“A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE OF THE PEOPLE AGED 40-70 YEARS REGARDING KNOWLEDGE AND AWARENESS OF GLAUCOMA IN SELECTED RURAL AREA OF TUMKUR WITH A
VIEW TO DEVELOP INFORMATION GUIDE SHEET.”
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
MR. JUGNU SHAH
COMMUNITY HEALTH NURSING
Akshaya College of Nursing,
Tumkur, Karnataka.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. Name of the Candidate : Mr. Jugnu Shah
And address M.Sc Nursing, 1st Year
Akshaya College of Nursing,
Tumkur, Karnataka.
2. Name of the Institution : Akshaya College of Nursing
3. Course of Study : M.Sc. Nursing 1st year,
And Subject COMMUNITY HEALTH NURSING
4. Date of Admission to :13/06/2011
Course
5. Title of the Topic : A descriptive study to assess the knowledge of the people aged 40-70 years regarding knowledge and awareness of glaucoma in selected rural area of tumkur with a view to develop Information guide sheet.”
6.INTRODUCTION
Glaucoma is a group of eye diseases that gradually steal sight without warning. In the early stages of the disease, there may be no symptoms. Experts estimate that half of the people affected by glaucoma may not know they have it.1Vision loss is caused by damage to the optic nerve. This nerve acts like an electric cable with over a million wires. It is responsible for carrying images from the eye to the brain. There is no cure for glaucoma—yet. However, medication or surgery can slow or prevent further vision loss. The appropriate treatment depends upon the type of glaucoma among other factors. Early detection is vital to stopping the progress of the disease.2
Glaucoma is a very misunderstood disease. Often, people don’t realize the severity or who is affected. Glaucoma can cause blindness if it is left untreated. And unfortunately approximately 10% of people with glaucoma who receive proper treatment still experience loss of vision.Glaucoma is not curable, and vision lost cannot be regained. With medication and/or surgery, it is possible to halt further loss of vision. Since glaucoma is a chronic condition, it must be monitored for life.2
The two main types of glaucoma are primary open angle glaucoma (POAG), and angle closure glaucoma. These are marked by an increase of intraocular pressure (IOP), or pressure inside the eye. When optic nerve damage has occurred despite a normal IOP, this is called normal tension glaucoma. Secondary glaucoma refers to any case in which another disease causes or contributes to increased eye pressure, resulting in optic nerve damage and vision loss. 3other forms of glaucoma are low-tension or normal-tension glaucoma, optic nerve damage and narrowed side vision occur in people with normal eye pressure. angle-closure glaucoma, the fluid at the front of the eye cannot reach the angle and leave the eye. The angle gets blocked by part of the iris. People with this type of glaucoma have a sudden increase in eye pressure. Symptoms include severe pain and nausea, as well as redness of the eye and blurred vision this is a medical emergency. Pigmentary glaucoma occurs when pigment from the iris flakes off and blocks the meshwork, slowing fluid drainage. A severe form, called neovascular glaucoma, is linked to diabetes.1
Glaucoma can be detected through a comprehensive eye exam that includes visual acuity test, visual field test, dilated eye test, tonometry and patchymetry. Glaucoma treatments include medicines, laser trabeculoplasty,conventional surgery, or a combination of any of these. While these treatments may save remaining vision, they do not improve sight already lost from glaucoma.4
6.1NEED FOR STUDY
Glaucoma is a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness.Everyone is at risk for glaucoma from babies to senior citizens. Yes, older people are at a higher risk for glaucoma but babies can be born with glaucoma (approximately 1 out of every 10,000 babies born in the United States).5
It is estimated that over 4 million Americans have glaucoma but only half of those know they have it. Approximately 120,000 are blind from glaucoma, accounting for 9% to 12% of all cases of blindness in the U.S. About 2% of the population ages 40-50 and 8% over 70 have elevated IOP.1
Glaucoma is the second leading cause of blindness in the world, according to the World Health Organization. Glaucoma is the leading cause of blindness among African-Americans. Glaucoma is 6 to 8 times more common in African-Americans than Caucasians. 1
African-Americans ages 45-65 are 14 to 17 times more likely to go blind from glaucoma than Caucasians with glaucoma in the same age group. The most common form, Open Angle Glaucoma, accounts for 19% of all blindness among African-Americans compared to 6% in Caucasians. Other high-risk groups include: people over 60, family members of those already diagnosed, diabetics, and people who are severely nearsighted.1
