|dc.description.abstract||Background: Cocoa farmers are known to face a lot of ocular health hazards
such as chemicals, ultraviolet radiations, farm equipment, plants, dust and
allergens among others in the field of work. This study sought to examine and
understand the factors that affect the ocular health of cocoa farmers in Ghana in
order to improve their knowledge and awareness on ocular health and safety
practices through a training intervention.
Methods: The study employed two quantitative approaches: a cross-sectional
survey and a quasi- experimental pre-post-test study design. The cross-sectional
study involved administration of a questionnaire and conducting a
comprehensive eye examination among participants, while the pre-post-test
study used a structured questionnaire to gather baseline knowledge and post
training knowledge on ocular health and safety practices among the participants
to establish a change. A multistage random sampling approach was used to
select participants from four cocoa growing districts of Ghana.
Results: Five hundred and fifty-six, out of the 576, who were recruited for the
first phase of the study, met the inclusion criteria, giving an eligibility rate of
96.5%. The participants consisted of 359 (64.6%) males and 197 (35.4%)
females with a mean age of 54.9 years (± 11.2). Educational attainment among
the participants was low, with 142 (25.5%) having had no formal education.
Participants spent an average of 33.3 (±13.4) hours per week on the farm, with
males spending more time 35.3 (±13.9) than females 29.6 (± 11.8) (p<0.001) and
also spent more hours on the farm than females (p<0.001).
Participants reported poor distance and near vision, itching/redness, pain and
tearing as major complaints. Anterior eye conditions recorded included pterygium
23.7% (CI: 20.3-27.5), allergic conjunctivitis 9.7% (CI: 7.4 - 12.5) and corneal
scar/opacity 6.1% (CI: 4.3 - 8.4). Other conditions included cataract 25.5% (CI:
22.0-29.3), glaucoma 15.8 (CI: 12.9 - 19.1) and macular disorders 4.9% (CI: 3.2 -
7.0). Posterior segment conditions and uncorrected refractive errors (67.6%)
were the major causes of moderate and severe visual impairment (MSVI)
(16.7%) and legal blindness (4.9%) among the population studied. Presbyopia
was present in 83.1% (CI: 79.7 - 86.1) of the participants.
The rate of ocular injuries was 143/12 854.5 worker years or 11.3/1 000 worker
years (95% CI: 9.4 - 31.0), which led to a lost work time injuries of 137 injuries/
12 854.5 worker years or 37.3/1000 worker years (95% CI: 34.1- 40.8) and were
predominantly in males. Blunt injuries from plants/branches and chemical injuries
were mostly reported. Only 34 (6.1%) reported using ocular protection. Barriers
to use of ocular protection included non availability of the equipment, lack of
funds and ignorance or lack of training. More than half of the participants
(52.4%) had never seen an eye care practitioner, while 25% reported seeking
eye care within the last one year preceding the study. Those who were
registered with the National Health Insurance Scheme were more likely to attend
a hospital/clinic for eye care services (OR = 3.93, 1.40 - 11.06, p = 0.009).
Barriers to utilization of eye facilities included lack of funds, long distance to
facility and long waiting time at eye facilities.
Two hundred participants enrolled for the quasi-experimented pre-post-tested
study, and had varied opinions on ocular health and safety practices on the farm.
They demonstrated a good knowledge on the ocular hazards they face at work,
although most were unaware of the effect of some of the hazards on the eye.
Farmers also had a poor knowledge on ocular protection but a fair knowledge on
first aid for ocular emergencies. Participants improved their knowledge scores
(overall 40 points) on ocular health and safety practices from a pre- median score
of 172 (IQR: 164 - 177.5) to 212 (IQR: 206 - 219.5) following the pre- and postevaluation
of the training intervention.
Conclusions: Eye disorders are prevalent among cocoa farmers in Ghana.
Farmers are engaged in improper ocular health and safety practices on the farm.
They also make insufficient use of appropriate protective eye devices and health
services. The study demonstrated that, with an ocular health intervention, cocoa
farmers can improve on their knowledge and awareness level on ocular health
and safety practices which may be of benefit to the farmer, employers and the