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ORIGINAL ARTICLE
Year : 2021  |  Volume : 24  |  Issue : 12  |  Page : 1828-1834

Spectacle design preferences among school children in Enugu State, Nigeria


1 Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu State, Nigeria
2 Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu State, Nigeria
3 Department of Paediatrics, University of Texas Health Science Centre, Houston, TX, USA

Date of Submission23-Aug-2020
Date of Acceptance16-Feb-2021
Date of Web Publication09-Dec-2021

Correspondence Address:
Dr. N N Udeh
Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_521_20

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   Abstract 


Background: Uncorrected refractive error has profound effects on children's educational and social development and spectacles are cost-effective in correcting this. However, the cosmetic appearance of spectacles may affect compliance to prescribed spectacles. Aims: This study explored spectacle design preferences of school children in Enugu State, Nigeria and any associated sociodemographic factors. A cross-sectional study among children aged 5–15 years from schools in Enugu state, Nigeria. Patients and Methods: The children independently selected from sets of spectacle frames, indicating their preferences on the basis of spectacle frame color, material, shape and size of the lens portion, design of the earpiece portions. Simple descriptive analysis was performed. Frequency tables were generated. Pearson's Chi-square test was used to test associations between categorical variables. Odds ratios were used to measure the strength of the associations where P < 0.05. Tests of significance were set at the 95% level. Results: A total of 1,167 children (45.6% male and 54.4% female) were seen. Majority of the children preferred red colored spectacle frames 467 (40%), plastic frames 723 (62%), rectangular shaped lens-pieces (55.2%), and frames with a straight earpiece 987 (84.6%). There is a strong association between gender and choice of spectacle colour (P < 0.01), gender and lens size preference (P < 0.05), and between school location and shapes of spectacle earpiece (P < 0.01). Conclusions: Spectacle preferences exist among the study population and some demographic factors are associated with these preferences which should be considered in any childhood refractive error services.

Keywords: Enugu, Nigeria, preferences, school children, spectacle, spectacle design


How to cite this article:
Aghaji A E, Udeh N N, Okoye O I, Oguego N C, Okoye O, Maduka-Okafor F C, Umeh C A, Ezegwui I R, Nwobi E A, Onwasigwe E N, Umeh R E. Spectacle design preferences among school children in Enugu State, Nigeria. Niger J Clin Pract 2021;24:1828-34

How to cite this URL:
Aghaji A E, Udeh N N, Okoye O I, Oguego N C, Okoye O, Maduka-Okafor F C, Umeh C A, Ezegwui I R, Nwobi E A, Onwasigwe E N, Umeh R E. Spectacle design preferences among school children in Enugu State, Nigeria. Niger J Clin Pract [serial online] 2021 [cited 2022 Jan 20];24:1828-34. Available from: https://www.njcponline.com/text.asp?2021/24/12/1828/332083




   Introduction Top


It is estimated that 116 million persons globally have refractive error, which is the commonest cause of visual impairment.[1] The World Health Organization estimates that 12.8 million children are visually impaired from uncorrected refractive error (URE) with a wide regional variation in the prevalence of 0.24% of children in Africa and 2.7% in China.[2] In addition, about 12% of children globally are myopic and 15% of children have some form of astigmatism.[3]

National and subnational prevalence of refractive error in children have been reported in China 18.8%,[4] South Africa 7%,[5] Ethiopia 3.5%,[6] and Nigeria 2.2%.[7]

Even within Nigeria the prevalence of refractive error in children varies from 0.7% in a rural south-eastern population,[8] to 6.8% in a semi-urban population in the southwest.[9]

Research suggests that with increased education and decreased outdoor activity, refractive error (myopia) will increase and an epidemic of myopia is predicted.[10]

URE is associated with social seclusion, lower employment opportunities, and affects the educational performance of children.[11] URE is readily remediable and spectacles are a cost-effective method for correcting refractive error. Refractive error studies in children have demonstrated a large unmet need for spectacles; 51.9% in Sao Paulo Brazil,[12] 60.7% in rural Southern China,[13] and 81% in South Africa.[14] It has been reported that lack of parents awareness, fear that spectacles may worsen vision, and cost are reasons for poor spectacle coverage.[12],[15],[16]

Even when spectacles are provided at no cost, compliance levels may remain low. About two-thirds of children in a school in India were not compliant with their free spectacles; the main reason for non-compliance was concern about their appearance.[17] Cosmesis may be a factor affecting spectacle compliance and indeed, the look of spectacles has been reported as a reason for non-compliance with spectacle wear in children.[18],[19],[20]

This suggests that if children are given their preferred spectacle designs, it may positively influence their spectacle compliance.

