire 20 (PBD-VFQ20) was used to determine the vision-related QoL. A standardized questionnaire asked for socio-demographic data and prior cataract surgery in one eye. After interview, patients were offered free surgery. Primary outcome was the mean QoL-score between acceptors and non-acceptors. Secondary outcomes were visual acuity and socio-demographic factors and their contribution to QoL-scores and the decision on acceptance or refusal.

RESULTS: Fifty nine people (16.5%) refused and 298 accepted cataract surgery. Vision-related QoL was poorer in people accepting than in those refusing (mean score 51.54 and 43.12 respectively). People with poor visual acuity were only slightly more likely to accept surgery than people with better vision; the strongest predictors of acceptance were the QoL-score and gender. Men were twice as likely to accept compared to women. Of people who accepted surgery, 73.8% had best eye vision of 20/200 or better.

CONCLUSION: In this population, visual acuity was of limited use to predict a person's decision to accept or refuse cataract surgery. QoL-scores provide further insight into which individuals will agree to surgery and it might be useful to adapt the QoL-questions for field use. Gender inequities remain a matter of concern with men being more likely to get sight-restoring surgery.

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BACKGROUND: Estimates of intraocular pressure (IOP) are influenced directly by the central corneal thickness (CCT). We assume and apply a single value for CCT (520 mum) in applanation tonometry estimates, although there is compelling evidence that CCT varies between individuals.
OBJECTIVE: To determine the influence of CCT and other factors on IOP among Ethiopians.
METHODS: A cross sectional study was conducted among 300 sampled individuals from June to July 2006. The CCT was measured using OcuScan(R) RxP Ophthalmic Ultrasound and readings of IOP were made with Goldmann applanation tonometer. The data was analyzed using SPSS version 12 and S-Plus 2000 of statistical packages.
RESULTS: Out of 300 individuals, 184 (61.3%) were males. The mean age was 42.57 years (SD+/-16.71), mean IOP 13.39 mm Hg (SD+/-2.81), and mean CCT 518.68 mum (SD+/-32.92). There was statistically significant relationship between CCT and IOP (r=0.199, P<0.001) and a borderline statistically significant detectable change of CCT with age (r=0.012

PURPOSE: To determine possible differences in visual acuity, socio-demographic factors and vision-related Quality of Life (QoL) between people accepting and people refusing sponsored cataract surgery.

METHODS: Three hundred and fifty seven local residents with visually impairing cataract, presenting at screening sites in Kwale District, Kenya were clinically assessed and interviewed. The World Health Organization (WHO) QoL-questionnaire WHO/Prevention of Blindness and Deafness Visual Functioning Questionnaire 20 (PBD-VFQ20) was used to determine the vision-related QoL. A standardized questionnaire asked for socio-demographic data and prior cataract surgery in one eye. After interview, patients were offered free surgery. Primary outcome was the mean QoL-score between acceptors and non-acceptors. Secondary outcomes were visual acuity and socio-demographic factors and their contribution to QoL-scores and the decision on acceptance or refusal.

RESULTS: Fifty nine people (16.5%) refused and 298 accepted cataract surgery. Vision-related QoL was poorer in people accepting than in those refusing (mean score 51.54 and 43.12 respectively). People with poor visual acuity were only slightly more likely to accept surgery than people with better vision; the strongest predictors of acceptance were the QoL-score and gender. Men were twice as likely to accept compared to women. Of people who accepted surgery, 73.8% had best eye vision of 20/200 or better.

CONCLUSION: In this population, visual acuity was of limited use to predict a person's decision to accept or refuse cataract surgery. QoL-scores provide further insight into which individuals will agree to surgery and it might be useful to adapt the QoL-questions for field use. Gender inequities remain a matter of concern with men being more likely to get sight-restoring surgery.

