Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 29  |  Issue : 1  |  Page : 34-38

Ophthalmic Patients’ Perceptive on Corona Virus Disease (Covid-19) Pandemic in Onitsha, Nigeria


1 Departmant of Ophthalmology, Nnamdi Azikwe University, Nnewi Campus, Nnewi; Centre for Eye Health Research and Training, Nnamdi Azikiwe University, Awka; Guinness Eye Centre Onitsha, Nigeria
2 Departmant of Ophthalmology, Nnamdi Azikwe University, Nnewi Campus, Nnewi; Guinness Eye Centre Onitsha, Nigeria

Date of Submission18-Aug-2020
Date of Decision01-Oct-2020
Date of Acceptance16-Dec-2020
Date of Web Publication16-Jul-2021

Correspondence Address:
Prof. Sebastian N.N Nwosu
Guinness Eye Centre, PMB 1534 Onitsha Nigeria, PMB 1534 Onitsh
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njo.njo_31_20

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  Abstract 


Objectives To determine patients’ perception of COVID-19 and their practice of disease prevention measures. Materials and Methods: Consenting, consecutive new adult patients at the Guinness Eye Centre Onitsha were interviewed using a pretested questionnaire. Information sought included patients’ COVID-19 knowledge, its symptoms, transmission, preventive measures, compliance, and worries. Results: Of 81 participants, the mean age was 47.9 ± 17.6 years; 31 (38.3%) were males; 61 (75.3%) attained secondary or higher education. All participants knew about COVID-19; radio/television was the most common information source (88.9%). Although 85.2% participants knew that COVID-19 is a communicable disease, 86.4% knew of its viral etiology and 86.4% knew that it could be transmitted by close contact with persons/fomites. Common symptoms known to the participants were cough (82.7%), fever (61.7%), and breathlessness (55.6 %); the most common known preventive measures were wearing face mask in public (90.1%) and handwashing (82.7%). Although 44.4% knew that physical distancing was a preventive strategy, only 11.1% knew that the distance of separation should be at least one meter; 49.4% always wore face mask in public, 61.7% washed hands frequently, whereas only 4.9% maintained physical distancing; 44.4% worried that pandemic restrictions negatively affected their access to eye care and 29.6% feared contracting the disease in eye clinics. Conclusions: All study participants knew of the COVID-19 pandemic. However, knowledge of the disease, its transmission, and preventive measures was suboptimal; many patients do not adhere to the recommended preventive measures. Repetitive public health education is required to improve compliance with disease control measures and allay fears.

Keywords: COVID-i9, ophthalmic patients, perception, prevention


How to cite this article:
Nwosu SN, Ezenwa AC, Uba-Obiano CU. Ophthalmic Patients’ Perceptive on Corona Virus Disease (Covid-19) Pandemic in Onitsha, Nigeria. Niger J Ophthalmol 2021;29:34-8

How to cite this URL:
Nwosu SN, Ezenwa AC, Uba-Obiano CU. Ophthalmic Patients’ Perceptive on Corona Virus Disease (Covid-19) Pandemic in Onitsha, Nigeria. Niger J Ophthalmol [serial online] 2021 [cited 2021 Nov 29];29:34-8. Available from: http://www.nigerianjournalofophthalmology.com/text.asp?2021/29/1/34/321644




  Introduction Top


The novel coronavirus infection (SARS-nCoV-2) that is responsible for the COVID-19 pandemic was first reported in Wuhan, China, in December 2019.[1] In less than 2 months, the disease had spread to involve more than 188 countries on all the continents of the world, infecting many people, some of whom died. Elderly persons as well as health workers are most vulnerable; the severity and mortality also appear high among COVID-19 patients who have such comorbidity as diabetes, hypertension, and obstructive airway diseases like asthma. In the prevailing circumstance, the World Health Organization (WHO) declared the novel coronavirus infection a pandemic and named it “COVID-19” disease in late January 2020.[1]

On February 27, 2020, the first case of COVID-19 was reported in Nigeria.[2] The disease has since spread to all parts of the country leaving in its trail many casualties including health workers and patients with ophthalmic disorders. By the end of June 2020, more than 25,000 COVID-19 positive cases had been officially reported in Nigeria by the Nigeria Centre for Disease Control (NCDC) with more than 600 deaths.[3] The disease would most likely spread further unless the public adheres to measures put in place by the NCDC aimed at flattening the epidemic curve. How quickly this is achieved depends on the people’s perception of the coronavirus disease outbreak.