The aim of this study is to explore spectacle preference in school children in Enugu state, Nigeria.


   Subjects and Methods Top


This was a school-based cross-sectional study among children in Enugu state, based on a modified Refractive Error in School Children (RESC) study protocol.[21] Approval from the ethics committee was obtained 2nd November 2017.

Enugu State is located in the southeast of Nigeria in the tropical rainforest zone. The estimated population is 4.4 million and over 41% of the population is <15 years of age.[22]

The research was carried out in accordance with the Helsinki Declaration and its later modifications. Approvals for the study in Enugu state were obtained from the University of Nigeria Teaching Hospital (UNTH) Human Research and Ethics Committee, Enugu State, the Universal Basic Education Board (UBEB), and the Enugu state Post Primary School Management Board (PPSMB). Each school authority gave institutional consent and parents of guardian of each recruited participant gave an informed consent.

This study was conducted between March and June 2018. Participants were selected by multistage cluster sampling. At the first stage, the Local Government Areas (LGAs) in the state were stratified into urban and rural. One LGA from each stratum was randomly selected. Four strata of schools were identified; Primary schools and secondary schools both public and private were enumerated. One from each stratum was selected. The schools formed the sampling frame and the classes were the sampling units (Primary 1–6 and Junior secondary forms 1–3) for public and private schools. A sample size of 1,080, consisting of 720 primary school and 360 junior secondary school students was calculated, allowing for 20% non-response, total sample size was 1,296. This was part of a larger Refractive Error Study in Children and the RESC protocol was followed. There were two research teams.

Each research team consisted of an ophthalmic nurse, an optometrist, and two ophthalmologists and a social scientist. They were trained using the RESC protocol for 5 days. A specially designed questionnaire to assess spectacle preference was also developed and pretested at the Pediatric Ophthalmology department of the University of Nigeria Teaching Hospital, Enugu. The study was piloted in a non-participating LGA in Enugu state, after which appropriate modifications were made to the study protocol.

For the spectacle preference study, all the recruited pupils were asked independently to select spectacle frames displayed for them on a table. A total of 17 labelled spectacle frames grouped in five different sets based on spectacle frame color, shape, and size of the lens portion of the frames, material with which the frames were made, and the design of the earpiece portions. The selection options are shown in [Table 1]. Mirrors were provided and the children were invited to examine themselves wearing the frames and select their preferred choice from each category. Their preferred options were recorded on a specially developed questionnaire by the study social scientist.
Table 1: Spectacle Selection Options For The Participants

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[Table 1] showing spectacle selection options for the respondents.

Data management

Each questionnaire was checked for completeness by the principal investigator (OIO). The data were double entered into a custom-made database in SPSS (Statistical Package for the Social Sciences, IBM Corporation) software version 22® by two trained data entry clerks and from here data analysis was done. Frequency tables were generated from the data. Simple descriptive analyses were performed. The Chi-square test was used to test associations between categorical explanatory variables (gender, place of residence, age) and response variables (color, shape, size of spectacles). Where any significant associations were found, odds ratios were calculated to determine the measure of the association. For the odds ratio calculation, the age groups were stratified into two groups: Younger (5–9 years) and older (10–15 years). Tests of significance were set at the 95% level.


   Results Top


Demographics

A total of 1,167 children (45.6% male and 54.4% female) were seen. Age range was 5–15 years (Mean 10.6 ± 3.0). The majority of respondents were in public schools (78.7%), schooled in rural areas (51.7%) and were in primary school (62.4%).

Spectacle frame preference

The majority of the children preferred red colored spectacle frames 467 (40%), frames made of plastic material 723 (62%) and with a straight earpiece 987 (84.6%). Spectacle frame color was significantly associated with gender (χ2 = 37.4, P < 0.001), age (χ2 = 80.6, P < 0.001) and location of school (χ2 = 59.2 P < 0.001). There was no association between the type of frame material and the demographic characteristics. Spectacle frame preferences is shown in [Table 2].
Table 2: Spectacle Frame Preferences

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Spectacle lens-piece preference

The preferred spectacle lens shape was rectangular (55.2%), while the preferred size was medium sized lenses 617 (52.9%). Lens shape preference was significantly associated with age (χ2 = 17.8, P = 0.007) and school location (χ2 = 20.2 P < 0.001). Lens size was significantly associated with gender (χ2 = 25.2, P < 0.001) and school location (χ2 = 16.1, P < 0.001). Spectacle lens preferences is shown in [Table 3].
Table 3: Spectacle Lens Preferences

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Based on these preferences, odds ratios were computed to determine the odds of selecting particular spectacle types for each explanatory variable as shown in [Table 4].
Table 4: Odds Ratios For The Association Between Spectacle Characteristics And Demographic Characteristics

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Table 4 showing odds ratios for the association between spectacle characteristics and demographic characteristics.

