CHAPTER ONE

INTRODUCTION

Background to the Study

Cataract is the opacity of the natural human lens, which may be caused by congenital, developmental, or
acquired factors. Cataract is the leading cause of blindness worldwide, accounting for more than half of the
39 million blind people globally, and its impact on blindness is particularly pronounced in Sub-Saharan
Africa. It affects all age groups, but is particularly prevalent in people over 50 years old. If timely
intervention is not instituted, it can lead to various catastrophic complications, ultimately resulting in
irreversible blindness. This condition's negative psycho-social and economic impact is evident at the
individual, family, and community levels (Alimaw et al., 2019).
According to the World Health Organization (WHO), cataract is the clouding of the lens of the eye, which
initially prevents clear vision and eventually progresses to blindness if left untreated. It causes increased
light sensitivity, decreased vision at night, seeing double images, and ultimately leads to total blindness.
Although the most common causes of cataract are related to the aging process, children can occasionally be
born with the condition, or a cataract may develop after eye injuries, inflammation, or other eye diseases.
Evidence suggests that women are at a greater risk than men for developing cataracts. This condition is the
most avoidable if timely intervention is instituted (Fikrie et al., 2021).
In Nigeria, reports from the national survey showed that cataract accounted for 43% of blindness and 45.3%
of severe visual impairment. The prevalence of cataract in the Nigeria national survey was 19.8% in persons
40 years and above. Cataract is associated with socio-economic problems leading to degradation of quality
of life (Amobi et al., 2021). Globally, at least 2.2 billion people have vision impairment. Among this, 65.2
million people suffer from moderate or severe distance vision impairment or blindness due to cataract. The
proportion of blindness due to cataract among all eye diseases ranges from 5% in developed countries to
50% or more in low- and middle-income regions of western and eastern sub-Saharan Africa (5.1%) and
South Asia (Fikrie et al., 2021).
Knowledge about cataracts is crucial for delaying its occurrence, promoting regular eye checkups , and
instituting timely interventions. These ultimately reduces the disease boarding. Moreover, accessing
knowledge about cataract is essential for designing effective health education and health promotion
programs. In developing countries, health education and promotion plays a significant role in reducing the
body of avoidable causes of blindness and visual impairments (Alimaw et al., 2019). Insufficient awareness
among eye patients often prevent them from receiving appropriate interventions, leading to low visual acuity
and blindness.
According to WHO (World Health Organization), there is no known prevention for cataracts. Reduction of
cigarette smoking, reduction of ultraviolet light exposure may lead the development of cataract. The WHO
prevention of blindness program provides technical support to member states in the development of
comprehensive eye care systems to address the burden of cataracts.

Statement of Problem
Cataracts remains a leading cause of visual impairment among adults worldwide, particularly in developing
countries were healthcare resources and public health education may be limited.
Emejuru et al., (2019), in their study on the awareness and knowledge of cataract and its prevention among
adults in Owerri, Nigeria, there is a concerning low level of awareness and understanding of cataracts and its
preventive measures among the general population. The researcher, during her visit to Owerri municipal
local government area, for community outreach, noticed that a lot of adults (more than 200 of them) lack the
knowledge about cataract, it's causes, how to detect it early and the preventive measures of cataracts. And
it's this gap in knowledge that has prompted the researcher to carry out this study.
Nwakuche et al., (2019), in their study on the prevalence of low vision in Owerri municipal in Imo State,
Nigeria, the prevalence of low vision was small in female (56.60%) than meals (43.33%). About 60% were
above 50 years of age. The major causes of low vision where cataract (35.29%), glaucoma (29.41%) and
glaucoma/cataract (23.52%).
Going by this record, and study by Nwakuche et al., (2019), the researcher noticed that cataract is a
significant public health concerned in Owerri municipal. Also she noticed that insufficient awareness and
education about cataracts and its prevention, early detection and treatment is a significant problem. This has
made the researcher to carry out the study focus on their awareness and the preventive practices of cataract
to prevent this condition from progressing to severe vision loss.

Objectives of the study

The specific objectives of the study is to:

1. Determine the level of the causes of cataract among adults in Owerri municipal, Imo State.
2. Determine the level of awareness of the signs and symptoms of cataract among adults in Owerri
municipal, Imo State.
3. Ascertain the preventive practices for cataract among adults in Owerri municipal, Imo State.
4. Ascertain barriers to effective cataract prevention and management in Owerri municipal, Imo State.

