1.0 ABSTRACT

The uncorrected refractive error is a major public health concern and is the biggest cause of visual impairment in the world. Refractive errors can be easily corrected with spectacles. Lack of knowledge, erroneous attitude and practices, contribute significantly to the magnitude of uncorrected refractive errors
The objective of this study is to assess the prevalence and type of hyperopia
in urban public primary school students as well as their performance psycho-social development.

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1.1.0 INTRODUCTION

Hyperopia results when the eye has insufficient refractive power for its axial length. The term hypermetropia comes from hyper, meaning “in excess”; met, meaning “measure”; and opia, meaning “of the eye.”
This refractive error may be the result of an eye having a relatively short axial length or reduced dioptric power of one or more of the refractive element.
Hyperopia in children has been associated with poor reading ability, low intelligence test scores, learning difficulties, and delay in visual perceptual skills development.However, the reason for these associations is unclear.
Borish” listed a number of systems for classifying hyperopia:
• Anatomical features • Degree of hyperopia • Physiological and pathological hyperopias • Action of accommodation
The prevalence of hyperopia in children appears to decrease during younger school-age years and then stabilize during adolescence.

2.0 SCOPE OF RESEARCH

The purpose of this study is to assess the prevalence and type of hyperopia in public primary school pupils and gender variation as well as the effects on their performance and psycho-social development. The study will be carried out in Kakamega Primary School located near Kakamega town, Lurambi constituency in Kakamega County.
The study will be carried out to find out the prevalence of hyperopia among the students. The methods that will be used include crossectional study with a mixed method approach.

3.0 RESEARCH PROBLEM STATEMENT

What is the extent of hyperopia in school going, children

4.0 KEY RESEARCH QUESTIONS

Does hyperopia affect performance

Does hyperopia affect the psycho-social development of children

Does gender influence hyperopia prevalence

5.0 AIM

To determine the prevalence of hyperopia in pupils of Kakamega primary in relation to quality of performance

6.0 OBJECTIVES

BROAD
To evaluate behavioural patterns of children with hyperopia
To study the effects of hyperopia on class performance

SPECIFIC
To determine the prevalence of hyperopia in students of Kakamega primary school

7.0 REVIEW OF RELATED LITERATURE

The global prevalence of refractive errors has been estimated from 800 million to 2.3 billion 1. In Kenya, the prevalence of refractive errors among primary school children (12-15years) in urban and rural areas has been found to be 11% 2 and 5.2% 3 respectively. In urban Kenya, myopia was found to be the most prevalent refractive error, with a prevalence of 10.2%, followed by hypermetropia at 0.3% and lastly astigmatism at 0.5% 2.
On the contrary, hypermetropia was the most prevalent refractive error at 3.2% then myopia at 1.7% and astigmatism at 0.3% 3. A survey of the prevalence of refractive errors among children aged 6-9 years in Kampala, Uganda by Kawuma et al found the prevalence of refractive error to be 11.6 percent 3.
These studies give as the prevalence of refractive error in two different age groups that is 6-9years and 12-15 years. The studies were done over ten years ago and literature is lacking in our set up on recent studies. In East Africa, data are also lacking in children who are seventeen years and above, in which case emmetropisation has occurred 4 and this study was able to address these some of these discrepancies in data.
‘In the African population, a recent study conducted in northwest Ethiopia aimed to determine the prevalence of refractive error among 420 students aged 7 to 15 in the Debre Markos District, since the rates of refractive errors had not been previously examined in this region.
Snellen charts were used to identify the student’s visual acuity or auto refraction in those subjects whose visual acuity was worse than 6/12. Hyperopia was present in 1.4% of cases, although the magnitude of the error was not specified. Female sex was significantly associated with refractive error.
In Ghana, a cross sectional study was carried out to determine the rates of hyperopia in public basic schools in Kumasi. A total of 1,756 subjects were randomly selected from 11 public schools. The hyperopia prevalence rate was determined to be 33.4%. Of those subjects diagnosed with being hyperopic, 64.7% had a magnitude with aspherical equivalent lower than +1.50D, 29.2% between +1.00D and + 1.50D and the remaining 6.1% had a magnitude greater than +1.50D. Among all hyperopes, 45.9% were males and 54.1% females.
A different study in Ghana, in which 2454 children from 53 private schools were enrolled, reported that hyperopia SER >2.00D in at least one eye as measured by retinoscopy and autorefraction was found in o.3% of children.
In South Africa, a sample of 4,890 children aged 5 to 15 in Durban area was examined by means of retinoscopy and autorefraction under cycloplegia. Hyperopia SER> +2.00D in at least one eye was present in 1.8% of children when measured with retinoscopy, slightly increasing to 2.6% when the method used was autorefraction under cycloplegia.6′

