ABSTRACT
To achieve the state of complete physical, mental and social well-being of
the population there is need to create awareness and stimulate actions
from the community to achieve health. However, there seems to be no
relationship between health practices and the information available on
people’s health in Anambra State. The central issue of this study is to
identify the factors responsible for the spread of glaucoma in Anambra
State by studying the records of adult patients in the three general
hospitals in Anambra State with functional eye clinics for the period
between 2002 and 2006 with appropriate research questions and
hypothesis formulated tot obtain data for the solution. The literature on
past studies on the factors influencing the incidence of glaucoma and its
management in Nigeria is reviewed. The Social Learning Theory and the
Health Belief Model (HBM) are used as the theoretical framework. The
study is designed as both a descriptive and a Cohort Survey seeking to
describe the distribution and incidence of glaucoma within Anambra
state of persons who experienced the same life event within 2002 to 2006.
The random sampling technique was used with the multi-stage sampling
procedure and the use of tables and percentages in data presentation.
The Chi squared (X2) was used in testing the hypotheses proposed.
Factors influencing the incidence of glaucoma among adult patients in
general hospitals in Anambra state between 2002 and 2006 based on
1446 patients and 200 questionnaires administered on general hospitals
staff included family history, increased 10P and others with a variable
incidence rate and an increased level of public awareness. The increase
in health education and eye examination centers are recommended and
the level of awareness of the glaucoma disease and its control is
recommended for more intense studies.
8
TABLE OF CONTENTS
Cover Page
Title Page – – – – – – – – – i
Approval Page – – – – – – – – ii
Certification Page – – – – – – – – iii
Dedication Page – – – – – – – – iv
Acknowledgement – – – – – – – – v
Abstract – – – – – – – – – vi
Table of Contents – – – – – – – – vii
List of Tables – – – – – – – – viii
CHAPTER ONE
INTRODUCTION – – – – – – – 1
Background of the Study – – – – – – – 1
Statement of the Problem – – – – – – – 4
Purpose of the Study – – – – – – – 5
Significance of the Study – – – – – – – 6
Scope of the Study – – – – – – – – 7
Research Questions – – – – – – – 7
Hypothesis of the Study – – – – – – – 8
9
CHAPTER TWO
REVIEW OF RELATED LITERATURE – – – – 9
The Concept of Glaucoma – – – – – – 9
Theoretical Framework of Analysis – – – – – 15
The Incidence of Glaucoma – – – – – – 17
Factors Influencing the Incidence of Glaucoma – – – 20
Prevention and Management of Glaucoma – – – – 23
Summary of the Review of Literature – – – – – 26
CHAPTER THREE
METHODOLOGY – – – – – – – 28
Research Deign – – – – – – – – 28
Area of Study – – – – – – – – 29
Population of the Study – – – – – – – 30
Sample and Sampling Technique – – – – – 31
Instrument for Data Collection – – – – – – 33
Validation and Reliability of the Instruments – – – – 33
Reliability of the Instruments – – – – – – 34
Method of Data Collection – – – – – – 34
Method of Data Analysis – – – – – – – 35
10
CHAPTER FOUR
PRESENTATION AND ANALYSIS OF DATA – – – 36
Testing of Hypothesis – – – – – – – 44
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATIONS
Discussion – – – – – – – – – 49
Conclusions — – – – – – – – – 52
Recommendations – – – – – – – – 53
Limitations of the Study – – – – – – – 54
References – – – – – – – – – 55
Appendix – – – – – – – – – 67
11
LIST OF TABLES
Table 1: Incidence of glaucoma among adult patients in general
hospitals, Awka, Enugwu-ukwu and Onitsha from 2002 – 2006.
,, 2: Incidence of glaucoma in relation to family history in
Anambra state from 2002 – 2006.
