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      Demographic factors associated with myopia knowledge, attitude and preventive practices among adults in Ghana: a population-based cross-sectional survey

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          Abstract

          Purpose

          Knowledge, positive attitude and good preventive practices are keys to successful myopia control, but information on these is lacking in Africa. This study determined the KAP on myopia in Ghana.

          Methods

          This was a population-based cross-sectional survey conducted among adults (aged 18 years and older) living across 16 regions of Ghana between May and October 2021. Data on socio-demographic factors (sex, age, gender, level of education, working status, type of employment, monthly income, and region of residence), respondents’ awareness, and knowledge, attitude and preventive practices (KAP) about myopia were collected. Composite and mean scores were calculated from eleven knowledge (total score = 61), eight attitude (48), and nine preventive practice items (33). Differences in mean scores were assessed using one-way analysis of variance (ANOVA) and standardized coefficients (β) with 95% confidence intervals (CI), using multiple linear regression to determine the associations between the dependent (KAP) and demographic variables.

          Results

          Of the 1,919 participants, mean age was 37.4 ± 13.4 years, 42.3% were aged 18–30 years, 52.6% were men, 55.8% had completed tertiary education, and 49.2% had either heard about myopia, or accurately defined myopia as short sightedness. The mean KAP scores were 22.9 ± 23.7, 33.9 ± 5.4, and 22.3 ± 2.8, respectively and varied significantly with many of the demographic variables particularly with age group, region, marital status, and type of employment. Multiple linear regression analyses revealed significant associations between region of residence and knowledge (β =—0.54, 95%CI:-0.87, -0.23, p < 0.001), attitude (β =—0.24, 95%CI:-0.35,-0.14, p < 0.001) and preventive practices (β = 0.07, 95%CI: 0.01, 0.12, p = 0.015). Preventive practices were also associated with type of employment (self-employed vs employee: β = 0.25, 95%CI: 0.15, 4.91, p < 0.05). Knowledge scores were significantly higher in those who lived in the Greater Accra (39.5 ± 18.5) and Eastern regions (39.1 ± 17.5) and lower among those who lived in the Upper West region (6.4 ± 15.6). Government employees and those with tertiary education had significantly higher mean knowledge scores compared with non-government employees (β = 4.56, 95%CI 1.22, 7.89, p = 0.007), and those with primary/no education (β = 18.35, 95%CI: 14.42, 22.27, p < 0.001).

          Conclusion

          Ghanaian participants had adequate knowledge of myopia but showed poor attitude and low preventive practices, which varied significantly between regions and were modified by socio-demographic factors. Further research into how education can be used to stimulate Ghanaians’ engagement in preventive practices is needed.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12889-023-16587-7.

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          Most cited references40

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          Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050.

          Myopia is a common cause of vision loss, with uncorrected myopia the leading cause of distance vision impairment globally. Individual studies show variations in the prevalence of myopia and high myopia between regions and ethnic groups, and there continues to be uncertainty regarding increasing prevalence of myopia.
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            Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study

            Pawar (2020)
            Summary Background Many causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error. Methods We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (<3/60 or less than 10° visual field around central fixation) by cause, age, region, and year. Because of data sparsity at younger ages, our analysis focused on adults aged 50 years and older. Findings Global crude prevalence of avoidable vision impairment and blindness in adults aged 50 years and older did not change between 2010 and 2019 (percentage change −0·2% [95% UI −1·5 to 1·0]; 2019 prevalence 9·58 cases per 1000 people [95% IU 8·51 to 10·8], 2010 prevalence 96·0 cases per 1000 people [86·0 to 107·0]). Age-standardised prevalence of avoidable blindness decreased by −15·4% [–16·8 to −14·3], while avoidable MSVI showed no change (0·5% [–0·8 to 1·6]). However, the number of cases increased for both avoidable blindness (10·8% [8·9 to 12·4]) and MSVI (31·5% [30·0 to 33·1]). The leading global causes of blindness in those aged 50 years and older in 2020 were cataract (15·2 million cases [9% IU 12·7–18·0]), followed by glaucoma (3·6 million cases [2·8–4·4]), undercorrected refractive error (2·3 million cases [1·8–2·8]), age-related macular degeneration (1·8 million cases [1·3–2·4]), and diabetic retinopathy (0·86 million cases [0·59–1·23]). Leading causes of MSVI were undercorrected refractive error (86·1 million cases [74·2–101·0]) and cataract (78·8 million cases [67·2–91·4]). Interpretation Results suggest eye care services contributed to the observed reduction of age-standardised rates of avoidable blindness but not of MSVI, and that the target in an ageing global population was not reached. Funding Brien Holden Vision Institute, Fondation Théa, The Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg.
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              The epidemics of myopia: Aetiology and prevention.

