• 1.

    Tabbara KF, 1999. Ocular complications of vernal keratoconjunctivitis. Can J Ophthalmol 34: 8892.

  • 2.

    Cameron JA, 1995. Shield ulcers and plaques of the cornea in vernal keratoconjunctivitis. Ophthalmology 102: 985993.

  • 3.

    Dahan E, Appel R, 1983. Vernal keratoconjunctivitis in the black child and its response to therapy. Br J Ophthalmol 67: 688692.

  • 4.

    BenEzra D, Pe'er J, Brodsky M, Cohen E, 1986. Cyclosporine eye drops for the treatment of severe vernal keratoconjunctivitis. Am J Ophthalmol 101: 278282.

    • Search Google Scholar
    • Export Citation
  • 5.

    Chenge B, Makumyamviri AM, Kaimbo WA, Kaimbo D, 2003. Tropical endemic limbo-conjunctivitis in Lúbumbashi, Democratic Republic of the Congo. Bull Soc Belge Ophtalmol 290: 916.

    • Search Google Scholar
    • Export Citation
  • 6.

    Diallo JS, 1976. Tropical endemic limboconjunctivitis. Rev Int Trach Pathol Ocul Trop Subtrop 53: 7180.

  • 7.

    Khan MD, Kundi N, Saeed N, Gulab A, Nazeer AF, 1986. A study of 530 cases of vernal conjunctivitis from the North West Frontier Province of Pakistan. Pakistan J Ophthalmol 2: 111114.

    • Search Google Scholar
    • Export Citation
  • 8.

    Resnikoff S, Cornand G, Filliard G, Hugard L, 1988. Limbal vernal conjunctivitis in the tropics. Rev Int Trach 3-4: 5371.

  • 9.

    Bonini S, Bonini S, Lambiase A, Marchi S, Pasqualetti P, Zuccaro O, Rama P, Magrini L, Juhas T, Bucci MG, 2000. Vernal keratoconjunctivitis revisited. A case series of 195 patients with long-term followup. Ophthalmology 107: 11571163.

    • Search Google Scholar
    • Export Citation
  • 10.

    Yemaneberhan H, Bekele Z, Venn A, Lewis S, Parry E, Britton J, 1997. Prevalence of wheeze and asthma and relation to atopy in urban and rural Ethiopia. Lancet 350: 8590.

    • Search Google Scholar
    • Export Citation
  • 11.

    Viinanen A, Munhbayarlah S, Zevgee T, Narantsetseg L, Naidansuren T, Koskenvuo M, Helenius H, Terho EO, 2007. The protective effect of rural living against atopy in Mongolia. Allergy 62: 272280.

    • Search Google Scholar
    • Export Citation
  • 12.

    Warrell DA, Fawcett IW, Harrison BD, Agamah AJ, Ibu JO, Pope HM, Maberly DJ, 1975. Bronchial asthma in the Nigerian Savanna Region. Quarterly J Med New Series XLIV: 325347.

    • Search Google Scholar
    • Export Citation
  • 13.

    Carswell F, Merrett J, Merrett TG, Meakins RH, Harland PS, 1977. IgE, parasites and asthma in Tanzanian children. Clin Allergy 7: 445453.

  • 14.

    Godfrey RC, 1975. Asthma and IgE levels in rural and urban communities in The Gambia. Clin Allergy 5: 201207.

  • 15.

    Merrett TG, Merrett J, Cookson JB, 1976. Allergy and parasites: the measurement of total and specific IgE levels in urban and rural communities in Rhodesia. Clin Allergy 6: 131134.

    • Search Google Scholar
    • Export Citation
  • 16.

    Dold S, Heinrich J, Wichmann H-E, Wjst M, 1998. Ascaris-specific IgE and allergic sensitization in a cohort of school children in the former East Germany. J Allergy Clin Immunol 102: 414420.

    • Search Google Scholar
    • Export Citation
  • 17.

    Sandford-Smith J, 1979. Vernal eye disease in Northern Nigeria. Trop Geogr Med 31: 321328.

  • 18.

    Ajaiyeoba A, 2005. Vernal keratoconjunctivitis and intestinal parasitic infestations in black children. J Natl Med Assoc 97: 15291532.

  • 19.

    Munyakazi A, Ntagaramba JF, 2005. Atlas of Rwanda. Oxford: MacMillan.

  • 20.

    Glewwe P, Grosh M, 2000. Designing household survey questionnaires for developing countries: lessons from 15 years of the living standards measurement study. Washington, DC: World Bank.

    • Search Google Scholar
    • Export Citation
  • 21.

    Rischewski D, Kuper H, Atijosan O, Simms V, Jofret-Bonet M, Foster A, Lavy C, 2008. Poverty and musculoskeletal impairment in Rwanda. Trans R Soc Trop Med Hyg 102: 608617.

    • Search Google Scholar
    • Export Citation
  • 22.

