ABSTRACT

Background:   Allergy has been reported to be the third most chronic condition with its ocular component being the main reasons children are presented to the health facility for consultation. Allergy conjunctivitis is characterized by inflammatory responses in the conjunctiva and other ocular surfaces which is mediated by hypersensitivity reaction to allergens. The aim of this study is to assess the prevalence of allergy conjunctivitis among children 0-5 years old in the Dockyard community Down Beach Limbe. Method: This cross- sectional study was carried out at Dockyard down Beach Limbe.  The targeted populations were children aged 0-5years and their corresponding parents or guardian. A simple random was used to select the respondents. Data were collected using structured questionnaires, who were analyzed using Microsoft excel 2013. Results: A total of 100 respondents participated in the study. Most of them were pre- schooler age range 36-59 months (57.0%), gender female (56.0%).  A greater proportion (100.0%) of factors that might lead to allergy conjunctivitis were expose to smoke. Conclusion: The study highlight  the prevalence of allergic conjunctivitis in children at Dockyard down Beach Limbe who were predispose to  smoking fish,  duty environment, using wood or charcoal as cooking fuel and living with pets like cat. Based on the study results health facilities should include eye examination as part of child welfare clinics. This will help identify cases of allergy conjunctivitis and other sight threatening eye conditions in children aged less than five years.

CHAPTER ONE

INTRODUCTION

• Background

In general, allergy is estimated to affect up to 40% of the people globally (Kyei et al., 2016). Although allergic eye disease or allergic conjunctivitis (AC) is the prominent and often debilitating feature amongst them, allergy has the tendency to affect several organ systems resulting in a variety of symptoms in the affected individual (Kahol et al., 2019). Among children, allergy has been reported to be the third most chronic condition with its ocular component being the main reason children are presented to the health facility for consultation (Kyei, 2018).

Allergic conjunctivitis (AC) also referred to as ocular allergy, is characterized by inflammatory responses in the conjunctiva and other ocular surfaces which is mediated by hypersensitivity reaction to allergens (Malu, 2014; Mashige, 2017). It has an estimated prevalence of 15-20% globally, though it is more common in hot and dry climates found in the Middle East, Africa, South America and some parts of Asia (La Rosa et al., 2013; Marey et al., 2017). Within the past four decades, despite an increasing prevalence of allergy conjunctivitis due to urbanization and increase in poor air quality, this ocular disorder has not received the needed attention and is often under diagnosed and inadequately diagnosed. This is in spite of those affected often experiencing severe symptoms like severe itching, swelling of the lids, tearing and mucoid discharge (Kahol et al., 2019). 

Severe, bilateral, recurrent and potentially sight threatening forms of allergy conjunctivitis like vernal keratoconjunctivitis (VKC) usually affects children which starts between 6 and 10 years, involving the conjunctiva and cornea. It often causes moderate to severe visual impairment, and is therefore a condition of public health importance especially in dry and hot regions of Africa with air rich in allergens (Al-Akily and Bamashmus, 2011; Arif et al., 2017; Duke et al., 2017; Naggalakshmi et al., 2014). 

In Africa, the prevalence of VKC is estimated to be between 2 to 6%. The disease commonly affects the conjunctiva and cornea of children and also accounts for about 21% of all general eye clinic attendance in children and a major cause school absenteeism (Duke et al., 2017). In Cameroon, a study of carried out by Omgbwa et al. (2009), at the Gynecology/Obstetrics and Pediatric Hospital in Yaoundé, revealed a prevalence (of AC) of 17.8% among children aged between 6 and 15; it represented the second pathology at that age after refractive errors. In Northern Cameroon, Koki et al. (2011), reported a rate of 33.5% for children aged between 4 months and 15 years.

For years, notable efforts such as vitamin A supplementation and measles immunization have been made by public health professionals, non-governmental organizations, donor agencies, eye care professionals and several governments in reducing visual impairment in children in resource limited settings, as visual impairment puts a limitation on the opportunities children have in education and when older, in employment (Courtright et al., 2014). Visual impairment also contributes to child mortality as studies indicate 60% of children die within one year of becoming blind (Courtright et al., 2011; Alrasheed et al., 2016). Caregivers or parents, play a major role in the recognition and management of ocular conditions of children. Therefore, their practices about the child’s eye disorder and its management deserves attention in research discourse (Amare and Mullu, 2015; Courtright et al., 2011).

The purpose of the study is to assess the prevelence of allergy conjunctivitis among children 0-5 years old in the dockyard community down Beach Limbe.