Children who chose red frames are 1.71 times more likely to be female and 1.5 times more likely to be in the older age group than those that chose other colors. Children who chose medium sized lenses are 1.4 times more likely to be female than those that chose other sizes.


   Discussion Top


Our study shows that females, urban dwelling, and older children have preference for particular spectacle characteristics. Our findings suggest that older females are more likely to choose red colored spectacles frames with medium sized lenses. It also indicates that the majority of children will prefer straight earpiece configurations to the curved variety.

Age and location of residence may play a role in spectacle preference. Our research showed that rectangular shaped lenses and straight earpieces were almost twice as likely to be preferred by children in urban areas, showing a spectacle preference difference between urban and rural children. A study in China reported that very few rural Chinese children worry about the cosmetic appearance of spectacles.[23] This may suggest that rural children are less likely to be concerned about cosmesis than their urban counterparts.

Also red spectacles were one and a half times more likely to be chosen by children in the older age group. Indeed, a research in Mexico reported that older children and urban children were more likely to be non-compliant with their spectacles because of cosmesis than younger or rural dwelling children.[24] Spectacle preferences of particular groups should be recognized and respected as this may improve spectacle compliance.

Over half of the respondents preferred frames with rectangular lenses and this choice was significantly associated with school location. Some of the results from our study are similar to a study on spectacle preference in China that showed plastic frames were preferable to metal frames and rectangular or oval frames were preferred to round ones. However, Chinese children preferred darker colored frames.[25] A study in India suggests that round spectacle frames may be more popular in urban dwelling children than their rural dwelling counterparts.[26] The preference of rectangular shaped lenses has implications for the manufacture of ready-made spectacles which will require the use of round frames for ease of adjustment of the axis of astigmatism.[24]

Research has shown that concerns about spectacle appearance are a major influence to spectacle compliance, regardless of the degree of vision improvement.[27] About 15% of native American children were not spectacle compliant because of cosmesis.[19] A study in India shows that 12% of children with spectacle non-compliance cited cosmesis as a reason. A study on barriers to spectacle wear in schoolchildren in Lagos, Nigeria shows that over a quarter of children with refractive error rejected the option of spectacles. However, no reason was reported for their decision.[28] It has been suggested that spectacle color design and size should be considered in prescribing spectacles for children.[26] Spectacle characteristics have important consequences for spectacle preference and may ultimately affect spectacle compliance. Children are twice as likely to be spectacle compliant if they like how they look in the spectacles.[19]

Implications for policy

Some of the challenges of bulk buying of affordable frames include sourcing cosmetically acceptable products and keeping abreast of trends.[29] Our study shows that certain demographic groups are more likely to make particular spectacle preferences. These preferences should be considered when stocking spectacle frames for children as satisfaction with spectacle appearance may improve spectacle compliance.

Strengths of the study

This is the first study to explore spectacle preferences in children in Nigeria. The robust RESC sampling methodology suggests that the findings from this study may be replicable in other settings with similar sociodemographic characteristics. It was part of a standard RESC study which used validated sampling methods and was representative of children in the region in terms of age, location, and gender. Limitation of the study. There were 17 different designs of spectacles that the respondents had to choose from. This may not reflect the reality where children may be asked to select spectacles with a combination of different characteristics. The relatively high measure of effect suggests that certain spectacle characteristics are associated with particular social groups, but these preferences may be culturally specific, and caution should be taken in generalizing the results. Also, spectacle designs and children's preferences may change over time. Furthermore, the cost implication of the spectacle designs was not explored. Cost could be a barrier to acquiring preferred spectacle designs.


   Conclusion Top


Spectacle design preferences exist among the study population and some demographic factors are associated with these preferences which should be considered in any childhood refractive error services. It is hoped that this study will generate more research on spectacle design preferences in children.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgements

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.



 
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    Tables

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



 

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