Estimates put the total number of suspected cases of glaucoma at around 65 million worldwide.In India, there are at least 12 million people affected with the disease, at least 1.5 million are blind from the disease. It is disheartening to see that more than 90% of people are unaware of the disease when first diagnosed even in urban area of metro city.6 The disease is more common in old age. As glaucoma usually causes blindness without any symptoms, it is appropriately referred to as the "sneak thief of sight". As longevity is increasing and so the population of India, glaucoma is going to become a major cause of ocular morbidity. Glaucoma is second only to cataract as the leading cause of preventable blindness in the world. Glaucoma causes irreversible blindness and many(50%) of the affected people are unaware of their condition.7
Referral pattern in india are quite different from the west. One third of those who become blind due to glaucoma had become visually impaired even before they had sought medical attention for their eyes. Blindness due to glaucoma can be curbed to a certain extent by educating the masses about the condition, and thereby influencing at risk individuals to participate in regular ophthalmic care.8
Once the researcher had been to one of the eye camps being organised by Surana project Drishti and found that the people in the community lack knowledge regarding glaucoma, its manifestations and treatment and hence felt the need to design a study to assess the effectiveness of self-instructional module on the knowledge and awareness of people regarding glaucoma.
6.2.REVIEW OF LITERATURE
Review of literature is the reading and organizing of previously written materials relevant to the specific problems to be investigated; framework and methods appropriate to perform the study.9
A study was conducted on the awareness of Glaucoma in the rural population of southern India. A total of 7775 subjects of all ages, representative of the rural population of Andhra Pradesh, participated in the Andhra Pradesh Eye Disease Study. Awareness of glaucoma (n = 18; 0.32%) was very poor in this rural population, and females were significantly less aware (p = 0.007). Awareness of glaucoma was also significantly less among illiterate persons (p < 0.0001), and socially backward population (p < 0.0001). Majority of the respondents who were aware of glaucoma (n = 10; 55.6%) did not know if visual loss due to glaucoma was permanent or reversible. The major source of awareness of glaucoma in this population was TV/magazines and other media followed by information from a relative or acquaintance suffering from the disease. Awareness of glaucoma is very poor in the rural areas of southern India. The data suggest the need for community-based health education programmes to increase the level of awareness and knowledge about glaucoma.10
A study was conducted on awareness of eye diseases in an urban population in southern India. A total of 2522 subjects of all ages, who were representative of the Hyderabad population, participated in the population-based Andhra Pradesh Eye Disease Study. Awareness of cataract (69.8%) and night blindness (60.0%) was moderate but that of diabetic retinopathy (27.0%) was low, while that of glaucoma (2.3%) was very poor. Knowledge of all the eye diseases assessed was poor. Subjects aged 30 years were significantly more aware of all eye diseases assessed except night blindness. Multivariate analysis revealed that women were significantly less aware of night blindness (odds ratio (OR) = 0.78; 95% confidence interval (CI) = 0.63–0.97). Education played a significant role in awareness of these eye diseases. Study subjects of upper socioeconomic status were significantly more aware of night blindness (OR = 2.20; 95% CI = 1.29–3.74) and those belonging to upper and middle socioeconomic strata were significantly more aware of diabetic retinopathy (OR = 2.79; 95% CI = 2.19–3.56). Muslims were significantly more aware of cataract (OR = 2.36; 95% CI = 1.84–3.02) and less aware of night blindness (OR = 0.52; 95% CI = 0.42–0.64). The major source of awareness of the eye diseases was a family member/friend/relative suffering from that eye disease. These data suggest that there is a need for health education in this Indian population to increase their level of awareness and knowledge of common eye diseases.11
A study was conducted on the awareness and knowledge levels about glaucoma and its determinants in an urban population of Chennai of south india. A total of 3850 subjects aged 40 years or above participated in the study. Systematic random sampling was used. Respondents having heard of glaucoma even before they were contacted for the study were defined as aware and respondents having some understanding of the eye disease were defined as knowledgeable. Overall 13.5% were aware of glaucoma; overall 8.7% had some knowledge about glaucoma. Among those 0.5% had good knowledge about glaucoma, 4% had fair knowledge and 4.2% had poor knowledge. Determinants of glaucoma awareness and knowledge were higher levels of education, female, age, religion and family history of glaucoma. Awareness and knowledge about glaucoma was very low among the urban population of Chennai. The study findings stress the need for health education for effective prevention of blindness due to glaucoma.5
