CHAPTER ONE

INTRODUCTION

Background to theStudy

Millions of people living in Nigeria are cut off from the mainstream of economic and social development due to heavy burden of diseases.  Among these diseases is glaucoma which is the result of too much  pressure in the eye. It is usually believed to begin after the age of 40  (forty) years and is a common cause of blindness (Mohammed,2001). Responsibility for health care in Nigeria is shared among the  constitutional tiers of government: federal, state and local. The local governments are supposed to take care of the primary level (emphasizing preventive Medicare), while state governments are responsible for the secondary level (emphasizing curative Medicare), and the federal government is in charge of the tertiary level of care (emphasizing referral Medicare) to which teaching and specialist hospitals belong. This implies that there are basically three health care levels in Nigeria: primary, secondary and tertiary health care levels. (Anyanwu, Oyefusi, Oaikhegn,  & Dimowo 1997:608). In Nigeria, glaucoma constitutes a medical, public health and socio- economic problem. This is because Nigeria is found to be one of the most endemic countries in the world, accounting for a  sizeable proportion  of the global cases, with about 6.7 million patients  with  glaucoma worldwide (WHO, 1992). The damaging and insidious nature  of glaucoma make it spread gradually without being noticed but causes seriousharm.

The Basic Health Service (BHS) scheme formed an important health programme of the Third Development Plan (1975-1980) and Fourth Development Plan (1981-1985) of the Federal Government. Under the BHS the government intended to significantly improve the modern health care system of the country within the framework of a three-tier national comprehensive health care delivery system mentioned earlier. Record achievement from the implementation of the BHS shows increases in personnel and institutions. For example, the number of registered medical practitioners in Nigeria rose from 10,399 in 1981 to 16,145 in 1987 (Mbanefo, Soyibo & Anyanwu)1996.

However, the unsuccessful implementation of the BHS programme made the federal government to embark on a new direction health care delivery whichmakesPrimaryHealthCare(PHC)thefocus.Therewasneedforcloseinvolvement of the local governments, local communities, and individuals in the implementation of the PHC in collaboration with the other two tiers of government. Activities that formed part of the PHC include: National Programme on Immunization (NPI), Campaign against River blindness, Oral Rehydration Therapy (ORT), among others (FMH, 1988). The incidence of glaucoma among adult patients refers to the rate of occurrence of this disease. In  epidemiology the interest is in the number  of new cases arising in a given period of time in a specified group of people. The American Academy of ophthalmology (1983) notes that an estimated 2 million people have been identified as having glaucoma. Of these 889,000 are visually impaired, 67,150 are legally blind and each year an additional 5,500 people become blind from glaucoma. Equally, in 1997 glaucoma caused 36,000 hospital admission in America, 25 million office visits and more than $440 million spent on direct health cost  on  glaucoma. It is from the implication of the data as given above and the fact that glaucoma is one of the avoidable causes of blindness that the need to maintain adequate and effective health care delivery system becomes imperative. Therefore this study examines the factors responsible for the occurrence of glaucoma among adult patients in Anambra state (2002- 2006).

Statement of theProblem

For Nigeria to achieve the state of complete physical, mental and social well-being of the population there is need to create awareness and stimulate actions from the community to achieve health. This can be accomplished through an effective health education which according to Onukwubiri (1994), bridges the gap between health information and  health practices. It is any combination of methods designed to facilitate voluntary change of behaviours of individuals or groups to promote  health. In Anambra state there seems to be no relationship between health practices and the information available on people’s health. The researcher observed during her clinical posting to Eye clinic at the General Hospital Enugwu-ukwu  that most adult glaucoma patients reported  to  the    clinic when their eye conditions had deteriorated. Furthermore, the adults suffering from the disease are not aware of the diseaseoccurrence. The central focus of this study therefore borders on identifying the factors responsible for the spread of glaucoma in Anambra State. In other words what are those constraints to effective primary health care delivery and health education in the state. This is done by studying the records of adult patients in the three General Hospitals in Anambra State with functional eye clinics for the period between 2002 –2006.

Purpose of theStudy

The broad purpose of the study is to examine the factors influencing the incidence of glaucoma among adult patients (in general hospitals) in Anambra state (2002 – 2006) and to highlight  the  problems  resulting from lack of information on factors influencing the incidence of  glaucoma.

The specific objectives of the studyinclude:

1. To determine the incidence of glaucoma among adult patients in Anambra state between 2002 –2006.

2. To verify the incidence of glaucoma in relation to family history in Anambra state between 2002 –2006.

4. To identify other factors influencing the incidence of glaucoma in adult patients in Anambra state from 2002 –2006.

5. To ascertain the number of people affected by glaucoma in relation to age from 2002 –2006.

6. To determine the relation between health information and incidence of glaucoma in Anambra State,and

7.  To examine the level of awareness of the glaucoma in Anambra state.

Significance of theStudy

The result of the study will be of immense benefit to health institutions, community members, researchers and government. The study on the factors influencing the incidence of glaucoma will give a preview of the level of incidence for intervention strategicplanning. Furthermore, this research will help to create awareness of the disease to the community members, as well as serve as related literature to other researchers by providing a fore-knowledge of what is obtainable and available on the ground as it concerns the area ofstudy.

The study is a determination of the factors influencing the incidence of glaucoma in adult patients in Anambra state between 2002 and 2006. This means that only available data on adult patients who visited the General Hospital in Awka, Enugwu-ukwu and Onitsha are used for the study. Another delimitation is that adults between the ages of  40  years  and above and studied as our interest is mostly on open angleglaucoma.

Researchquestions

1. What is the incidence of glaucoma among adult patients in Anambra state between 2002 and2006?

2. What is the incidence of glaucoma in relation to family history  in Anambra state from 2002 –2006?

3. What is the incidence of glaucoma in relation to gender in Anambra state from 2002 –2006?

4. What other factors influence the incidence of glaucoma in adult patients in Anambra state from 2002 –2006?

5. What is the number of people affected by glaucoma in  relation  to age from 2002 –2006?

6. How does health information  effect the incidence of glaucoma  in Anambrastate?

7.  What is the level of awareness of glaucoma in Anambrastate?