In the absence of vaccines or effective curative pharmacotherapy, preventive measures involving lifestyle and social interaction changes were recommended by the WHO[4] as means of controlling the spread of this highly contagious disease. In Nigeria, these changes were reinforced by the government via the NCDC. Second, fearing that COVID-19 could be spread by asymptomatic patients in eye clinics and anxious to prevent such incidences, international ophthalmology and other eye care societies provided guidelines on how to modify eye care procedures to ensure the safety of both patients and health workers.[5],[6],[7],[8],[9],[10],[11] Accordingly, eye hospitals and clinics within Nigeria modified their patient care rules with the Lagos University Teaching Hospital also publishing its eye care triage guidelines.[12] The success of the new approaches to eye care depends on patients’ cooperation, which in turn would be determined by the patients’ understanding of the pandemic.

Thus, although disease containment measures using public health approach have been advocated, the degree of adherence and practice of these measures by patients is not known. It is therefore necessary to scientifically determine the patients’ perception of COVID-19 as well as their practice of the recommended precautionary measures aimed at containing the spread of the disease.

This article reports on the perception of the COVID-19 pandemic as well adherence to disease preventive measures by new adult ophthalmic patients at the Guinness Eye Centre Onitsha Nigeria.


  Materials and Methods Top


This study was conducted at the outpatients’ clinic of the Guinness Eye Centre Onitsha (the ophthalmic wing of the Nnamdi Azikiwe University Teaching Hospital) from May 11 to 29, 2020. The institutional review board of our hospital reviewed for ethical concerns and approved the questionnaire used for this study. Written, informed consent of each participant was obtained. Thereafter, consenting consecutive new adult patients (participants) responded to a pretested, structured, self-administered questionnaire on knowledge of COVID-19, its symptoms, mode of transmission and spread, preventive measures, and their compliance with the practice of these measures; also explored were their concerns with regard to the possible effects of COVID-19 on their ophthalmic ailments. In administering the questionnaire, care was taken to minimize chances of disease transmission. Thus, precautions of hand washing, social (physical) distancing, and face mask wearing were strictly adhered to. The interview held in a well-aerated large room accommodating only the interviewer and the participant at a time. (During this period, to avoid crowding, patients were not attended to in the smaller purpose built consulting rooms). It should be clarified that given the peculiar period of COVID-19 pandemic with severe restriction of movement; its attendant disruption of socio-economic activities and the need to urgently obtain information that would enable the formulation of relevant ophthalmic health education message, patients were not randomly sampled. Data obtained were analyzed with the Statistical Package for the Social Sciences (SPSS) version 25.


  Results Top


Eighty-one consecutive, new adult patients (participants) were interviewed. [Table 1] shows the socio-demographic characteristics of the participants. There were 31 (38.3%) males and 50 (61.7%) females. The age range was 18 to 91 (mean, 47.9 ± 17.6) years. The 30 to 59 years age bracket constituted 59.1% participants. Although 61 (75.3%) participants attained at least secondary education, only three (3.7%) did not have any formal education.
Table 1 Socio-demographic characteristics

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All the participants were aware of coronavirus disease (COVID-19). The sources of information about COVID-19 are shown in [Table 2]. Some participants obtained information about the disease from multiple sources. The most common information source was radio/television that accounted for 88.9%; the workplace was the least point of obtaining information and it accounted for only 8.7%.
Table 2 Source of information on COVID-19

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[Table 3] shows the participants’ knowledge of disease etiology, transmission, and symptoms. Although 69 (85.2%) participants knew that COVID-19 is a communicable disease, 11 (13.6%) were ignorant of this fact and one participant (1.2%) felt that COVID-19 is a noncommunicable disease. Although 59 (86.4%) participants knew that COVID-19 disease is caused by a virus, 70 (86.4%) knew that the disease could be transmitted by close contact with persons and fomites. The most common coronavirus disease symptoms known to the participants were cough (82.7 %), fever (61.7 %), and breathlessness (55.6 %).
Table 3 Disease knowledge

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[Table 4] shows the participants’ knowledge of COVID-19 preventive strategies. Wearing a face mask in the public (73, 90.1%) and handwashing (67, 82.7%) were the COVID-19 preventive measures the participants were most conversant with. Although 36 (44.4%) participants knew that physical distancing was a COVID-19 preventive strategy, the knowledge of the minimum distance of separation was unclear to many. Although 30 (37.0%) participants had no idea of the minimum distance, 42 (51.9%) thought the minimum distance was less than 0.3 meter; only nine (11.1%) knew that the distance of separation should be at least 1 meter.
Table 4 Knowledge of COVID-19 preventive strategies

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[Table 5] shows the practice of preventive strategies by the participants. Although 40 (49.4%) always wore a face mask in public, 10 (12.3%) never did so. Only 50 (61.7%) washed hands or used hand sanitizers frequently, whereas only four (4.9%) maintained physical distancing.
Table 5 Practice of COVID-19 preventive measures

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The COVID-19 pandemic was also associated with psychological stress among the participants. Thus, 36 (44.4%) participants felt that the COVID-19 pandemic restrictions negatively affected their access to eye care; of these, 24 (29.6%) did not feel safe consulting in the eye clinic for fear of contracting the coronavirus disease. Similarly, 41 (50.6%) participants were concerned that their eye diseases might deteriorate because of the suspension of non-emergency services, including elective surgeries, in the hospital.