BACKGROUND: Estimates of intraocular pressure (IOP) are influenced directly by the central corneal thickness (CCT). We assume and apply a single value for CCT (520 mum) in applanation tonometry estimates, although there is compelling evidence that CCT varies between individuals.
OBJECTIVE: To determine the influence of CCT and other factors on IOP among Ethiopians.
METHODS: A cross sectional study was conducted among 300 sampled individuals from June to July 2006. The CCT was measured using OcuScan(R) RxP Ophthalmic Ultrasound and readings of IOP were made with Goldmann applanation tonometer. The data was analyzed using SPSS version 12 and S-Plus 2000 of statistical packages.
RESULTS: Out of 300 individuals, 184 (61.3%) were males. The mean age was 42.57 years (SD+/-16.71), mean IOP 13.39 mm Hg (SD+/-2.81), and mean CCT 518.68 mum (SD+/-32.92). There was statistically significant relationship between CCT and IOP (r=0.199, P<0.001) and a borderline statistically significant detectable change of CCT with age (r=0.012

OBJECTIVE: To determine the barriers to uptake of eye care services and to establish the pattern of utilization of eye care services in the Nairobi Comprehensive Eye Care Services (NCES) Project; the catchment area of the Mbagathi District Eye Unit of Nairobi. DESIGN: Community based survey conducted from 15th to 31st October 2007. Setting: Kibera and Dagoreti divisions of Nairobi City. SUBJECTS: Of the 4,200 people of all ages who were randomly selected; 4,056 were examined giving a response rate of 96.6%. Of those not examined, 126 (3.0%) were not available and 15 (0.4%) refused to be examined. Mean age of the study population was 22 years. RESULTS: A total of 294 subjects (7.2%) despite having some ocular disorder, had not visited any health facility to seek treatment. The majority, 144 (49%) gave the reason as no perceived need to seek treatment as the problem did not bother them; especially those with refractive error. A third, 97 (33%), gave the reason as lack of money, 22 (7.5%) said that they did not know where to seek eye care and 20 (6.8%) said they had no time to seek eye care. Only 3 said that the health facility where to go for eye care was too far. The population in the survey area has vast number of nearby secondary and tertiary eye care facilities to choose from. The majority of subjects indicated Mbagathi District Hospital (20.9%), Kikuyu Eye Unit (18.5%), Kenyatta National Hospital (12.1%) and private clinics (10.9%) as their health facilities of choice for eye care. The rest preferred Lions Sight First Eye Hospital, St Mary's Hospital, City Council Health Centers and optical shops. 7.7% of the subjects would visit a health centre or dispensary if they had an eye problem. A signifi cant proportion of respondents (7.5%) had no idea where they could seek treatment for eye disorders; most of them knew Mbagathi District Hospital and Kenyatta National Hospital but were not aware that eye care services were available at these facilities. CONCLUSION: Despite the large number of eye care facilities surrounding the NCES, community members are not able to access their services mainly because of lack of felt need (ignorance) and lack of money (poverty). RECOMMENDATIONS: There is need for eye health education and review of cost of services to the very poor communities within the NCES. It is important to strengthen the community eye care structures and referral network now that the project area has excess secondary and tertiary health facilities offering eye care services.

OBJECTIVE: To determine the barriers to uptake of eye care services and to establish the pattern of utilization of eye care services in the Nairobi Comprehensive Eye Care Services (NCES) Project; the catchment area of the Mbagathi District Eye Unit of Nairobi. DESIGN: Community based survey conducted from 15th to 31st October 2007. Setting: Kibera and Dagoreti divisions of Nairobi City. SUBJECTS: Of the 4,200 people of all ages who were randomly selected; 4,056 were examined giving a response rate of 96.6%. Of those not examined, 126 (3.0%) were not available and 15 (0.4%) refused to be examined. Mean age of the study population was 22 years. RESULTS: A total of 294 subjects (7.2%) despite having some ocular disorder, had not visited any health facility to seek treatment. The majority, 144 (49%) gave the reason as no perceived need to seek treatment as the problem did not bother them; especially those with refractive error. A third, 97 (33%), gave the reason as lack of money, 22 (7.5%) said that they did not know where to seek eye care and 20 (6.8%) said they had no time to seek eye care. Only 3 said that the health facility where to go for eye care was too far. The population in the survey area has vast number of nearby secondary and tertiary eye care facilities to choose from. The majority of subjects indicated Mbagathi District Hospital (20.9%), Kikuyu Eye Unit (18.5%), Kenyatta National Hospital (12.1%) and private clinics (10.9%) as their health facilities of choice for eye care. The rest preferred Lions Sight First Eye Hospital, St Mary's Hospital, City Council Health Centers and optical shops. 7.7% of the subjects would visit a health centre or dispensary if they had an eye problem. A signifi cant proportion of respondents (7.5%) had no idea where they could seek treatment for eye disorders; most of them knew Mbagathi District Hospital and Kenyatta National Hospital but were not aware that eye care services were available at these facilities. CONCLUSION: Despite the large number of eye care facilities surrounding the NCES, community members are not able to access their services mainly because of lack of felt need (ignorance) and lack of money (poverty). RECOMMENDATIONS: There is need for eye health education and review of cost of services to the very poor communities within the NCES. It is important to strengthen the community eye care structures and referral network now that the project area has excess secondary and tertiary health facilities offering eye care services.

