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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 31  |  Issue : 3  |  Page : 309-314

Preferred spectacles among nigerian school children: Report from a refractive error in school children (RESC) study


1 Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu, Nigeria
2 Department of Ophthalmology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
3 Department of Ophthalmology, Federal Medical Centre, Owerri, Imo, Nigeria
4 Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
5 Division of Neonatal Perinatal Medicine, University of Texas Health Science Centre, Houston, Texas, USA

Date of Submission30-Aug-2021
Date of Decision04-Feb-2022
Date of Acceptance19-Feb-2022
Date of Web Publication24-Jun-2022

Correspondence Address:
Ngozi Chinyelu Oguego
Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJM.NJM_158_21

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  Abstract 


Background: Refractive error (RE) is the most common cause of visual impairment globally and affects about 12.8 million children (5–15 years). Uncorrected RE in children could lead to irreversible vision loss in the paediatric age group. Spectacles are commonly used to correct RE although preferred spectacle design pattern among children may influence spectacle use. Aims: This study aims to assess school children's preferred spectacle designs and the factors associated with these preferences in south east Nigeria. Subjects, Materials and Methods: A representative cross-sectional study among school children aged 5–15 years in South-East Nigeria. Participants were asked to independently select preferred spectacles displayed based on: frame colour, material, shape of ear-piece, lens size, and shape. Statistical analysis of data to yield frequencies and test of association was done using Chi-square. Binary logistic regression tested the strength of association. Adjusted odds ratios were calculated at 95% confidence interval and P < 0.05 were considered significant. Results: The study comprised 5723 school children (males 46.9% and females 53.1%), aged 10.49 ± 2.74 years. Their commonly preferred spectacles were red coloured (35.4%), had straight earpiece (80.6%), of plastic materials (62.8%), rectangular lens shape (55.3%), and medium lens sized (58.6%). Age was the most associated factor with spectacle choice preference among the school children (P < 0.05 in four out of the five possible preferences evaluated). Conclusions: Spectacle preferences exist among the study population. Some demographic factors are associated with these preferences which should be considered in any childhood RE services.

Keywords: Nigeria, preferred spectacle, school children, spectacle design


How to cite this article:
Udeh NN, Aghaji AE, Okoye OI, Oguego NC, Okoye O, Maduka-Okafor FC, Ezegwui IR, Ezisi CN, Achigbu EO, Nwobi A E, Onwasigwe N E, Umeh RE, Aneji CU. Preferred spectacles among nigerian school children: Report from a refractive error in school children (RESC) study. Niger J Med 2022;31:309-14

How to cite this URL:
Udeh NN, Aghaji AE, Okoye OI, Oguego NC, Okoye O, Maduka-Okafor FC, Ezegwui IR, Ezisi CN, Achigbu EO, Nwobi A E, Onwasigwe N E, Umeh RE, Aneji CU. Preferred spectacles among nigerian school children: Report from a refractive error in school children (RESC) study. Niger J Med [serial online] 2022 [cited 2022 Aug 19];31:309-14. Available from: http://www.njmonline.org/text.asp?2022/31/3/309/348054




  Introduction Top


Uncorrected refractive error (RE) is the most common cause of visual impairment worldwide.[1],[2] It causes disability that impairs learning and quality of life,[3] affecting about 12.8 million children aged 5–15 years.[4] Spectacle is recommended and common for correcting RE in children.[5],[6],[7] However, spectacle compliance is better (22%–75%) when children made choice of spectacle frame.[8],[9] In China, plastic and rectangular frames were preferred,[10] while poor cosmesis affected compliance in Mexico.[11] Children with craniofacial malformations preferred custom spectacle.[12] Data on spectacle preferences among African children are scant. We report finding on spectacle preferences among children in southeast Nigeria.


  Subjects and Methods Top


This cross-sectional school-based survey was conducted between March and June 2018, using the modified refractive error study in children (RESC) study protocol.[13] This study was part of a larger Refractive Error Study in Children (RESC) in southeast Nigeria.