A study was conducted on Knowledge, attitudes and practices regarding glaucoma in the urban and suburban population of Lomé. An interview using a questionnaire was conducted among an opportunistic sample of 767 people living in the capital city of Lomé and in some of its suburbs. The interview targeted people aged 20 to 65 years; the questions were either closed or open. Variables measured included education status, e.g., schooling years, economic status and professional situation. The knowledge of eye diseases accounted for 84% among the population studied; the most well-known being myopia, cataract, presbyopia, and glaucoma in decreasing order. Glaucoma was known by 228 people (29.7%) among whom 25% were aware of glaucoma blindness cases; 61.5% declared that glaucoma was a serious condition; 4.4% admitted the use of traditional eye-healers; 56.1% were not confident in the local doctors for the treatment of glaucoma.12
A study was conducted on Knowledge, attitudes, and self care practices associated with glaucoma among hospital workers in Ile-Ife, Osun State, Nigeria. A random sample of the workers at Obafemi Awolowo University Teaching Hospital in Nigeria was interviewed. All respondents were asked the year of their last visit within the past one year to an eye care practitioner. A total of 205 members of staff were interviewed; 85 (41.5%) were males and 120 (58.5%) females. Female sex (P=0.003), medical profession (P=0.007), ophthalmic specialty (P=0.0001), secondary or tertiary education (P=0.001), and recent visit to an eye practitioner (P=0.012) were significant predictors of knowledge of glaucoma as a blinding disease. Younger people believed blindness prevention and treatment were the highest priorities compared with other diseases. Those who work in the ophthalmic unit and those who had relatives who had been blind from glaucoma also considered blindness treatment to be the highest priority compared with other diseases. People with a relative that had previous diagnosis of glaucoma (P=0.0001), older people (P=0.003), females (P=0.001), and people with correct knowledge of common eye diseases (P=0.0005) were significantly more likely to be under eye care. No interaction was found between knowledge and positive attitudes to self care practices. In conclusion, this study shows that there is a gap in the knowledge and understanding of glaucoma among Nigerian hospital workers, especially among the non-medical staff. There is therefore a need for eye health promotion activities targeting all workers at primary healthcare facilities.13
A study was conducted on Knowledge of glaucoma, and its relationship to self-care practices, in a population sample. A cluster random sample of the Melbourne population 40 years of age and older was interviewed. One thousand seven hundred and eleven residents living in five randomly selected Melbourne metropolitan suburbs, each consisting of two adjacent census collector districts. Seventy per cent of the sample had heard of glaucoma. However, only 22% provided a description that demonstrated a reasonable understanding of the disease. A lack of awareness and knowledge of glaucoma appeared to be negatively related to self-care practices. Serious deficiencies in the basic knowledge of glaucoma in the community was demonstrated. This has significant public health implications as only a small percentage of the at-risk population may present themselves for assessment and treatment. Informing the community about glaucoma is an important step in promoting preventative ophthalmic care and reducing visual impairment and blindness.14
A study was conducted on Glaucoma awareness and screening uptake in relatives of people with glaucoma. A questionnaire was administered to 52 patients with primary open-angle glaucoma. They were asked about their awareness of glaucoma clustering within families, and the need for glaucoma screening in relatives of glaucoma patients. Patients were asked to identify one or more first-degree relatives, aged over 40 years and thus eligible for free glaucoma screening in the United Kingdom. These relatives were mailed a similar questionnaire. Ninety relatives were identified, of whom 70 (78%) returned questionnaires. Only 53% of responding relatives thought they were at increased lifetime risk of developing glaucoma. Though 81% of relatives had been screened, many were screened infrequently. We compared the responses of patients' siblings and patients' offspring. Perceived lifetime glaucoma risk was similar in the two groups, but the (older) siblings had a significantly lower awareness of the free screening service (p = 0.03) and attended for screening less frequently (p = 0.07). Uptake of regular, free glaucoma screening at least every 2 years was 57% among offspring and 30% among siblings (p = 0.005). Relatives of people with glaucoma should be made more aware of the need for glaucoma screening and encouraged to use the free screening service. Older relatives should be particularly targeted.15