Research questions
1. What is the level of awareness of the courses of cataract among adults in Owerri municipal, Imo
State?
2. What is the level of awareness of the signs and symptoms of cataract among adults in Owerri
municipal, Imo State?
3. What are the preventive practices of cataract among adults in Owerri municipal, Imo State?
4. What are the barriers to effective cataract prevention and management in Owerri municipal, Imo
State?

Significance of the study

The findings from this study will be beneficial to the following stakeholders stated below:
Nursing profession: The study will help nursing professionals design better education programs, improve
patient education and enhance their overall understanding of cataract-related issues. It can help nurses
identify gaps in current knowledge and practices, which can inform the development of targeted
interventions to improve cataract awareness and management.
Healthcare providers: This study can be used to tailor healthcare services to meet the specific needs of the
population, improve patient outcomes and address gaps in knowledge and practices.

Future Researchers: The study will contribute to the existing body of knowledge on cataract awareness and
preventive practices. The findings can also contribute to the development of new research questions,
methodology and interventions that can be tested in future studies, ultimately leading to the advancement of
knowledge in the field of cataract research.

The Society: By raising public awareness, the study will empower individuals to take proactive steps in
maintaining their eye Health and recognizing the early signs of cataract. This increased knowledge can lead
to early diagnosis and treatment; improving overall eye health and reducing the burden of cataract-related
complications on the society.

Scope of the study

This study is delimited to awareness and preventive practices of cataract, risks and symptoms; limited to
adults from 40 to 75 years. It is encompassing both genders and various socioeconomic statuses in Owerri
municipal, Imo State. This study will be conducted over a period of 6 months, allowing for data collection
across different seasons to accept variations in awareness and practices over time.

Operational definition of terms.

Awareness of cataract: In this study, this refers to the level of knowledge and understanding among adults
in owerri municipal regarding the courses, symptoms, risk factors, and consequences of cataract, accessed
through structured questionnaires and interviews.
Causes of cataract: This refers to the extent to which adults in Owerri Municipal, Imo State are informed
and educated about the factors that contribute to the development of cataracts. This includes understanding
the risk factors, potential triggers, and preventive measures that can be taken to lower the likelihood of
cataract formation in their lives.

Signs and Symptoms of cataract: This is the extent to which adults in Owerri Municipal, Imo State are
informed and educated about the visible indicators and early warning signs that suggest the presence of
cataracts. This includes recognizing changes in vision, such as blurred or cloudy vision, difficulty with glare,
faded colours, and poor night vision, as well as being able to identify potential symptoms like double vision
or frequent changes in eyeglass prescriptions.
Preventive practices of cataracts: In this context, this at the behaviours and actions adopted by adults in
Owerri municipal to reduce the risk of developing cataract, including regular eye examinations, wearing UV
protective I will, maintaining a healthy diet rich in vitamins supporting eye Health and avoiding smoking,
alcohol consumption and excessive son exposure.
Adults: In this studying, these are individuals aged 40 years to 75 years (male and female), residing in
Owerri municipal, Imo State.
Owerri municipal: This is the study setting. Owerri municipal is a local government area characterized by
diverse social economic backgrounds, which make it an ideal area to study.

CHAPTER TWO
LITERATURE REVIEW
The relevant literatures from journals, internet and textbooks with discussed under the following headings:
Conceptual Review:
• Concept of Cataract.
• Types of Cataracts,
• Causes of Cataract
• Pathophysiology of Cataract
• Signs and symptoms of Cataract
•Diagnosis and treatment of Cataract.

Theoretical Review
Empirical Review
Summary of the Literature Review

Conceptual Review
Concept of Cataract
Cataract is a common eye condition that affects many adults worldwide, including those in Owerri
Municipal, Imo State. Cataract refers to opacity of crystalline lens in the known eye (Chitkara, 2014),
muscle, it is opacity of the natural crystalline lens of the eye and it remains the most common cause of visual
loss in humans. According to clinical of thermology (2014), cataract is an opacity in the crystalline lens of
the eyes that causes a decrease in vision and impairs the lenses ability to focus light on the retina. Cataract is
an opacity of the lens of the eye that impairs vision and can be surgically removed (Girkin et al., 2016).
Cataract is a clouding of the lens of the eye that causes a decrease in vision and impairs the lenses ability to
focus light on the retina, typically resulting from aging process (Roberts et al., 2018).
In view of these definitions from different authors, the researcher can describe cataract as a vision impairing
eye condition characterized by the development of an opacity in the crystalline lens, affecting light focus on
the retina, and can be surgically removed.

