ResultsThe clinical information was limited in many of these cases, but the great majority of conjunctival biopsies had been diagnosed either as pterygium or pinguecula (Fig. 1), though the criteria for this differentiation were not constant. There were also some patients with a clinically invasive carcinoma (Fig. 2) and a few with other lesions such as papilloma.
HISTOPATHOLOGYThe main histological features and the diagnosis are shown in Tables 1 and 2; 167 lesions were reclassified as 'solar keratosis' with varying degrees of 102 on 11 May 2018 by guest. Protected by copyright.
Self-treatment for eye diseases is very common in most developing countries yet there has been little investigation of such attitudes and practices. In many settings, people do not proceed beyond self-treatment and do not receive care from either traditional healers or Western eye care providers. Visual impairment and blindness can be the result. We conducted population-based survey of use of eye care services and self-treatment in two districts of Malawi. Adults were administered a detailed interview regarding their use of eye care services (Western and traditional as well as self-treatment) and their knowledge and use of traditional eye medicines. Self-treatment was defined as use of either Western or traditional medicines by the individual for their most recent eye condition. Only eye conditions that were considered severe by the study subjects were correlated with treatment options. Interviews were carried out among 800 adults in the study areas. Self-treatment was reported for the last episode of eye disease by 39.8% of the study population. Factors associated with self-treatment included sex, religion and socioeconomic status. Even though 76.8% of the respondents reported treatment from the health center or hospital to be the least expensive option, many opted for self-treatment first. Among those opting for self-treatment 72% used traditional eye medicines. Even among cases that individuals considered to be quite severe (these included cataract, trachoma and conjunctivitis), self-treatment was the option of choice in 22.2% of cases.
A case-control study of breast-feeding and weaning patterns associated with xerophthalmia was conducted among children aged 24-71 mo in Southern Malawi in 1983. One hundred fifty-two children with active xerophthalmia were compared to 151 clinically normal children matched on age (+/- 12 mo), sex, and village of residence. All children were initially breast-fed; however, children with xerophthalmia began weaning onto porridge (p = 0.05) and ceased breast-feeding earlier (p less than 0.01 for 24-47 mo olds), had a shorter weaning interval (p less than 0.005), and were fully weaned from the breast for a longer duration (p less than 0.025) than the controls. The association between earlier cessation of breast-feeding and subsequent xerophthalmia was strongest during the immediate post-weaning years. These findings imply a protective role for breast-feeding against xerophthalmia in early childhood.
Genetic factors are the main causes of childhood blindness in developed countries (Sorsby, I966; Fraser and Friedmann, I967; Merin, Lapithis, Horowitz, and Michaelson, I972; Goldstein, 1972 Chronicle, 1973).Since the early I960S the Eye Departnent of the Hadassah Hebrew University Hospital in Jerusalem has been sponsoring the ophthalmological care in many African countries (Michaelson, 1972). In Malawi sponsoring started in I965. After io years a study was undertaken in order to evaluate the causes of blindness in the past, the current causes of blindness, and to assess the expectations for the future.We report here a retrospective study on the causes of blindness as presented by students in blind school institutions all over Malawi.
Patients and methodsTwo hundred and seventy students attending 17 blind school institutions were examined. The location of these schools is shown in the Figure. Admission to them is non-selective and depends on the number of vacant places available at the time of application. However, the following conditions play a role as selective factors. (i) Owing to tradition and culture fewer females than males apply. Therefore the relative proportion between sexes in this study does not reflect the real situation.(2) Blindness due to causes that may influence the life expectancy will not be found and their contribution to 'all' causes of blindness will not be shown in this study.(3) Admission to the blind schools is generally at the age of 4 to 6 years, therefore most cases will represent mainly the causes of blindness in childhood.
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