  Discussion Top


All the participants in this study were adults and more than 75% of these adults had acquired at least secondary school education. Therefore, the opinion expressed by this cohort should be considered reliable. This study was undertaken when the movement of people in parts of Anambra State was still severely restricted (“lockdown”). Perhaps an online-based survey would have been appropriate during the COVID-19 pandemic. However, the clime of this work has its challenges for such given the unstable internet services and lack of information on the mobile phones of most of the patients. In any case, the participants were new patients whose personal information or records were hitherto unknown to the hospital.

The short study period and the relatively small sample size were necessitated by the exigencies of that period: there was a severe restriction of movement with a consequent drop in patients’ hospital attendance; many issues regarding COVID-19 transmission and containment were still evolving. Therefore, there was an urgent need to obtain information that would enable the effective formulation of a health education program for ophthalmic patients. The small sample size is thus a limitation of this work and the results should be interpreted with caution. As the COVID-19 pandemic lingers, a larger sample size preferably from a multicenter study may provide more generalizable information.

Since the declaration of the novel coronavirus disease (SARS-nCoV-2, COVID-19) a pandemic by the WHO in late January 2020, the Nigeria public has been continuously sensitized about the disease and the campaign was intensified following the identification of the index case. Therefore, it was expected that all adults would have at least heard of the disease and also would have learned about the ensuing health emergency at the time of this study. Thus, although it was not surprising that all the participants had heard about the coronavirus disease, the relatively poor knowledge of its nature, transmission, and containment measures by the participants is worrisome.

The findings in this study reinforce the need for persistent health education of the public on all aspects of COVID-19 pandemic. Based on the findings of the present study, it would appear that health education delivery would reach a wider audience through the medium of radio and television channels; other means of sensitization of the public may be weaker than the radio/television media. Obtaining information about COVID-19 at the workplace and other public gatherings is apparently unpopular. However, this finding needs to be interpreted with caution. The present study was conducted just after the severe restriction of movement (“lockdown”) was lifted. During the lockdown, schools, markets, and government offices were shut down and so interaction among people was minimal with attenuation of person-to-person information dissemination and experience sharing. Thus, in order not to leave anyone behind, it is still recommended that every means of public enlightenment be employed in the efforts to contain the spread of the novel coronavirus disease.

The practice of preventative or COVID-19 containment measures by the participants was suboptimal. The poor compliance may be attributed to several factors. For instance, wearing a face mask is uncomfortable in a humid environment; frequent hand-washing or use of hand sanitizers requires time for full adaptation to the new lifestyle. It should also be pointed out that many donning a face mask, strap it around the chin and indeed do not cover the mouth and nose. These “jaw or chin masks” are unlikely to prevent or minimize the virus transmission for the mouth and nose of the infected. Even, mask may exchange infective agents from chin to face (and vice versa) as many wearers often shift the mask from the chin to the face (and vice versa). Thus, as part of health education, proper wearing of the face mask especially in public places should always be emphasized.

Of all the nonpharmacologic containment measures, physical (social) distancing appeared to be the most difficult to practice by the participants. This is not surprising. Ours is a gregarious society where people routinely hug each other and shake hands as part of greetings, show of affection and appreciation. Nevertheless, it is gratifying that most participants were aware of these measures, even if they apply them inefficiently. However, it is conceivable that sustained health education and persistent persuasion would eventually lead to more positive changes.

It could be argued that persons seriously ill from COVID-19 disease, such as those requiring oxygen and respirators, are rarely encountered in ophthalmic practice and that the participants in the present study did not represent typical COVID-19 patients and therefore may not be painstaking enough in adhering to the recommended preventive measures. But this line of argument is flawed because prior to coming down with severe pulmonary disease, coronavirus infected persons pass through asymptomatic but infectious phase. At this stage, some of the patients would present with conjunctivitis[13],[14],[15] or retinal changes.[13] Besides, the NCDC sensitization campaign is for all citizens and not just for confirmed COVID-19 cases. Therefore, the findings in the present study of less than expected knowledge of COVID-19 pandemic as well as a suboptimal practice of preventive measures are worrisome and these call for more pro-active efforts on the part of both the government and citizens.