Types of Cataracts
Cataracts can manifest in different forms depending on their location within the lens and the underlying
cause:

1. Age-Related Cataracts: These develop gradually over time and are primarily associated with aging.
They are further classified into subtypes such as nuclear sclerosis, cortical cataracts, and posterior
subcapsular cataracts (NEI, 2021).

2. Congenital Cataracts: Present at birth or develop during infancy due to genetic mutations, intrauterine
infections, or metabolic disorders (NEI, 2021).

3. Secondary Cataracts: Arise as a complication of other ocular conditions like uveitis, glaucoma, or
following eye surgery (NEI, 2021).

4. Traumatic Cataracts: Result from direct trauma to the eye, causing disruption of the lens fibers and
subsequent opacity (NEI, 2021).

5. Radiation Cataracts: Occur following exposure to ionizing radiation, such as that used in cancer
treatment (NEI, 2021).

6. Becerra (2020) states that toxic cataracts is one of the types of cataract and it is as a result of long-term
use of corticosteroids either systematically or topically or exposure to environmental pollutants.

Causes of Cataract

According to Becerra (2020), the causes of cataracts can be categorized as follows:

Age-Related Cataracts: As people age, the lens becomes more susceptible to oxidative process, protein
denaturation comma and accumulation of advanced ligation and products (AGEs), leading to opacification
and vision loss.

Congenital Cataracts: These are present at birth and can be caused by genetic factors, maternal infections
during pregnancy, or exposure to teratogenic drugs.

Secondary Cataracts: These can develop as a complication of other eye conditions, such as uveitis and so
on.
Traumatic Cataracts: trauma to the eye can cause physical damage to the lens, leading to cataract
formation.

Radiation Cataracts: exposure to ionizing radiation, such as x-rays or gamma rays, can cause damage to
the lens and lead to cataract formation.

Metabolic Cataracts: Certain metabolic disorders such as galactosemia can lead to cataract formation.

Toxic Cataract: Exposure toxic substances, such as certain medications or environmental pollutants can
cause cataract.

Gupta and Dua (2015) emphasized that one age is the most common risk factor for cataract formation, other
modifiable factors such as ultraviolet radiation exposure commerce smoking and poor nutrition can also
contribute to cataract development.

Pathophysiology of Cataract

The lens of the eye is composed of water and proteins arranged in a precise manner
to maintain transparency and allow light to pass through. However, with aging and
other factors, these proteins can become denatured or clump together, leading to
opacity or cloudiness in the lens. This process disrupts the normal transmission of
light to the retina, resulting in visual impairment; characteristic of cataracts (National
Eye Institute [NEI], 2021).

According to Singh and Mahajan (2016), the complex mechanisms behind cataract
formation involve multiple factors, including protein denaturation and aggregation,
advanced glycation end products( AGEs) , reduced antioxidant defense, and calcium
accumulation. Age, genetics, UV radiation systemic conditions contributes to this
processes, ultimately leading to the pacification of the lens and vision loss.

Signs and Symptoms of Cataract

The symptoms of cataracts can vary depending on their severity and location within
the lens. Common manifestations include:

- Blurred or hazy vision

- Increased sensitivity to glare, especially in bright sunlight or when driving at night

- Difficulty reading or performing tasks that require clear vision

- Changes in color perception or contrast sensitivity

- Double vision or multiple images in affected eye(s)

- Frequent changes in eyeglass prescription due to fluctuations in visual acuity

(American Academy of Ophthalmology [AAO], 2021).

Diagnosis and Treatment

Diagnosis of cataracts typically involves a comprehensive eye examination conducted by an ophthalmologist

or optometrist. This may include visual acuity tests, slit-lamp examination, and dilated eye evaluation to
assess the extent of lens opacity and its impact on vision (AAO, 2021). Treatment options for cataracts vary
depending on the severity and impact on visual function. Non-surgical management may involve
prescription eyeglasses or contact lenses to improve visual clarity, while surgical intervention, such as
cataract extraction and intraocular lens implantation, is often recommended for advanced cases (AAO,
2021).

2.2 THEORETICAL FRAMEWORK

The nursing theory that would be suitable for this study is the Health Belief Model (HBM). The Health
Belief Model is often used to understand individuals' health behaviors and their decision-making processes
regarding preventive health actions. It emphasizes the role of perceived threat, perceived benefits, perceived
barriers, and self-efficacy in influencing health-related behaviors.