OBJECTIVE: To determine the barriers to uptake of eye care services and to establish the pattern of utilization of eye care services in the Nairobi Comprehensive Eye Care Services (NCES) Project; the catchment area of the Mbagathi District Eye Unit of Nairobi. DESIGN: Community based survey conducted from 15th to 31st October 2007. Setting: Kibera and Dagoreti divisions of Nairobi City. SUBJECTS: Of the 4,200 people of all ages who were randomly selected; 4,056 were examined giving a response rate of 96.6%. Of those not examined, 126 (3.0%) were not available and 15 (0.4%) refused to be examined. Mean age of the study population was 22 years. RESULTS: A total of 294 subjects (7.2%) despite having some ocular disorder, had not visited any health facility to seek treatment. The majority, 144 (49%) gave the reason as no perceived need to seek treatment as the problem did not bother them; especially those with refractive error. A third, 97 (33%), gave the reason as lack of money, 22 (7.5%) said that they did not know where to seek eye care and 20 (6.8%) said they had no time to seek eye care. Only 3 said that the health facility where to go for eye care was too far. The population in the survey area has vast number of nearby secondary and tertiary eye care facilities to choose from. The majority of subjects indicated Mbagathi District Hospital (20.9%), Kikuyu Eye Unit (18.5%), Kenyatta National Hospital (12.1%) and private clinics (10.9%) as their health facilities of choice for eye care. The rest preferred Lions Sight First Eye Hospital, St Mary's Hospital, City Council Health Centers and optical shops. 7.7% of the subjects would visit a health centre or dispensary if they had an eye problem. A signifi cant proportion of respondents (7.5%) had no idea where they could seek treatment for eye disorders; most of them knew Mbagathi District Hospital and Kenyatta National Hospital but were not aware that eye care services were available at these facilities. CONCLUSION: Despite the large number of eye care facilities surrounding the NCES, community members are not able to access their services mainly because of lack of felt need (ignorance) and lack of money (poverty). RECOMMENDATIONS: There is need for eye health education and review of cost of services to the very poor communities within the NCES. It is important to strengthen the community eye care structures and referral network now that the project area has excess secondary and tertiary health facilities offering eye care services.

OBJECTIVE: To determine the barriers to uptake of eye care services and to establish the pattern of utilization of eye care services in the Nairobi Comprehensive Eye Care Services (NCES) Project; the catchment area of the Mbagathi District Eye Unit of Nairobi. DESIGN: Community based survey conducted from 15th to 31st October 2007. Setting: Kibera and Dagoreti divisions of Nairobi City. SUBJECTS: Of the 4,200 people of all ages who were randomly selected; 4,056 were examined giving a response rate of 96.6%. Of those not examined, 126 (3.0%) were not available and 15 (0.4%) refused to be examined. Mean age of the study population was 22 years. RESULTS: A total of 294 subjects (7.2%) despite having some ocular disorder, had not visited any health facility to seek treatment. The majority, 144 (49%) gave the reason as no perceived need to seek treatment as the problem did not bother them; especially those with refractive error. A third, 97 (33%), gave the reason as lack of money, 22 (7.5%) said that they did not know where to seek eye care and 20 (6.8%) said they had no time to seek eye care. Only 3 said that the health facility where to go for eye care was too far. The population in the survey area has vast number of nearby secondary and tertiary eye care facilities to choose from. The majority of subjects indicated Mbagathi District Hospital (20.9%), Kikuyu Eye Unit (18.5%), Kenyatta National Hospital (12.1%) and private clinics (10.9%) as their health facilities of choice for eye care. The rest preferred Lions Sight First Eye Hospital, St Mary's Hospital, City Council Health Centers and optical shops. 7.7% of the subjects would visit a health centre or dispensary if they had an eye problem. A signifi cant proportion of respondents (7.5%) had no idea where they could seek treatment for eye disorders; most of them knew Mbagathi District Hospital and Kenyatta National Hospital but were not aware that eye care services were available at these facilities. CONCLUSION: Despite the large number of eye care facilities surrounding the NCES, community members are not able to access their services mainly because of lack of felt need (ignorance) and lack of money (poverty). RECOMMENDATIONS: There is need for eye health education and review of cost of services to the very poor communities within the NCES. It is important to strengthen the community eye care structures and referral network now that the project area has excess secondary and tertiary health facilities offering eye care services.