              There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80-90%, and an accompanying high prevalence of high myopia in young adults (10-20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epidemics are linked, since the increasingly early onset of myopia, combined with high progression rates, naturally generates an epidemic of high myopia, with high prevalences of "acquired" high myopia appearing around the age of 11-13. The major risk factors identified are intensive education, and limited time outdoors. The localization of the epidemic appears to be due to the high educational pressures and limited time outdoors in the region, rather than to genetically elevated sensitivity to these factors. Causality has been demonstrated in the case of time outdoors through randomized clinical trials in which increased time outdoors in schools has prevented the onset of myopia. In the case of educational pressures, evidence of causality comes from the high prevalence of myopia and high myopia in Jewish boys attending Orthodox schools in Israel compared to their sisters attending religious schools, and boys and girls attending secular schools. Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge. Reforms to the organization of school systems to reduce intense early competition for accelerated learning pathways may also be important.
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                Author and article information

                Contributors
                l.osuagwu@westernsydney.edu.au , l.osuagwu@westernsyndey.edu.au
                socansey2@ucc.edu.gh
                drndep@gmail.com
                sylvester.kyeremeh@knust.edu.gh
                godwin.ovenseri-ogbomo@uhi.ac.uk
                bekpenyong@unical.edu.ng
                k.agho@westernsydney.edu.au
                Kureu@yahoo.com
                mashigek@ukzn.ac.za
                kelechi.ogbuehi@otago.ac.nz
                ta.rasengane@gmail.com
                nanadark2005@gmail.com
                kovinn@gmail.com
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                4 September 2023
                4 September 2023
                2023
                : 23
                : 1712
                Affiliations
                [1 ]GRID grid.1029.a, ISNI 0000 0000 9939 5719, Bathurst Rural Clinical School (BRCS), School of Medicine, , Western Sydney University, ; PO Box 9008, Bathurst, NSW 2795 Australia
                [2 ]GRID grid.16463.36, ISNI 0000 0001 0723 4123, African Vision Research Institute, Discipline of Optometry, , University of KwaZulu-Natal, ; Westville Campus, Durban, 3629 South Africa
                [3 ]GRID grid.413081.f, ISNI 0000 0001 2322 8567, Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, , University of Cape Coast, ; Cape Coast, Ghana
                [4 ]GRID grid.413097.8, ISNI 0000 0001 0291 6387, Health Education & Health Promotion Unit, Department of Public Health, Faculty of Allied Medical Sciences, College of Medical Sciences, , University of Calabar, ; Calabar, Cross River State Nigeria
                [5 ]GRID grid.9829.a, ISNI 0000000109466120, Department of Optometry and Visual Science, College of Science, , Kwame Nkrumah University of Science & Technology (KNUST), ; Kumasi, Ghana
                [6 ]GRID grid.23378.3d, ISNI 0000 0001 2189 1357, Department of Optometry, Centre for Health Sciences, , University of the Highlands and Islands, ; Inverness, IV2 3JH UK
                [7 ]GRID grid.413097.8, ISNI 0000 0001 0291 6387, Epidemiology and Biostatistics Unit, Department of Public Health, , University of Calabar, ; Calabar, Nigeria
                [8 ]GRID grid.1029.a, ISNI 0000 0000 9939 5719, School of Health Sciences, , Western Sydney University, ; Campbelltown, NSW 2560 Australia
                [9 ]Roberts Eyecare Associates, Vestal, NY USA
                [10 ]GRID grid.29980.3a, ISNI 0000 0004 1936 7830, Department of Medicine, Dunedin School of Medicine, , University of Otago, ; Dunedin, New Zealand
                [11 ]GRID grid.412219.d, ISNI 0000 0001 2284 638X, Department of Optometry, , University of the Free State and Universitas Hospital, ; Bloemfontein, South Africa
                [12 ]Koforidua Regional Hospital, Koforidua, Eastern Region Ghana
                [13 ]GRID grid.1005.4, ISNI 0000 0004 4902 0432, School of Optometry and Vision Science, , University of New South Wales, ; Sydney, NSW Australia
                Article
                16587
                10.1186/s12889-023-16587-7
                10476336
                37667219
                850a4381-0b42-475e-88ba-55cbe109d3a0
                © BioMed Central Ltd., part of Springer Nature 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 4 September 2022
                : 22 August 2023
                Categories
                Research
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                © BioMed Central Ltd., part of Springer Nature 2023

                Public health
                myopia,knowledge,attitude,preventive practices,sub-saharan africa,ghana
                Public health
                myopia, knowledge, attitude, preventive practices, sub-saharan africa, ghana

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