The Health Belief Model (HBM) is a widely used theoretical framework in health psychology and nursing
that seeks to understand and predict individuals' health-related behaviors. Developed in the 1950s by social
psychologists Hochbaum, Rosenstock, and Kegels, the HBM is based on the premise that individuals' beliefs
about health threats, perceived benefits of action, perceived barriers to action, and self-efficacy influence
their likelihood of engaging in health-promoting behaviors.

Key Constructs of the Health Belief Model:

1. Perceived Susceptibility: This refers to an individual's subjective perception of their risk of developing a
particular health condition. For example, individuals who perceive themselves to be at high risk of
developing cataracts due to family history or environmental factors may be more motivated to engage in
preventive behaviors.

2. Perceived Severity: This refers to an individual's perception of the seriousness and consequences of a
health condition. Individuals who perceive cataracts as a severe condition that can lead to vision loss and
impaired quality of life are more likely to take preventive actions.
3. Perceived Benefits: This refers to an individual's beliefs about the effectiveness of a specific health
action in reducing the threat of a health condition or its severity. For example, individuals who believe that
regular eye examinations and UV-protective eyewear can reduce their risk of developing cataracts are more
likely to engage in these behaviors.

4. Perceived Barriers: This refers to the perceived obstacles or costs associated with adopting a health-
promoting behavior. Barriers may include financial constraints, lack of access to healthcare services, or
cultural beliefs. Identifying and addressing perceived barriers is essential for promoting behavior change.

5. Cues to Action: These are external or internal triggers that prompt individuals to take action to protect
their health. Cues to action may include advice from healthcare providers, media campaigns, or personal
experiences with illness.

6. Self-Efficacy: This refers to an individual's confidence in their ability to successfully perform a specific
health behavior. Individuals with high self-efficacy are more likely to overcome obstacles and persist in their
efforts to adopt healthy behaviors.

Application of the theory to the study

1. Perceived Threat: Assessing individuals' perception of their susceptibility to cataracts and the severity of
cataract-related vision loss. This can help understand how individuals perceive the threat posed by cataracts
and their motivation to engage in preventive practices.

2. Perceived Benefits: Evaluating individuals' beliefs about the effectiveness of preventive practices in
reducing the risk of developing cataracts. This can shed light on the perceived benefits of adopting
preventive behaviors such as regular eye check-ups and UV-protective eyewear.

3. Perceived Barriers: Identifying the barriers that individuals perceive in adopting preventive practices,
such as lack of awareness, financial constraints, or cultural beliefs. This can inform strategies to address
these barriers and promote preventive behaviors.

4. Self-Efficacy: Assessing individuals' confidence in their ability to adopt and maintain preventive
practices. This can help identify factors that enhance or hinder individuals' self-efficacy in engaging in
preventive behaviors.

By applying the Health Belief Model, the study can gain insights into the factors that influence awareness
and preventive practices related to cataracts among adults in Owerri Municipal, Imo State, and develop
targeted interventions to promote healthy behaviors and reduce the burden of cataract-related vision loss.

2.3 EMPIRICAL REVIEW

Aliyu et al. (2017) conducted a study to assess the knowledge of cataract patients regarding cataract and its
surgery (cataract extraction surgery) at MakafinDala community of Dala local government in Kano State.
Method: This study utilized a descriptive cross-sectional survey study design, the quantitative study
involve interviewer administered questionnaire of 60 respondents who are cataract receipient at Makafin
Dala. Result: The finding of the study showed that only 23.3% of the respondents attended hospital for
intervention, 41.7% do not know what cataract means and 41.7% said it is due to ageing. The study further
revealed that knowledge of cataract patients regarding cataract and its surgery is poor since 18.3% said
medication is the effective cataract treatment, 15% said it is couching while 58.3% do not know there are
different surgical techniques for cataract. Barriers to effective cataract prevention were 66.7%, 53.5% and
73.3%, who agreed that fear of pain, surgery, surgical outcome as well as financial costs of cataract surgery
as a reason that can prevent people from seeking cataract intervention. Conclusion: The study concluded
that, poor knowledge and negative attitude among cataract patients is a leading factor responsible for not
preventing early cataract intervention there by increasing the number of cataract cases and blindness in our
society. Recommendation: The study recommended that eye patients should be educated through
mass awareness campaign, sensitization and mobilization, government should initiate and implement free
cataract programs that will ensure a wide coverage of cataract patient nationwide. Training of eye care
providers and incorporate acquisition of newer skills and training methods to ensure trainees are at par
with those in other part of the world.