,, 3: Gender distribution of glaucoma patients in general
hospitals, Awka, Enugwu-ukwu and Onitsha from 2002 – 2006
,, 4: Factors Influencing the incidence of glaucoma among adult
patient attending the general hospitals, Awka, Enugwu-ukwu
and Onitsha from 2002 – 2006
,, 5: Number of glaucoma patients in relation to Gender and age
group from 2002 – 2006.
,, 6: Influence of health information on the incidence of
glaucoma in Anambra state.
,, 7: Level of awareness of glaucoma in Anambra state
,, 8: Theoretical frequencies of the incidence of glaucoma disease
among adult patients in Anambra state from 2002 – 2006
,, 9: Glaucoma patients in Anambra state in relation to gender
from 2002 – 2006
12
,, 10: Heredity and other factors influencing the incidence of
glaucoma in general hospitals, Awka, Enugwu-ukwu and
Onitsha from 2002 – 2006
,, 11: Contingency table for family history and regular eye
examination respondents
13
CHAPTER ONE
INTRODUCTION
Background to the Study
Millions of people living in Nigeria are cut off from the mainstream of
economic and social development due to heavy burden of diseases.
Among these diseases is glaucoma which is the result of too much
pressure in the eye. It is usually believed to begin after the age of 40
(forty) years and is a common cause of blindness (Mohammed, 2001).
Responsibility for health care in Nigeria is shared among the
constitutional tiers of government: federal, state and local. The local
governments are supposed to take care of the primary level (emphasizing
preventive Medicare), while state governments are responsible for the
secondary level (emphasizing curative Medicare), and the federal
government is in charge of the tertiary level of care (emphasizing referral
Medicare) to which teaching and specialist hospitals belong. This implies
that there are basically three health care levels in Nigeria: primary,
secondary and tertiary health care levels. (Anyanwu, Oyefusi, Oaikhegn,
& Dimowo 1997: 608).
14
In Nigeria, glaucoma constitutes a medical, public health and socioeconomic
problem. This is because Nigeria is found to be one of the most
endemic countries in the world, accounting for a sizeable proportion of
the global cases, with about 6.7 million patients with glaucoma
worldwide (WHO, 1992). The damaging and insidious nature of
glaucoma make it spread gradually without being noticed but causes
serious harm.
The Basic Health Service (BHS) scheme formed an important health
programme of the Third Development Plan (1975-1980) and Fourth
Development Plan (1981-1985) of the Federal Government. Under the
BHS the government intended to significantly improve the modern health
care system of the country within the framework of a three-tier national
comprehensive health care delivery system mentioned earlier. Record
achievement from the implementation of the BHS shows increases in
personnel and institutions. For example, the number of registered medical
practitioners in Nigeria rose from 10,399 in 1981 to 16,145 in 1987
(Mbanefo, Soyibo & Anyanwu) 1996.
However, the unsuccessful implementation of the BHS programme made
the federal government to embark on a new direction health care delivery
which makes Primary Health Care (PHC) the focus. There was need for
15
close involvement of the local governments, local communities, and
individuals in the implementation of the PHC in collaboration with the
other two tiers of government. Activities that formed part of the PHC
include: National Programme on Immunization (NPI), Campaign against
River blindness, Oral Rehydration Therapy (ORT), among others (FMH,
1988).
The incidence of glaucoma among adult patients refers to the rate of
occurrence of this disease. In epidemiology the interest is in the number
of new cases arising in a given period of time in a specified group of
people.
The American Academy of ophthalmology (1983) notes that an estimated
2 million people have been identified as having glaucoma. Of these
889,000 are visually impaired, 67,150 are legally blind and each year an
additional 5,500 people become blind from glaucoma. Equally, in 1997
glaucoma caused 36,000 hospital admission in America, 25 million office
visits and more than $440 million spent on direct health cost on
glaucoma.
16
It is from the implication of the data as given above and the fact that
glaucoma is one of the avoidable causes of blindness that the need to
maintain adequate and effective health care delivery system becomes
imperative. Therefore this study examines the factors responsible for the
occurrence of glaucoma among adult patients in Anambra state (2002-
2006).
