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Indian Pediatr 2015;52:
783-785 |
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Ocular Morbidity among Students in Relation
to Classroom Illumination Levels
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Shailesh Wagle, Ramachandra Kamath, *Rajnarayan
Tiwari and #Shreemathi
Mayya
From Department of Public Health and #Statistics,
Manipal University, Manipal, Karnataka; and *Occupational Medical
Division, National Institute of Occupational Health, Meghani Nagar,
Ahmedabad, Gujarat; India.
Correspondence to: Dr Rajnarayan R Tiwari, Scientist
E, National Institute of Occupational Health, Meghani Nagar, Ahmedabad
380 016, Gujarat, India.
Email:
[email protected]
Received: October 30, 2014;
Initial review: January 28, 2015;
Accepted: June 23, 2015.
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Objective: This cross-sectional study was done to find the
prevalence of eye strain and other ocular morbidities among students in
Udupi, Karnataka.
Methods: The study protocol included interview,
visual acuity examination using Snellen chart, and measuring classroom
illumination through lux meter.
Results: 26% students had visual morbidity and
the most prevalent symptoms of eyestrain were headache (38.6%), watering
of eyes (25.7%), pain around eyes (15.6%) and blurred vision (11.9%).
55.5% classrooms and 88.4% blackboards did not have proper illumination.
Conclusions: Low classroom illumination levels
may be a possible factor for development of visual morbidity.
Keywords: Asthenopia, Eyestrain, School children, Factors.
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T he quality of the environment provided by the
school greatly affects a student’s health. Illumination is one such
factor, reported by research studies to have significant effect not only
on the performance of the students, but also on their physical and
mental health [1]. Having their origin in childhood, many ocular
morbidities go unnoticed and are responsible for affecting the
performance of a child in school and also to cause severe disability in
future [2]. Low levels of illumination have also been proven to be a
factor in development of asthenopia or eye strain [3]. Thus the present
study was carried out to assess the prevalence of eye strain and other
ocular morbidities among students of government primary schools in Udupi
taluk in Karnataka, and to assess possible associations between
eyestrain and level of classroom illumination.
Methods
The present cluster-based cross-sectional study was
conducted in government primary schools in Udupi taluk. After ethical
clearance from the Institutional Ethics Committee, students from Class 6
and 7 of nine randomly selected schools were included in the study.
Students with congenital eye problems, with history of trauma or
surgical procedure of the eyes were excluded. Students who had not been
studying in the same school from Class 3, i.e., at least 3 years
in the same school environment were also excluded to ensure equal
duration of exposure to illumination in classrooms. Written informed
consent from head teachers of all schools and verbal assent was taken
from each student before examination.
Students were interviewed using a semi-structured
questionnaire that included details regarding personal characteristics
and visual symptoms. Standard procedures using a standard Snellen "E"
chart was used to conduct vision testing [4]. A score of less than 6/9
with either or both was taken as case of visual morbidity. A separate
"school detail form" was used to gather details about the school, and
classroom and blackboard illumination were assessed separately using
standard calibrated digital lux meter (LX-1010B).
Results
Of the 596 students enrolled in the study, 319
(53.5%) were boys. When asked regarding housing conditions, 92.1%, 78.4%
and 84.6% reported availability of electricity, tube lights and
television in their homes, respectively. Using Snellen E chart, 155 (26
%) were found with visual morbidity (Table I).
TABLE I Distribution of Visual Acuity and Symptoms among Students (N=596)
Visual Morbidity Status |
Frequency (%) |
Reduced visual acuity |
155 (26.0) |
Visual Symptoms |
Frequency (%) |
Unclear view in Class |
68 (11.4) |
Double image |
8 (1.3) |
Blurred vision |
71 (11.9) |
Watering of eyes |
153 (25.7) |
Pain around eyes |
93 (15.6) |
Redness of eyes |
20 (3.4) |
Vision checked by a doctor |
18 (3.0) |
Non Visual Symptoms |
Headache |
230 (38.6) |
Tired feeling |
3 (0.5) |
Unsatisfied with sleep |
33 (5.5) |
The measurement of illumination levels showed that
among the 69 classrooms and blackboard evaluated, 61 (88.4%) blackboards
and 38 (55.1%) classrooms failed to meet the standard level of 300 lux
[5]. Classroom illumination was found to have significant association
with visual morbidity [OR=1.5 (1.0-2.2); P=0.0047] while
blackboard illumination levels were not associated with visual morbidity
(Table II).
TABLE II Association Between Visual Morbidity and Blackboard and Classroom Illumination Levels
Illumination level |
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Visual morbidity
|
P value |
Unadjusted |
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Present (%) |
Absent (%) |
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OR (95%CI) |
Classroom illumination level |
Improper (<300 lux) |
102 (29) |
250 (71) |
0.047 |
1.5 (1.0 – 2.2) |
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Proper (>300 lux) |
53 (21.7) |
191 (78.3) |
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Blackboard illumination level |
Improper (<300 lux) |
24 (32.4) |
50 (67.6) |
0.178 |
1.43 (0.69-1.97) |
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Proper (>300 lux) |
131 (25.1) |
391 (74.9) |
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Discussion
This cross-sectional study in government primary
schools in a district in Southern India showed visual morbidity in 26%
students. A significant number of classrooms (55.1%) and blackboards
(88.4%) in these schools had sub-optimal illumination.
The prevalence of visual morbidity is similar to
findings of other National [2,6,7] and International [8,9] studies. An
earlier study in the same region also reported that 65% of classrooms in
primary schools in were not adequately illuminated or ventilated [10]. A
study from in Pakistan [11]
also found that classroom illumination was a statistically significant
factor for causing visual morbidities.
The study has the limitation of finding the
prevalence of only refractive error as the study design did not allow
for the detailed evaluation of each subject. However, all efforts were
made that the study subjects share the same environment so as to
minimize the effect of other factors.
Thus based on the study findings it is recommended
that the students should be periodically examined for visual health with
the help of trained professionals at school level. At the school level,
regular infrastructural audit should be conducted to assess the
environmental parameters which may affect students’ health adversely.
Emphasis should be given on utilization and maintenance of appropriate
artificial illumination sources such as tube lights and bulbs.
Contributors: SW: collection, analysis and
interpretation of data; RK: Analysis and interpretation of data; RT:
Analysis and interpretation of data and preparation of manuscript; SM:
Statistical analysis of data.
Funding: None; Competing interest: None
stated.
Ethical Clearance: The Manipal University Ethics
Committee has cleared this study.
Consent of the guardian: As the study was carried
out during school timings it was not feasible to take consent of
parents. However the consent of the class teachers who are guardian of
the students during school hours was taken. In addition the verbal
assent of the participating student was also taken.
What This Study Adds?
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High proportion of classrooms
and blackboards in the study area were sub-optimally
illuminated.
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Classroom illumination was significantly associated with
visual morbidity among the study population.
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