Misra et al. (2017) conducted a study to assess the awareness and preventive practices related to cataract in
urban slums of Delhi. Methods: This study design was a population-based cross-sectional study. Participants
aged 18–60 years were recruited from randomly selected five slums of South Delhi. They were interviewed
using a semi-structured interview schedule on awareness and eye health-seeking practices related to cataract.
The practices were recorded if the respondents themselves or any other member of the family was diagnosed
with cataract in previous 2 years. Results: A total of 1552 respondents participated in the study, of which,
89.9% had heard of cataract but only (42%) were aware of any symptom of cataract. The common
symptoms of cataract reported by the participants were white opacity in eyes (25.9%) and loss of vision
(20.6%). Surgery as a treatment of cataract was known to only 559 (40.1%) participants. Awareness about
surgery as treatment of cataract was significantly higher among people aged 45–60 years (adjusted odds
ratio = 2.89, 95% confidence interval = 2.11–3.97) and in educated people (adjusted OR = 3.69 95% CI =
2.37–5.73). Out of 84 respondents who had been diagnosed with cataract, the health-seeking practices were
observed by 70 (83.3%) participants. Among them, 51 (72.9%) had undergone surgery and another 19
(27.1%) had been advised to wait for surgery. Most of the operated patients 48 (94.1%) attended the
postoperative follow-up. Conclusion: The study findings suggest the majority of participants have heard of
cataract, but there is low awareness of its symptoms and treatment, and good eye health-seeking practices
observed for cataract in urban slum population. Gaps in awareness observed can be filled up by
implementing proper eye health education programs.
Alimaw et al. (2019) conducted a study to assess knowledge regarding cataract and associated factors to
effective cataract prevention and management among adults in Gondar town Northwest Ethiopia. Methods:
A community-based cross-sectional study was conducted on 836 adults age ≥18years, using multi-stage
systematic random sampling technique. Data were collected using pre-tested structured questionnaires
through face to face interview. The collected data was entered to Epi info version 7 and analyzed using SPSS
version 20. Binary logistic regression was used to identify associated factors. Result: Among 845 eligible
adults, 98.9% (836) of them were fully participated. Of the total participants, 67.2% (562) of them had
awareness about cataract [95% CI, 63.8–70.2]. Among 562 participants, 61.7% of them had good knowledge
about cataract [95% CI, 57.5–66.00]. It was also found that higher level of education [AOR = 2.86, 95%CI:
1.37–5.96], higher family monthly income [AOR = 1.92, 95%CI: 1.03–3.57], having previous eye
examination [AOR = 1.53, 95% CI: 1.02–2.31] and positive family history of cataract [AOR = 1.76, 95%CI:
1.03–3.01] were positively associated with good knowledge. Conclusion: Significant portion of the
participants had good knowledge about cataract, which was positively associated with higher level of
education, higher family monthly income, presence of previous eye examination and positive family history
of cataract. However, significant knowledge gap regarding the risk factors and prevention strategies was
recognized. Hence, it might be logical to pay special attention in prospering knowledge on how to prevent
the occurrence of the disease.

Singh and Patel, (2022) conducted a study on the effectiveness of UV-blocking eyewear in the prevention of
cataracts in adults. Methodology: This longitudinal study involved a cohort of 1,000 adults from regions
with high UV exposure levels. Participants were divided into two groups, one using UV-blocking eyewear
and the other not using any protective eyewear, tracked over a period of five years. Results: The incidence of
cataract development was significantly lower in the group using UV-blocking eyewear. Specifically, the
eyewear group showed a 40% reduction in new cataract cases compared to the control group. Conclusion:
The study concluded that consistent use of UV-blocking eyewear could effectively reduce the risk of
cataracts in adults exposed to high levels of UV radiation. This finding supports the recommendation of UV
protection as a preventive tool against cataracts.