Objective: To establish ocular fi ndings in Kenyan children with HIV/AIDS. Design: Hospital-based cross sectional study .

Setting: Mbagathi District Hospital (Nairobi) MSF-Belgium HIV clinic support center and paediatric ward.

Subjects: HIV infected children.

Results: A total of 208 HIV infected children were examined. The overall prevalence of ocular fi ndings was 67.3% (140 patients). 113 patients (54.3%) of the patients were on ARV therapy. The most common finding was adnexal lesions observed in 40.9% of the patients, followed by posterior segment findings in 31.3%. Conjunctival microvasculopathy (30 patients,14.4%), allergic conjunctivitis (27 patients, 13.0%) and molluscum contagiosum 12 patients, 5.8%) were the main adnexal findings. Five cases (2.4%) of infectious conjunctivitis, 4 cases (1.9%) of herpes zoster ophthalmicus (HZO) and conjunctival growth were also recorded. Keratoconjunctivitis (6 patients, 2.9%), anterior uveitis (6 patients, 2.9%), and corneal ulcer (3 patients, 1.4%) were the main anterior segment findings. Peripheral retinal perivasculitis (28 patients, 13.5%) was the commonest posterior segment finding, followed by cotton wool spots (18 patients, 8.7%) and presumed retinal pigment epitheliopathy (18 patients, 8.7%) . Two cases of white retinal infiltrate associated with frosted branch vasculitis and 2 cases of focal retinal haemorrhages were also observed. Tuberculosis was the major systemic finding (93 patients, 44.7%). This study found that ocular findings are directly related to the duration of exposure to HIV infection (age), to the severity of clinical state of the disease (WHO clinical staging)and to the severity of immune suppression (CD4 count).

Conclusion: The results of this study suggest a high prevalence of ocular findings in Kenyan children with HIV/AIDS. Retinal perivasculitis was the commonest retinal finding observed. Further studies are needed to investigate the unusual fi ndings of retinal pigment epitheliopathy observed in this study.

Objective: To determine the prevalence and pattern of eye diseases and visual

impairment in the Nairobi Comprehensive Eye Care Services (NCES) Project; the

catchment area of the Mbagathi District Eye Unit of Nairobi.

Design: Community based survey conducted from October 15th to 31st 2007

Setting: Kibera and Dagoreti divisions of Nairobi City

Subjects: 4200 people of all ages were randomly selected; 4056 were examined

(96.6% response rate). 122 (2.9%) were not available and 15 (0.4%) declined

to be examined.

Results: Females: 54.2%, Males: 45.8%. Mean age; 22.4 years, SD; 16.5. Only

241(5.9%) aged >50years old. The leading eye disorders in Kibera and Dagoretti

divisions are conjunctival disorders including allergic conjunctivitis and conjunctival

growths. This was found to affect 7.6% of the subjects. This was followed by

refractive errors found in 5.3% of the subjects. Cataract was found in 30 subjects

(0.7%). Disorders of the retina and the optic nerve were found in 1.1% of the

subjects and corneal disorders in 0.5%. The prevalence of visual impairment was

0.6%, severe visual impairment was 0.05% and blindness was 0.1%. This indicates

that most of the ocular disorders encountered were not visually threatening. The

main cause of visual impairment is refractive errors and the causes of severe visual

impairment and blindness are cataract, corneal opacity and glaucoma.

Conclusion: The population of the NCES is relatively young and the prevalence of

blindness and visual impairment is low. The main cause of visual impairment was

refractive errors and the causes of severe visual impairment and blindness were

cataract, corneal opacity and glaucoma.

Recommendations: The level of blindness in NCES is low and the project should

focus more on rendering eye care and not treatment of blindness. There is need to

address the issue of refractive errors as this was one of the main ocular problems

encountered. In this survey, it was not possible to perform detailed refraction and

hence it was recommend that a refractive error survey be conducted; especially

in school going children.