The University of Nigeria Teaching Hospital (UNTH) Research and Ethics Committee, Enugu State reviewed and gave approval for the study which was carried out in accordance with the Helsinki Declaration and its later modifications. Approvals were also obtained from the Universal Basic Education Board and Postprimary School Management Board of each state. Institutional consent was granted by each school authority and informed consent obtained by parents/guardian of each child recruited.

The school children aged 5–15 years in South East Nigeria were the study population. South East Nigeria a component of the 6 geopolitical zones in the country which is made up of 5 states-Abia, Anambra, Ebonyi, Enugu, and Imo-with an estimated population of 21.9 million.[14]

Participants were selected in each state using multistage cluster sampling technique. At the initial stage, the Local Government Areas (LGAs) in the state were stratified into urban and rural and one LGA was randomly selected from each stratum. Then, four school strata were formed comprising of public and private of both primary and secondary schools. A school from each stratum was selected, and these selected schools formed the sampling frame. The classes which included primary 1–6 and junior secondary children aged 5–15 years, with an overlap of the age group both for the primary and the junior secondary school).

The total sample size was 5723. Based on the state by state population, 1133, 1151, 1096, 1167, 1176 were recruited from Abia, Anambra, Ebonyi, Enugu, and Imo states respectively. Two research teams were trained by the principal investigators and a Community Eye Health Specialist/Technical Adviser familiar with the RESC protocol. A 5-day training was carried out using the RESC protocol and each team comprised 2 ophthalmologists, an ophthalmic nurse, optometrist and a sociologist all of whom were experienced in paediatric eye care and research.

The study tool was a pretested questionnaire asking children to indicate their preference of spectacle based on five spectacle characteristics: (i) frame colour (black, blue, brown, green, red, white and yellow); (ii) frame/lens size (small ≤40 mm, medium >40 <46 mm, large ≥46 mm); (iii) lens shape (round, oval and square); (iv) frame material (metal and plastic); and (v) ear-piece shape (straight and curved).

The questionnaire for this study was developed and pretested in children at the eye clinic of the Ophthalmology Department in the UNTH, Enugu State prior to the survey. A pilot of this study was done in a LGA in Enugu State, which is unpublished and not a part of this study and report.

In this study, participants selected their choice from each group sequentially; with mirrors provided to aid them to see themselves wearing the spectacles before making their choices. These choices were recorded, and the questionnaire filled; with a check for completeness assessed on the spot by another team member.

Data obtained were double entered by trained data entry clerks into a database in SPSS (Statistical Package for the Social Sciences) [IBM SPSS Statistics for Windows, Version 22.0. Armonk, NewYork: IBM Corporation] software version 22®. Data analysis was done to yield frequencies, and test of association between categorical variables was done using the Chi-square test while those with significant associations (P ≤ 0.05) were subjected to binary logistic regression to test the strength of association. Tests of significance were set at the 95% level.


  Results Top


Demographics

There were 5723 school children surveyed, consisting of 2686 (46.9%) males and 3037 (53.1%) females. Their mean age was 10.49 ± 2.74 years. Most of the participants were in public schools, 3200 (55.9%) compared to private schools; more were in primary schools 3762 (65.7%) than secondary schools and more were schooling in urban setting 2873 (50.2%). [Table 1] shows the demographic characteristics of school children surveyed.
Table 1: Demographic characteristics of school children surveyed

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Spectacle preferences

Red-coloured spectacle frames were the most commonly preferred 2027 (35.4%) of the eight options of colours followed by blue colour 921 (16.1%). The majority of the children preferred frames with straight earpiece 4611 (80.6%) and those made of plastic materials 3593 (62.8%). Rectangular lens shape 3167 (55.3%) and medium lens sizes 3355 (58.6%) were mostly preferred. [Table 2] shows the spectacle choice preferences of the participants.
Table 2: Spectacle choice preferences of participants

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Associations with spectacle frame preferences

The choice of red over other colours of spectacle (including no choice at all) was strongly associated with the children's age (P = 0.04), gender (P < 0.001), and type of school (P = 0.009). However, there was no association with the school location or class of the child (P > 0.05). [Table 3] shows the binary logistic regression model of factors associated with school children's preferences for red over other spectacle colours or no choice of colour.
Table 3: Binary logistic regression model of factors associated with school children's preferences for red over other spectacle colours or no choice of colour