Statement of the Problem
For Nigeria to achieve the state of complete physical, mental and social
well-being of the population there is need to create awareness and
stimulate actions from the community to achieve health. This can be
accomplished through an effective health education which according to
Onukwubiri (1994), bridges the gap between health information and
health practices. It is any combination of methods designed to facilitate
voluntary change of behaviours of individuals or groups to promote
health.
In Anambra state there seems to be no relationship between health
practices and the information available on people’s health. The researcher
observed during her clinical posting to Eye clinic at the General Hospital
Enugwu-ukwu that most adult glaucoma patients reported to the clinic
17
when their eye conditions had deteriorated. Furthermore, the adults
suffering from the disease are not aware of the disease occurrence.
The central focus of this study therefore borders on identifying the factors
responsible for the spread of glaucoma in Anambra State. In other words
what are those constraints to effective primary health care delivery and
health education in the state. This is done by studying the records of adult
patients in the three General Hospitals in Anambra State with functional
eye clinics for the period between 2002 – 2006.
Purpose of the Study
The broad purpose of the study is to examine the factors influencing the
incidence of glaucoma among adult patients (in general hospitals) in
Anambra state (2002 – 2006) and to highlight the problems resulting
from lack of information on factors influencing the incidence of
glaucoma.
The specific objectives of the study include:
1. To determine the incidence of glaucoma among adult patients in
Anambra state between 2002 – 2006.
2. To verify the incidence of glaucoma in relation to family history
in Anambra state between 2002 – 2006.
18
3. To identify the incidence of glaucoma in relation to gender in
Anambra state between 2002 to 2006.
4. To identify other factors influencing the incidence of glaucoma
in adult patients in Anambra state from 2002 – 2006.
5. To ascertain the number of people affected by glaucoma in
relation to age from 2002 – 2006.
6. To determine the relation between health information and
incidence of glaucoma in Anambra State, and
7. To examine the level of awareness of the glaucoma in Anambra
state.
Significance of the Study
The result of the study will be of immense benefit to health institutions,
community members, researchers and government. The study on the
factors influencing the incidence of glaucoma will give a preview of the
level of incidence for intervention strategic planning.
Furthermore, this research will help to create awareness of the disease to
the community members, as well as serve as related literature to other
researchers by providing a fore-knowledge of what is obtainable and
available on the ground as it concerns the area of study.
19
Scope of Study
The study is a determination of the factors influencing the incidence of
glaucoma in adult patients in Anambra state between 2002 and 2006. This
means that only available data on adult patients who visited the General
Hospital in Awka, Enugwu-ukwu and Onitsha are used for the study.
Another delimitation is that adults between the ages of 40 years and
above and studied as our interest is mostly on open angle glaucoma.
Research questions
1. What is the incidence of glaucoma among adult patients in
Anambra state between 2002 and 2006?
2. What is the incidence of glaucoma in relation to family history
in Anambra state from 2002 – 2006?
3. What is the incidence of glaucoma in relation to gender in
Anambra state from 2002 – 2006?
4. What other factors influence the incidence of glaucoma in adult
patients in Anambra state from 2002 – 2006?
5. What is the number of people affected by glaucoma in relation
to age from 2002 – 2006?
6. How does health information effect the incidence of glaucoma
in Anambra state?
7. What is the level of awareness of glaucoma in Anambra state?
20
Hypotheses of the Study
Ho1: There is no significant relationship between the incidence of
glaucoma disease among different age groups of the study from
2002 – 2006.
Ho2: There is no significant difference in the incidence of glaucoma
between males and females of the study group from 2002 – 2006.
Ho3: There is no significant difference in the incidence of glaucoma and
hereditary among the study group from 2002 – 2006.
Ho4: There is no significant relationship between health information and
the incidence of glaucoma in Anambra state.
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