Finally, concerns expressed by some participants with regard to possible deterioration of their eye health consequent of the COVID-19 induced disruption of eye health services should be taken seriously. This finding brings to the fore the need to provide mental health support for ophthalmic patients especially in a period of uncertainty.[16] Chronic eye diseases often induce anxiety on the afflicted. A previous study in our hospital had reported that most glaucoma patients suffer anxiety and depression engendered by fear of blindness.[17] In addition to mental health support, the patients who are unable to come to a hospital or those whose appointments are postponed could also be attended via telemedicine and video-conferencing. This will ensure that they continue with their medications and will also to allay their fears.

In conclusion, although all the participants in the present study were aware of the coronavirus pandemic, the knowledge of disease, its transmission, and preventive measures were suboptimal. Of more concern is that not many adhere to the nonpharmacologic preventive measures. Repetitive health education of the public is required to improve compliance with the recommended control measures for this highly contagious disease.



 
  References Top

1.
World Health Organization. Timeline: WHO’s COVID-19 response. https://www.who.int/emergencies/diseases/coronavirus disease (COVID-19)/Timeline: WHO“s COVID-19 response. Accessed August 14, 2020.  Back to cited text no. 1
    
2.
Nigeria Centre for Disease Control. First case of coronavirus disease confirmed in Nigeria. https://covid19.ncdc.gov.ng. Accessed March 10, 2020.  Back to cited text no. 2
    
3.
Nigeria Centre for Disease Control. Update on COVID-19 cases in Nigeria 30 June 2020. https://covid19.ncdc.gov.ng. Accessed July 2, 2020.  Back to cited text no. 3
    
4.
World Health Organization. Coronavirus disease (COVID-19) advice for the public. https://www.who.int/emergencies/diseases/coronavirus disease (COVID-19)/Advice for the public. Accessed August 14, 2020.  Back to cited text no. 4
    
5.
American College Surgeons. COVID-19 guidelines for triage of ophthalmology patients. https://www.facs.org/COVID-10 clinical guidelines. Accessed May 4, 2020  Back to cited text no. 5
    
6.
American Academy of Ophthalmology. Eye care during coronavirus (COVID-19) pandemic. https://www.aao.org>tips-prevention. Accessed May 25, 2020.  Back to cited text no. 6
    
7.
Royal College of Ophthalmologists. PPE and staff protection requirements for ophthalmology. https://www. Rcophth.ac.uk/wp-content/upload/ 2020 /04/UPDATE D-RCOphth-PPE-for ophthalmology- 090420.pdf. Accessed May 3, 2020.  Back to cited text no. 7
    
8.
International Agency for Prevention of Blindness. COVID-19 and Eye Health. https://www.iapb.org> Resources>knowledge. Accessed August 14, 2020.  Back to cited text no. 8
    
9.
The College of Optometrists. COVID-19: College updates − College clinical guidelines. https://www.college-optometrists.org/covid-19/clinical guidelines. Accessed August 14, 2020.  Back to cited text no. 9
    
10.
Kyari F, Watts E. How to adapt your eye services in the time of COVID-19. Commun Eye Health J 2020;33:10-13.  Back to cited text no. 10
    
11.
Jun ISY, Hui KKO, Songbo PZ. Perspectives on coronavirus disease 2019 control measures for ophthalmology clinics based on a Singapore Center experience. JAMA Ophthalmol 2020;138:435-6.  Back to cited text no. 11
    
12.
Onakoya A. COVID-19: Adaptations and changes at Guinness Eye Centre Nigeria. Commun Eye Health J 2020;33:14-15.  Back to cited text no. 12
    
13.
Gupta A, Madhavan MV, Sehgal K et al. Extra-pulmonary manifestations of COVID-19. Nat Med 2020;26:1017-32.  Back to cited text no. 13
    
14.
Seah I, Su X, Lingan G. Re-visiting dangers of the coronavirus in ophthalmology practice. Eye 2020;34:1155-7.  Back to cited text no. 14
    
15.
Wu P, Duan F, Luo C et al. Characteristics of ocular findings of patients with coronavirus disease (COVID-19) in Hubei Province, China. JAMA Ophthalmol 2020;138:575-8.  Back to cited text no. 15
    
16.
Eaton J. Well-being and mental health during COVID-19 outbreak. Commun Eye Health 2020;33:8–9.  Back to cited text no. 16
    
17.
Ezenwa AC, Nwosu SNN. Satisfaction with eye care among adult glaucoma patients in Onitsha Nigeria. Acta Sci Ophthalmol 2020;3:27-31.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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