Strabismus as seen in children aged 3 to 5 years attending Nairobi city council day nursery schools in Nairobi province, Kenya

Abstract

Kenya has an estimated population of 30 million people and out of this 50% fall below the age of 15 years. The birth rate is estimated to be between 3 - 4%. Taking this into account and the fact that the incidence of childhood strabismus is about 5%, then the number of pre-school going children with strabismus and hence amblyopia is quite significant. Amblyopia is noted to be the most often cause for blindness in young people up to the age of 30 years, and it will develop in any child with manifest constant strabismus which is not treated. Early detection and treatment of amblyopia by patching gives excellent results. Though amblyopia is the main worry in a child with strabismus, it is also important to note that strabismus also has an adverse effect on the affected persons livelihood, self image, ability to obtain work, interpersonal relationships, schooling and sports activity throughout life. There is a wide variety of views on the etiology of strabismus but for the practicing ophthalmologist the etiology of strabismic deviations is of small importance. Early detection and rational treatment overshadows the etiological factors which of course should not be ignored in totality. Evidence from various studies cited here has shown that early screening, early detection and early treatment is the way forward as far as strabismus is concerned. A cross-sectional study of strabismus as seen in children aged 3 to 5 years attending Nairobi City Council Day Nursery schools was conducted over a period of3 months, July 2002, September 2002 and October 2002. The aim of the study was to determine if an Orthoptic eye assessment is necessary in pre-school going children in Kenya. Assessment for strabismus was done by taking visual acuity performing extra ocular muscle motility, performing Brueckener, Hirschberg, Krimsky and cover tests. A total of 559 children underwent an orthoptic assessment. The male to female ratio was 1:1. 3% of them had strabismus and exotropia was the commonest type of squint (94%). 56% of the squinting children had Amblyopia. One of the children with squint underwent squint surgeryby a visiting ophthalmologist during a workshop organized by the Department of Ophthalmology,UON. In conclusion the prevalence of strabismus in pre-school going children seen in the study was similar to most studies reported in the western countries.