Chen and Kumar, (2021) conducted a study on the dietary antioxidants and their role in cataract prevention:
A systematic review. Methodology: The review analyzed twenty studies that reported on the dietary intake
of antioxidants and the incidence of cataracts. The data sources included randomized controlled trials and
observational studies from various geographical locations. Results: The aggregated data showed a clear link
between higher intake of antioxidants, such as vitamins C and E, lutein, and zeaxanthin, and a decreased risk
of cataract formation. The protective effect was most pronounced in populations with high oxidative stress
levels. Conclusion: Chen and Kumar’s review suggests that increasing the dietary intake of antioxidants
could be a viable strategy for cataract prevention. The authors recommend incorporating antioxidant-rich
foods into daily diets as a part of public health interventions aimed at reducing cataract-related morbidity.
Morales and Rodriguez, (2023) conducted a study on the impact of smoking cessation on cataract
development: A prospective cohort study. Methodology: This prospective cohort study enrolled 800 adult
smokers who were counseled and monitored for smoking cessation over a period of ten years. The
participants were assessed for the development of cataracts, comparing those who successfully quit smoking
with those who continued. Results: Results indicated a significant reduction in the incidence of cataract
formation among participants who ceased smoking. After 10 years, the non-smoking group showed a 30%
lower rate of cataract development compared to those who continued smoking. Conclusion: The study
provides compelling evidence that smoking cessation is associated with a decreased risk of developing
cataracts. This study supports the implementation of targeted smoking cessation programs as a preventive
measure against the onset of cataract, particularly in high-risk populations. The researchers advocate for
increased awareness and intervention strategies that emphasize the ocular benefits of quitting smoking.

Khoza et al. (2020) conducted a study to explore barriers related to the low uptake of cataract services
through engaging health service providers. Methods: This study used a qualitative design to explore barriers
related to the uptake of cataract surgery and care from professional nurses’ perspective in Vhembe District of
Limpopo province, South Africa. The target population comprised of 20 ophthalmic service providers. Of
these 20 in Limpopo Province, 15 were general nurses involved in eye health service provision, 3 registered
ophthalmic nurses and 2 registered eye specialists. Data was collected through the use of a digital tape
recorder, transcribed and then thematically analyzed. Results: The majority of the respondents were aged
between 56 and 60 years and females constituted 80% of the respondents. Reported barriers related to the
provision of cataract services by patients were: Lack of provision of comprehensive awareness programs;
Failure to tailor-make cataract programs that overcome cultural myths; Unavailability of cataract services at
the grass-root level; Shortage of ophthalmologist and supportive ophthalmic health professionals; and
inadequate cataract facilities and resources. Conclusion: There is a need for the development of
comprehensive awareness campaigns and the integration of traditional health systems and the modern
system to overcome myths associated with cataracts.

Shetti et al. (2022) conducted a study aimed to evaluate the factors preventing cataract surgery acceptance in
rural patients. Setting: An observational cross-sectional study was conducted between June 2019 to
December 2019 in eye screening camps in rural areas of south Karnataka, India. Methods: An observational
cross-sectional study was conducted between June 2019 and December 2019. A total of 4114 patients were
screened at camps, out of which 500 patients above the age of 50 years, diagnosed with cataracts but had
refused cataract surgery earlier, were included. Data were collected on demography, visual acuity, cataract or
lens status, source of information on cataract surgery in camps, reasons for refusal of cataract surgery
previously. Barriers to cataract surgery uptake (CSU) were classified as attitudinal, social, economical and
psychological factors and reasons for uptake of cataract surgery in the current visit were recorded in the
form of a questionnaire and analysed. Results: The mean age of the participants was 65.8 years. The male to
female ratio was 1.1:1. The prevalence of cataract blindness in our study population was 11.5%, which was
significant (p = 0.000). Announcements and pamphlets were the most common source of information on
cataract surgery in camps. Significant barriers to CSU were attitudinal factors, mainly the ability to manage
daily work (66.4%) with cataract; one eye had an adequate vision (57.4%). The next common barrier was an
economic factor as they waited for a camp to avail themselves of free service (61.5%). The least common
barriers were female gender (13.2%), fear related to surgery (11.8%), old age (9.6%), God’s will/fate (6.2%),
lack of transport (5.4%). The critical factors in CSU in the camps were a provision of free surgery,
accessible transport, the camp being conducted closer to their home and motivation by the health workers.
Conclusion: Although economic barriers were efficiently taken care of by the government through national
programmes, attitudinal barriers seem to be the most important barriers to achieve the goal of reducing
blindness because of cataract in rural population.