Objective: To determine the changing of drug sensitivity patterns for s. aureas
as the second commonest bacteria of the conjunctival normal fl ora in Nairobi,
Kenya

Design: Descriptive retrospective study

Setting: University of Nairobi, Department of Ophthalmology and Kikuyu Eye Unit
Subjects: 37 (28%) asymptomatic volunteers at KNH and KEU with no signs of
ocular infections or ocular surface abnormalities from January 1994 to December
1997 were selected.

Results: A total of 37 cases were tested positive for S. aureus. The micro
organism showed high resistance to amoxtcillin, aminoglycosides, 1st and 2nd
generation Flouroquinolones except Ofl oxacin and tetracycline. It was sensitive
to carbenocillin, polymyxin B and chloramphenocol and highly sensitive to
Cephalexin and ciprofl oxacin.

Conclusion: The percentage of positive fi nding of S. aureus of the conjunctival
normal flora is comparable to that in other regions of the world. We found a high
resistance to most of the commonly locally prescribed antibiotics.

Objectives: To determine visual outcome, intraoperative and postoperative
complications due to childhood cataract surgery at Kenyatta National Hospital
(KNH).

Design: Retrospective study.

Setting: Kenyatta National Hospital (KNH)

Subjects: Records of 77 children with cataracts seen in KNH between 1995 and
2005 were reviewed; 8 patients were excluded. A total of 121 eyes analyzed
from 58 children with bilateral and 11 with unilateral cataracts. Information of
up to 6 months post-op was analyzed.

Results: The mean duration between the time when cataract was fi rst noted and
presentation at KNH was 6.4 months for congenital cataract and 35.7 months for
developmental cataract. In 28 eyes, primary IOL implantation was performed,
17 eyes had secondary IOL implantation and 76 eyes remained aphakic. There
was some improvement in visual acuity at 2 months after surgery compared
to the visual acuity at presentation (p<0.001). However, there was no further
improvement in visual acuity at 4 and 6 months after surgery (p=0.213 and
0.238 respectively). The main complications at 2, 4 and 6 months after surgery
were posterior capsular opacifi cation and updrawn pupil. PCO occurred in 41.4%
of the operated eyes; mainly in patients who had lens washout without anterior
vitrectomy.

Conclusion: The outcome of childhood cataract surgery at KNH was poor despite
low rate of complications occurring during surgery. The poor outcome was
attributed to late presentation, poor aphakic correction, development of PCO
and loss to follow up.

Objective: To determine whether prolonged labour increased the rate of exposure
of the newborn eyes to maternal vaginal fl ora, and whether this exposure led to
higher risk of developing neonatal conjunctivitis.

Study design: cohort study

Settings: Kenyatta National hospital and Pumwani Maternity Hospital in Kenya
between August 2000 and March 2001.

Subjects: Fifty four cases of prolonged labour (PL) and 55 cases of controls
were studied. Conjunctival swabs were taken from all the newborns and high
vaginal swabs taken from every second mother. A case pair consisted of such
a pair where samples were taken from both the mother and her baby. 23 case
pairs of PL and 19 of controls were studied. This was done on average 24hrs
after delivery.

Results: Conjunctival swabs were positive in 63% of the prolonged labour (PL)
group compared to 51% of the control group (odds ratio 1.9; p-value 0.09). The
rate of transmission of vaginal fl ora to the eyes of the newborns was 57% in the
PL group compared to 40% in the controls (odds ratio 1.95; p value 0.27). The
longer, from birth, it took before taking the conjunctival swabs from the baby,
the higher was the likelihood of obtaining a positive culture (p-value 0.017 MW
test). The longer the duration of labour in the PL group, the higher the rate of
development of conjunctivitis (p-value 0.029 MW test). Staphylococcal aureus,
Staphylococcal epidermidis and E.coli were the three most common organisms
isolated in both groups.