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The preference for medium-sized lenses over other sizes or no choice at all is strongly associated with child's age (P < 0.001) and gender (P = 0.001) while the preference for rectangular shaped spectacles over other shapes is strongly associated with child's age (P = 0.008), gender, class and school location with P < 0.001. [Table 4] shows the binary logistic regression model of factors associated with participant's preferences and no preferences for lens sizes and spectacle shapes.
Table 4: Binary logistic regression model of factors associated with school children's preferences and no preferences for lens sizes and spectacle shapes

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The preference for straight over curved ear-piece frames is strongly associated with child's age (P < 0.001), class (P < 0.001), and type of school ownership (P = 0.03) while preference for plastic spectacle material over metal is associated significantly with child's class (P < 0.001) and type of school ownership (P < 0.001). [Table 5] shows a binary logistic regression model of factors associated with school children's preferences for shapes of earpiece and spectacle material.
Table 5: Binary logistic regression model of factors associated with school children's preferences for shapes of ear piece and spectacle material

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  Discussion Top


This study found that age was a strong determinant of spectacle choice preference among school children. It has a significant association with school children's preferred frame colour, shape of earpiece, lens shape, and size although age is not associated with the participants preferred lens material. Thus, making it the most common factor associated with their preferences. Although the red colour was generally preferred by the children in this study, older children (11–15 years) are more likely to prefer red colour than the younger age group. A study on colour preferences among Nigerian school children reported that school children generally prefer red colour irrespective of their ages.[15] However, the colour red having a wide range of shades (varying through lighter to darker red, and from a brighter range to dull red); as well as the varying study designs may be attributed to these finding s. Older age is a documented risk factor for noncompliance with spectacle wear among school children.[11] This may imply that colour preference of older school children should be factored in the provision of spectacles in planning of school eye health programs in the study area.

We found that gender was a significant determinant of the preferred choice of spectacle frame colour, lens size, and shape, but it was not associated with preference for spectacle material and shape of earpiece in our findings. Females preferred medium size, plastic materials, red colour, and rectangular shape lens compared to males. A direct comparison cannot be made with another study,[10] that reported on spectacle preferences among school children due to variations in study designs. However, girls' preference of red-coloured spectacles compared with boys may have practical implications in stocking spectacles in paediatric eye care.

In our study, lens shape preference was significantly associated with urban location of the school. This may have deeper implications as urban residence was found to be a risk factor associated with noncompliance to spectacle wear among school children in Mexico.[11]

In contrast to our finding of straight earpiece been preferred in this study, school children's preference of curved earpiece has been observed in another study in China.[10] Parents and children have suggested that a curved earpiece is likely to hold the glasses in place and likely to ensure compliance of spectacle wear in children.[10] This suggests that cultural or contextual factors may play a role in children's spectacle preference.

Our finding that the school class being associated with spectacle lens shape and material is similar to a Chinese report,[10] where both primary and secondary school children considered material (plastic generally more preferred to metal) and shape very important in their evaluation of glasses design. Rectangular/square-shaped lens preference over round ones in their study,[10] is also similar to our findings. This may have implication when considering the manufacturing of paediatric spectacles presently; although it is a known fact that there is usually a trend with choices which may vary over time.

To the best of our knowledge, this is the first study to explore the spectacle preferences of school children in Nigeria. Spectacles are available in many shapes, sizes, and colours and our selection may not have been representative of all the spectacles available. However, every effort was made to include the wide array of options available to us at the time of this study, and our findings indicate that there are spectacle preferences amongst school children. This study did not explore the cost implication of these preferred spectacles and this may be a barrier to the use of spectacles among school children in a resource-limited setting.[16] Further research is however indicated to determine how these choices may influence spectacle compliance among children.


  Conclusions Top


This study highlighted the spectacle designs preferred by school children in South-East Nigeria; findings may be used as a guide in planning paediatric spectacle services to enhance compliance to spectacle use among children. Further studies are needed to ascertain how the inclusion of popular preferences and especially allowing the child to make his choice will affect compliance with spectacle uptake and use by school children. Parents, caregivers, and relevant healthcare providers must recognize and incorporate the spectacle preference of the child when considering refractive correction.