Bizuneh et al. (2021) conducted a study aimed to determine the barriers to cataract surgery utilization among
cataract blind patients presenting to campaign sites in Ethiopia. Methods: An institution-based cross-
sectional design study was conducted to select 209 patients. The study was conducted from July to August
2020. A structured questionnaire was used to collect socio-demographic data and barriers for not having
cataract surgery. Physical examination such as visual acuity, slit lamp bio microscopy and direct
ophthalmoscopy was done for all participants. Epi Info 7 was used for data entry and Statistical Package for
Social Science/SPSS version 23 was used for analysis after data were exported. Descriptive methods were
employed for analysis. Results: A total of 209 subjects were recruited in the study with a mean age of 64.2
(±14.6) years, with a range of 32–99 years. From the total study subjects, 53% were males and 40.2% were
over 66 years old. Upon presentation to the campaign site, 33% of study subjects had visual acuity of
operable eye under blindness category and half of the study subjects (50.2%) had mature cataract. The most
reported barriers were waiting until cataract becomes mature (18.7%), fear of surgery complications
(16.7%), far from eye health institution (16.4%) and lack of income/cost for surgery (11.5%). Conclusion:
Recognizing the severity and the blindness burden of cataract in Ethiopia, creating public awareness,
establishing eye health institutions, increasing the number of eye health professionals, increasing the
quantity and the quality of cataract campaigns to alleviate these barriers are of paramount importance at the
country level.

2.4 SUMMARY OF REVIEWED LITERATURE

Cataracts pose a significant public health challenge globally, affecting individuals of all ages and leading to
substantial morbidity and visual impairment. Early detection, timely intervention, and appropriate
management are essential in addressing this burden and improving the quality of life for affected
individuals. Continued research efforts, public health initiatives, and access to comprehensive eye care
services are critical in preventing and managing cataract-related vision loss on a global scale.
In this research, the Health Belief Model (HBM) was employed as the guiding theoretical framework. This
model is particularly suited for studies focusing on preventive health behaviors as it addresses the
perceptions of the risk of a disease and the benefits of avoiding it. In applying the HBM to the study, it is
hypothesized that increasing an individual's knowledge about the risks and potential severity of cataracts,
along with clear communication about the benefits of preventive practices such as UV-blocking sunglasses
and regular eye examinations, will motivate behavioral changes.

1. Empirical studies consistently show varying levels of awareness about cataracts among adults. It
found that while awareness of cataracts as a health issue was high, specific knowledge about
prevention and treatment options was lacking among older adults. The preventive measures for
cataracts, as illustrated in empirical studies, include lifestyle changes and regular eye examinations.
A notable study by Morales and Rodriguez (2023) emphasized the impact of smoking cessation on
reducing cataract risk, showing a 30% lower incidence among individuals who quit smoking
compared to persistent smokers.

In summary, the literature indicates that while there is a general awareness of cataracts as a health issue,
there is a need for more targeted information regarding preventive practices and risk factors. It also
underscores the importance of health interventions in improving both awareness and the adoption of
effective preventive measures against cataracts.

CHAPTER THREE

METHODOLOGY

This chapter emphasizes on the method used by the researcher in this study and was discussed under the
following subheadings: design, setting, target population, sampling (size and formula), sampling technique,
instrument for data collection, validity of instruments, reliability of instruments, method of data collection,
method of data analysis and Ethical considerations.

Design

Design refers to the overall strategy used to integrate the different component of the study in a coherent and
logical way.

The researcher adopted a descriptive survey which is mainly concerned with describing events as they are in
their natural setting without manipulating the result of the study. The research design approach is present-
oriented and based on ongoing events as it provides a detailed description of existing awareness, preventive
practices of cataract among adult. This design was successfully used by Kome et al., 2021 in a similar study
to determine the knowledge, attitudes and practices of patience with cataracts in Nigeria and it was
successful.
Setting

The research was conducted in Owerri municipal. With a municipal is a local government area in Imo State,
Nigeria. It's headquarters is in the city of Owerri. It has an area of 58 km 2 and the population of 127,213
according to 2006 census. Owerri Municipal shares it’s northern border with Owerri North Local
Government Area. The southern boundary of Owerri municipal is delineated by the boundary with owerri
West local government area. It's boarded at the east by Ezinihitte Local Government Area and the west is the
marketed by the boundary with Mbaitoli Local Government Area. Owerri Municipal consists of five villages
namely:- Umuororonjo, Amawom, Umuonyeche, Umuodu, and Umuoyima ( collectively known as Owerri
Nchi Ise). Each village has a head but there is only one traditional ruler governing the five villages.

Target population

The target population for this study consists of all male and female adults of owerri municipal LGA between
40 years and 75 years residing in the five villages within or Owerri Municipal regardless of their education
of socioeconomic background. The total number of 308 adults were used for the study.

Table 1: Names of the villages in owerri municipal and number of male and female adults (40-75years)

Month Villages Male and female

adults (40-
75years)
Jan.– Feb. Unuororonjo 52
Feb.-March Umuoyima 62
March-April Umuonyeche 79
April-May Umuodu 64
May-June Amawom 51
Total 308
Source: Village Register

Inclusion Criteria

• Adults between 40 to 75 years

• Individuals residing in households within the five villages.