Conclusion: Prolonged labour increased the rate of transmission of maternal
vaginal flora to the eyes of the newborns and to subsequent development of
neonatal conjunctivitis.

vTo establish the prevalence and pattern of ocular disorders in psychiatric patients admitted in Mathari Hospital. Design: Hospital based cross sectional study. Setting: Mathari Hospital wards from November 2006 to February 2007. Subjects: Three hundred patients admitted in Mathari Hospital wards that scored >22 marks on the mini mental state exam (MMSE) and gave consent. Results: A total of 300 patients were seen. The prevalence of ocular disorders in this group of patients was 41.3%. The commonest disorders were lens and corneal deposits which contributed 42.7%, refractive errors 25.8%, cataracts 5.6%, glaucoma 4.8%, while other conditions contributed 21.1%. There were no reported cases of self-infl icted ocular injuries. Fifty four patients had ocular side effects commonly associated with antipsychotic drugs (lens and corneal deposits and retinal pigmentary changes) and hence the prevalence of ocular side effects of antipsychotic drugs was 18%. Conclusions: There is a relatively high prevalence of ocular disorders in this group of patients (41.3%). The prevalence of ocular side effects for antipsychotic drugs was relatively high at 18%.

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OBJECTIVES: To estimate the prevalence of active trachoma (TF) in children aged one to nine years and potentially blinding trachoma (TT) in adults aged 15 years and older in six known trachoma-endemic districts in Kenya. DESIGN: Community based survey. SETTING: Six known trachoma endemic districts in Kenya (Samburu, Narok, West Pokot, Kajiado Baringo and Meru North). SUBJECTS: A total of 6,982 children aged one to nine years and 8,045 adults aged 15 years and older were randomly selected in a two stage random cluster sampling method: Twenty sub-locations (clusters) per district and three villages per sub-location were randomly selected. Eligible children and adults were enumerated and examined for signs of trachoma. RESULTS: Blinding trachoma was found to be a public health problem in all the surveyed districts. Active trachoma was a district wide public health problem in four districts (Samburu, Narok, West Pokot and Kajiado) and only in some of the sub-locations of the other two (Baringo and Meru North). CONCLUSIONS: There is need for district trachoma control programmes preferably using the WHO recommended SAFE strategy in all the surveyed districts. Extrapolation of these survey results to the entire country could not be justified. There is need to survey the remaining 12 suspected endemic districts in Kenya.

Objectives: To assess the vision of PSV drivers operating in Nairobi city and to establish whether poor sight is associated with the occurrence of motor vehicle accidents. Design: Cross-sectional study Setting: Nairobi city bus and matatu (small vans and minibuses) terminuses. Subjects: 539 randomly selected PSV drivers. Results: Sixty eight percent of the drivers did not have their sight checked during driving test. Drivers with inadequate vision were more frequently involved in accidents than those with adequate vision but difference was not statistically significant (p=0.76). Drivers with cataracts were 3 times more likely to be involved in accidents than those without (p=0.007). Conclusions: Majority of PSV drivers do not undergo visual acuity testing before acquiring driving licenses. Recommendation: Visual acuity testing should be made mandatory when applying for and renewing driving licenses.

OBJECTIVES: To estimate the prevalence of active trachoma (TF) in children aged one to nine years and potentially blinding trachoma (TT) in adults aged 15 years and older in six known trachoma-endemic districts in Kenya. DESIGN: Community based survey. SETTING: Six known trachoma endemic districts in Kenya (Samburu, Narok, West Pokot, Kajiado Baringo and Meru North). SUBJECTS: A total of 6,982 children aged one to nine years and 8,045 adults aged 15 years and older were randomly selected in a two stage random cluster sampling method: Twenty sub-locations (clusters) per district and three villages per sub-location were randomly selected. Eligible children and adults were enumerated and examined for signs of trachoma. RESULTS: Blinding trachoma was found to be a public health problem in all the surveyed districts. Active trachoma was a district wide public health problem in four districts (Samburu, Narok, West Pokot and Kajiado) and only in some of the sub-locations of the other two (Baringo and Meru North). CONCLUSIONS: There is need for district trachoma control programmes preferably using the WHO recommended SAFE strategy in all the surveyed districts. Extrapolation of these survey results to the entire country could not be justified. There is need to survey the remaining 12 suspected endemic districts in Kenya.