8.0 CONCEPTUAL FRAMEWORK
The study will be carried out to find out the prevalence of hyperopia among the students.The general effects on performance in both boys and girls and variation.the expected study should last for 3 weeks.

9.0 RESEARCH METHODS AND MATERIALS

Study Design and Study Population: Cross-sectional school-based study with a qualitative component in at least 400 public primary school pupils of Kakamega County, Kenya.

Data collection Procedure: The pupils should be selected by multistage random sampling and those included in each class category should be based on the proportion of students in each stratification. All class 1 and 7 pupils selected should participate in the study. These classes represent an age group of 5 to 15 years.
First, a semi-structured questionnaire will be administered to the pupils followed by an eye examination that consists of visual acuity using a Log MAR chart. The cut off for defining significant refractive error is VA less than 6/12 in the better eye. For those whose vision will be less than 6/12 in the better eye, a dry objective refraction will be performed followed by subjective refraction. Pupils with spectacles are to be tested for uncorrected and corrected VA.

The power of spectacles is read using the lensometer. For those wearing spectacles and VA worse than 6/12 in the better eye with correction, objective then subjection refraction is to be done. If VA does not improve by at least two lines in all pupils anterior and posterior examination is to be performed to determine the cause. The pupils will then participate in Focus Group Discussion of 8-12 students and in-depth interviews with key informants (class or head teacher). The information gathered is to be recorded in a questionnaire or a tape recorder.

Data Analysis
Graphs, tables and charts will be used to analyse means and proportions. Chi-square test is to be used to compare means and proportions.

9.1.STUDY INCLUSION AND EXCLUSION CRITERIA
All class 1 and 7 pupils that will be selected will be included in the study.

9.1.1.MATERIALS REQUIRED
1. Two Retinoscopes- for refraction.
2. Two Ophthalmoscopes (direct and indirect) – For anterior and posterior segment
examination.
3. Two 20 Diopter loupe- For anterior and posterior segment examination.
4. Torches with batteries and spare bulbs- for anterior segment examination
5. 3 LogMAR charts – for visual acuity assessment
6. Refraction set and trial frames – for refraction
7. Lensometer – measuring the power of spectacles
8. Blinders( curtains)
9. Data collection forms – Questionnaires
10. Stationary- referral papers, data collection forms, pencils, pens, staplers etc.
11. The vehicle for hire and fuel
12. Tape recorder
13. Photograph

9.2.0ETHICAL CONSIDERATIONS

1.Permission from the head teacher of school is to be obtained
2. Assent from the students is to be sort and obtained.
3. Confidentially of students records is to be observed.
4.Spectacle correction and follow up is recommended for all the students found to have a refractive error.
5. Students with other ocular diseases will be referred to local eye hospitals.

10.0.EXPECTED RELEVANCE

a)We hope that by the end of the study we will be able to know if the presence of hyperopia affects the pupils’ academics and their psycho-social behaviour.
b)We hope to provide more detailed data to Public Health Institutions in Kenya
c)We hope to find out the prevalence of hyperopia
d)We hope to raise awareness of hyperopia

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