• Both Male and Female residents.

• Individuals with or without a history of cataract diagnosis or treatment.

Sample size

Taro yameni's formula was used to determine the sample size. The formula is giving as:

n = N

1 + N (e) 2

Where n = Sample Size

N= Target Population

1= a Constant

e= limit of tolerable error (0.05)

Following the taro yamani formula, the sample size of the 308 adults were determined (c appendix for
details).

Sampling technique

The researcher used stratified random sampling technique. The researcher randomly selected a subset of
adults from each villages within Owerri Municipal, which forms the Strata. The 173 participants required for
the study will be selected from each stratum in proportion to the total population of the village. The relative
size was worked out as follows:

Formula = Target Population × Sample Size

Total Population

Example for Umuororonjo:

52 × 173. = 8996. = 29.208. = 29

308 308.

In the same way, the formula is used for working out the sample size of the population for
the rest of the villages. See Appendix.

Table 2 : Distribution of Sample Size in each Village

S/N Names Of Villages Target Population Sample Size
1 Umuororonjo 52 29
2 Umuoyima 62 35
3 Umuonyeche 79 44
4 Umuodu 64 36
5 Amawom 61 29
Total 308 173

To ensure that each individual has an equal chance of pain included in the study, papers will
be folded according to the target population of each Village. The pieces of paper will be
prepared, with “Yes” and “No” written on them. In Umuororonjo, 52 pieces of paper will be
folded, 29 will be labelled “Yes” and 23 will be labelled “No”. In Umuoyima, 62 pieces of
paper will be folded; 35 will be labelled yes and 27 will be labelled “No”. In Umuonyeche,
79 pieces of paper will be folded; 44 will be labelled yes and 35 will be labelled “No”. In
Umuodu , 64 pieces of paper will be labelled; 36 will be labelled “yes” and 28 will be
labelled “No”. In Amawom, 51 pieces of paper will be folded; 29 will be labeled “yes” by 22
will be labelled “No”. Those who will pick the paper labelled “Yes” will be separated from
others and the questionnaire given to them to answer.

Reliability of the Instrument

Reliability of an instrument is defined as the consistency of which an instrument measures
what is supposed to measure. It is therefore the consistency and dependability of a measuring
to from the researchers perspective. The reliability of the instrument was ascertained through
a pilot study. This identifies any problem that may be encountered while administering the
questionnaire during the data collection. This was done through a trial test approach carried
out using 10% of the study sample (that is 17 adults). 17 copies of the questionnaire will be
administered twice to 17 adults at Owerri West local government area as they have similar
characteristics with the study population. After filling the questionnaire , the responses was
collected. The second time the same questionnaire but fresh copies was administered to the
same group after 1 week; results of the first and second test was compared and analyzed
using Percussion Product Moment Correlation Coefficient (PPMCC) to ascertain the
consistency of the instrument. It yielded a high positive correlation of 0.93, meaning the
instrument is very reliable.

Method of Data Collection

The researcher will obtain a letter of identification from the Coordinator of Post Basic
Ophthalmic Nursing School, and the researchers identity will be used to obtain permission,
to administer the questionnaire, from each Village heads of the five(5) villages. This will be
done with the help of five assistance who are well known in the town. The data collection
will last for 5 days.

Method of Data Analysis

The questionnaire will be sorted, edited for completeness to ensure a suitability for analysis.
The responses will be organized and analyzed using frequency tables and percentages
according to the objectives of the research.

Ethical Considerations
The following will be duly considered following the principles of morality, right and wrong
of an action.
A letter of introduction: This will be collected from the Coordinator of Post Basic
Ophthalmic Nursing School, will be attached to each of the questionnaire, explaining that the
research is purely for academic purpose.
Informed consent: the researcher will obtain consent from the village heads to carry out the
study in the village and personal consent of individual respondent will be obtained.
Confidentiality: The researcher will ensure that all informations gotten from respondents
are confidential and will not disclose to anyone
Anonymity: The researcher will ensure that anonymity of the respondent, by not including
any self-identifying information like name, phone numbers, in the questionnaire.
Respect for human dignity: The respondent will be approached cautiously and is respectful
or insulting questions will not be asked.
Voluntary participation: the respondents will be given the right to voluntarily the side to
participate in the study and for them to give the researcher necessary assistance on the
collection of data.
Plagiarism: plagiarism will be avoided by commending and referencing every author whose
work or write up will be used in the study.

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