OBJECTIVES: To estimate the prevalence of active trachoma (TF) in children aged one to nine years and potentially blinding trachoma (TT) in adults aged 15 years and older in six known trachoma-endemic districts in Kenya. DESIGN: Community based survey. SETTING: Six known trachoma endemic districts in Kenya (Samburu, Narok, West Pokot, Kajiado Baringo and Meru North). SUBJECTS: A total of 6,982 children aged one to nine years and 8,045 adults aged 15 years and older were randomly selected in a two stage random cluster sampling method: Twenty sub-locations (clusters) per district and three villages per sub-location were randomly selected. Eligible children and adults were enumerated and examined for signs of trachoma. RESULTS: Blinding trachoma was found to be a public health problem in all the surveyed districts. Active trachoma was a district wide public health problem in four districts (Samburu, Narok, West Pokot and Kajiado) and only in some of the sub-locations of the other two (Baringo and Meru North). CONCLUSIONS: There is need for district trachoma control programmes preferably using the WHO recommended SAFE strategy in all the surveyed districts. Extrapolation of these survey results to the entire country could not be justified. There is need to survey the remaining 12 suspected endemic districts in Kenya.

OBJECTIVES: To estimate the prevalence of active trachoma (TF) in children aged one to nine years and potentially blinding trachoma (TT) in adults aged 15 years and older in six known trachoma-endemic districts in Kenya. DESIGN: Community based survey. SETTING: Six known trachoma endemic districts in Kenya (Samburu, Narok, West Pokot, Kajiado Baringo and Meru North). SUBJECTS: A total of 6,982 children aged one to nine years and 8,045 adults aged 15 years and older were randomly selected in a two stage random cluster sampling method: Twenty sub-locations (clusters) per district and three villages per sub-location were randomly selected. Eligible children and adults were enumerated and examined for signs of trachoma. RESULTS: Blinding trachoma was found to be a public health problem in all the surveyed districts. Active trachoma was a district wide public health problem in four districts (Samburu, Narok, West Pokot and Kajiado) and only in some of the sub-locations of the other two (Baringo and Meru North). CONCLUSIONS: There is need for district trachoma control programmes preferably using the WHO recommended SAFE strategy in all the surveyed districts. Extrapolation of these survey results to the entire country could not be justified. There is need to survey the remaining 12 suspected endemic districts in Kenya.

OBJECTIVES: To estimate the prevalence of active trachoma (TF) in children aged one to nine years and potentially blinding trachoma (TT) in adults aged 15 years and older in six known trachoma-endemic districts in Kenya. DESIGN: Community based survey. SETTING: Six known trachoma endemic districts in Kenya (Samburu, Narok, West Pokot, Kajiado Baringo and Meru North). SUBJECTS: A total of 6,982 children aged one to nine years and 8,045 adults aged 15 years and older were randomly selected in a two stage random cluster sampling method: Twenty sub-locations (clusters) per district and three villages per sub-location were randomly selected. Eligible children and adults were enumerated and examined for signs of trachoma. RESULTS: Blinding trachoma was found to be a public health problem in all the surveyed districts. Active trachoma was a district wide public health problem in four districts (Samburu, Narok, West Pokot and Kajiado) and only in some of the sub-locations of the other two (Baringo and Meru North). CONCLUSIONS: There is need for district trachoma control programmes preferably using the WHO recommended SAFE strategy in all the surveyed districts. Extrapolation of these survey results to the entire country could not be justified. There is need to survey the remaining 12 suspected endemic districts in Kenya.

OBJECTIVES: To estimate the prevalence of active trachoma (TF) in children aged one to nine years and potentially blinding trachoma (TT) in adults aged 15 years and older in six known trachoma-endemic districts in Kenya. DESIGN: Community based survey. SETTING: Six known trachoma endemic districts in Kenya (Samburu, Narok, West Pokot, Kajiado Baringo and Meru North). SUBJECTS: A total of 6,982 children aged one to nine years and 8,045 adults aged 15 years and older were randomly selected in a two stage random cluster sampling method: Twenty sub-locations (clusters) per district and three villages per sub-location were randomly selected. Eligible children and adults were enumerated and examined for signs of trachoma. RESULTS: Blinding trachoma was found to be a public health problem in all the surveyed districts. Active trachoma was a district wide public health problem in four districts (Samburu, Narok, West Pokot and Kajiado) and only in some of the sub-locations of the other two (Baringo and Meru North). CONCLUSIONS: There is need for district trachoma control programmes preferably using the WHO recommended SAFE strategy in all the surveyed districts. Extrapolation of these survey results to the entire country could not be justified. There is need to survey the remaining 12 suspected endemic districts in Kenya.