Limitations

This study was carried out using the spectacle designs available; diligent efforts were made to procure as many designs as possible. However, we acknowledge that there may be other designs which were not in the selection presented to the participants.

Acknowledgment

This study was supported by the Tertiary education trust fund (Grant Number: TETF/DESS/NRF/UUNN/NSUKKA/STI/VOL. 1/B4.7).

Financial support and sponsorship

The Nigeria tertiary education trust fund (TETfund).

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Flaxman SR, Bourne RR, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, et al. Global causes of blindness and distance vision impairment 1990–2020: A systematic review and meta-analysis. Lancet Glob Health 2017;5(12):e1221-34.  Back to cited text no. 2
    
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Chan VF, Singer S, Naidoo KS. Disability-related-distress in primary school learners with vision impairment due to uncorrected refractive error in KwaZulu-Natal Province, South Africa – A qualitative study. PLoS One 2020;15:e0229108.  Back to cited text no. 3
    
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Resnikoff S, Pascolini D, Mariotti SP, Pokharel GP. Global magnitude of visual impairment caused by uncorrected refractive errors in 2004. Bull World Health Organ 2008;86:63-70.  Back to cited text no. 4
    
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Barria F, Conte F, Muñoz S, Leasher JL, Silva JC. Prevalence of refractive error and spectacle coverage in schoolchildren in two urban areas of Chile. Rev Panam Salud Publica 2018;42:e61.  Back to cited text no. 5
    
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Sewunet SA, Aredo KK, Gedefew M. Uncorrected refractive error and associated factors among primary school children in Debre Markos District, Northwest Ethiopia. BMC Ophthalmol 2014;14:95.  Back to cited text no. 7
    
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Morjaria P, McCormick I, Gilbert C. Compliance and predictors of spectacle wear in schoolchildren and reasons for non-wear: A review of the literature. Ophthalmic Epidemiol 2019;26:367-77.  Back to cited text no. 8
    
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Gogate P, Mukhopadhyaya D, Mahadik A, Naduvilath TJ, Sane S, Shinde A, et al. Spectacle compliance amongst rural secondary school children in Pune district, India. Indian J Ophthalmol 2013;61:8-12.  Back to cited text no. 9
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Zhou Z, Kecman M, Chen T, Liu T, Jin L, Chen S, et al. Spectacle design preferences among Chinese primary and secondary students and their parents: A qualitative and quantitative study. PLoS One 2014;9:e88857.  Back to cited text no. 10
    
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Castanon Holguin AM, Congdon N, Patel N, Ratcliffe A, Esteso P, Toledo Flores S, et al. Factors associated with spectacle-wear compliance in school-aged Mexican children. Invest Ophthalmol Vis Sci 2006;47:925-8.  Back to cited text no. 11
    
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Brodie FL, Nattagh K, Shah V, Swarnakar V, Lin S, Kelil T, et al. Computed tomography-based 3D modeling to provide custom 3D-printed glasses for children with craniofacial abnormalities. J AAPOS 2019;23:165-7.e1.  Back to cited text no. 12
    
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Negrel AD, Maul E, Pokharel GP, Zhao J, Ellwein LB. Refractive Error Study in Children: Sampling and measurement methods for a multi-country survey. Am J Ophthalmol 2000;129:421-6.  Back to cited text no. 13
    
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National Bureau of Statistics. Projected Population by State (2012-2016); 2018. p. 1-26. Available from: https://nigerianstat.gov.ng/download/775. [Last accessed on 2021 Mar 05].  Back to cited text no. 14
    
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Koleoso ON, Ehigie BO, Akhigbe KO. Colour preference among children in a Nigerian Montessori school. Mediterr J Soc Sci 2014;5:325-32.  Back to cited text no. 15
    
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Odedra N, Wedner SH, Shigongo ZS, Nyalali K, Gilbert C. Barriers to spectacle use in Tanzanian secondary school students. Ophthalmic Epidemiol 2008;15:410-7.  Back to cited text no. 16
    



 
 
    Tables

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



 

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