• Problem Statement

In lower and middle- income countries, considerable achievements have been made in the fight against measles, vitamin A deficiency and ophthalmia neonatorum in the last decades such that they are no longer regarded as leading cause of childhood blindness. At the same time conditions like severe forms of allergy conjunctivitis are now becoming important cause of corneal blindness (Duke et al., 2016), but because of the recurrent nature of symptoms, it is often under reported and the need for treatment  ignored by parents and patients. It is also under diagnosed and hence missed, as clinicians mostly overlook the ocular components of allergy in favor of systemic symptoms (Kahol et al., 2019; Mashige, 2015). 

Most prevalence studies focus on ages five and above because most literature suggest allergy conjunctivitis in children usually begin at age five. However, current clinical observations indicate that more children below the age of five years presents to the hospital with allergy conjunctivitis including the severe form which is VKC. Parents often bring children with allergy conjunctivitis to the hospital very late, especially when the condition becomes severe or complicated. This occurs in spite of the existence of frequent interactions between health professionals and the child from birth to five years through community health workers for their childhood immunizations (Mafwiri et al., 2014). Consequently, these children are denied treatment or the condition is deemed to be a normal occurrence which does not necessitate ocular care. 

Though, the initial course of the disease may be mild and often self-limiting, it can however develop into a severe form with severe itching, photophobia, burning sensation, mucoid discharge, swollen lids, and pain (Ahmed et al., 2019; Arif et al., 2017; Marey et al., 2017), which disrupts normal school activities as children tend to miss class resulting in poor academic performance (Alemayehu et al., 2019). Furthermore, the psychosocial, physical activity and quality of life of the child are affected as they are often restricted from engaging in their preferred activities as a preventive measure in controlling the effects of the disease (Bremond-Gignac et al., 2008; Duke et al., 2016). 

In some communities in Africa, there are several beliefs with regards to eye diseases or conditions in children. These beliefs include that certain eye conditions do not need treatment and that ocular conditions occur as a result of eating spicy foods, eggs or clay during pregnancy, witchcraft, looking at the nakedness of a parent, a mother’s misbehavior towards the in-laws and angering the ancestors (Mafwiri et al., 2014). In instances, where the seriousness of eye conditions are recognized by caregivers, they often make choices which result in poor visual outcomes of the child as they are exposed to orthodox and alternative eye  care services within the community (Ayanniyi et al., 2010).

Ignoring childhood blindness would have an impact on adult blindness as the number of blind years in children if they survive a lifetime will be higher (Paranjpe et al., 2016), the quality of life is affected, and the cost and loss of productivity incurred by the child and family as a result of the lifetime of blindness is considerable (Kumah et al., 2017).

• Rationale

Childhood eye conditions need urgent attention.  Caregivers and mothers tend to spend more time with the child and have a responsibility to detect danger signs and ensure that they get the right intervention, especially in children who cannot talk. This is important as some of these childhood eye conditions can develop into severe visual impairment or blindness if left untreated (Courtright et al., 2011).

Several studies have been done on AC in Africa and a few in Cameroon, but these studies have been mainly prevalence studies focusing on ages above five years. This is perhaps due to most literature suggesting that AC often present in children at age five and above. No study of AC specifically among children aged under five years has been done in Cameroon. Due to the risk of visual impairment resulting from AC and its co-morbidities and the quest to reduce the burden of avoidable blindness in children especially those aged below five years, it is important to know the burden of AC among this age group and provide interventions particularly at the community level. Within the community, the prime focus is parents and caregivers because they influence the daily living of children and this include practices that affect the management of childhood conditions including AC.

1.4 Research Question

1. What is the prevalence of allergy conjunctivitis in children 0 – 5 years old in dockyard community Down Beach limbe?
2. What are the factors associated with allergy conjunctivitis in children 0 – 5 years old in dockyard community down Beach limbe?
3. How caregivers manage allergy conjunctivitis in children 0 – 5 years old in dockyard community down Beach limbe?
   • Research Objectives
     • General Objective

The purpose of this study was to assess the prevalence of allergy conjunctivitis among children 0 – 5 years old in dockyard community down Beach limbe.

• Specific Objectives

1. To determine the prevalence of allergy conjunctivitis in children 0 – 5 years old in dockyard community down Beach limbe.
2. To identify the risks factors associated with allergy conjunctivitis in children 0 – 5 years old in dockyard community down Beach limbe
3. To identify strategies used by caregivers in managing allergy conjunctivitis in children 0 – 5 years old in dockyard community down Beach limbe