    Lee T, Anderson S, 1985. Heterogeneity of mechanisms in exercise induced asthma. Thorax 40: 481487.

  • 23.

    Hanifin J, Rajka G, 1980. Diagnostic features of atopic dermatitis. Acta Derm Venereol 92: 4447.

  • 24.

    Loughlin EH, Spitz SH, 1949. Diagnosis of helminthiasis. JAMA 139: 9971000.

  • 25.

    Bremond-Gignac D, Donadieu J, Leonardi A, Pouliquen P, Doan S, Chiambarretta F, Montan P, Milazzo S, Hoang-Xuan T, Baudouin C, Aymé S, 2008. Prevalence of vernal keratoconjunctivitis: a rare disease? Br J Ophthalmol 92: 10971102.

    • Search Google Scholar
    • Export Citation
  • 26.

    Everaerts M-C, Doutetien C, 1993. Chronic tropical endemic limboconjunctivitis (TELC) in southern Benin: epidemiological and meteorological data. Rev Int Trach Pathol Ocul Trop Subtrop Sante Publique 70: 199214.

    • Search Google Scholar
    • Export Citation
  • 27.

    The Government of Rwanda K, 2003. Third General Census of Population and Housing of Rwanda. Final results: statistical tables.

  • 28.

    Hugg T, Ruotsalainen R, Jaakkloa MS, Pushkarev V, Jaakkola JJK, 2008. Comparison of allergic diseases, symptoms and respiratory infections between Finnish and Russian school children. Eur J Epidemiol 23: 123133.

    • Search Google Scholar
    • Export Citation
  • 29.

    Nicolaou N, Siddique N, Custovic A, 2005. Allergic disease in urban and rural populations: increasing prevalence with increasing urbanization. Allergy 60: 13571360.

    • Search Google Scholar
    • Export Citation
  • 30.

    Weinberg EG, Van Niekerk CH, Shore SC, Heese HD, Van Schalkwyk DJ, 1977. Prevalence of asthma. Lancet 2: 500.

  • 31.

    Abdurrahman MB, Taqi AM, 1982. Childhood bronchial asthma in northern Nigeria. Clin Allergy 12: 379384.

  • 32.

    Macfarlane JT, Bachelor M, Ridyard JB, Ball PA, 1979. Asthma, IgE and environment in northern Nigeria. Clin Allergy 9: 333337.

  • 33.

    Zeyrek CD, Zeyrek F, Sevinc E, Demir E, 2006. Prevalence of asthma and allergic diseases in Sanliurfa, Turkey, and the relation to environmental and socioeconomic factors: is the hygiene hypothesis enough? J Investig Allergol Clin Immunol 16: 290295.

    • Search Google Scholar
    • Export Citation
  • 34.

    Scrivener S, Yemaneberhan H, Zebenigus M, Tilahun D, Girma S, Ali S, McElroy P, Custovic A, Woodcock A, Pritchard D, Venn A, Britton J, 2001. Independent effects of intestinal parasite infection and domestic allergen exposure on risk of wheeze in Ethiopia: a nested case-control study. Lancet 358: 14931499.

    • Search Google Scholar
    • Export Citation
  • 35.

    Mitchell HS, 1970. Bronchial asthma in Kenya. East Afr Med J 47: 142145.

  • 36.

    Turton JA, 1976. IgE, parasites, and allergy. Lancet 25: 686.

  • 37.

    Hodges MG, Keane-Myers AM, 2007. Classification of ocular allergy. Curr Opin Allergy Clin Immunol 7: 424428.

  • 38.

    McConchie BW, Norris HH, Bundoc VG, Trivedi S, Boesen A, Urban JF, Keane-Myers AM, 2006. Ascaris suum-derived products suppress mucosal allergic inflammation in an interleukin-10-independent manner via interference with dendritic cell function. Infect Immun 74: 66326641.

    • Search Google Scholar
    • Export Citation
  • 39.

    Orren A, Dowdle EB, 1975. Effects of allergy, intestinal helminthic infestation and sex on serum IgE concentrations and immediate skin hypersensitivity in three ethnic groups. Int Arch Allergy Appl Immunol 49: 814830.

    • Search Google Scholar
    • Export Citation
  • 40.

    Lynch NR, Palenque M, Hagel I, Diprisco MC, 1997. Clinical improvement of asthma after anthelminthic treatment in a tropical situation. Am J Respir Crit Care Med 156: 5054.

    • Search Google Scholar
    • Export Citation
  • 41.

    Alshishtawy MM, Abdella AM, Gelber LE, Chapman MD, 1991. Asthma in Tanta, Egypt: serologic analysis of total and specific IgE antibody levels and their relationship to parasite infection. Int Arch Allergy Appl Immunol 96: 348354.

    • Search Google Scholar
    • Export Citation
  • 42.

    Joubert JR, De Klerk HC, Malan C, 1979. Ascaris lumbricoides and allergic asthma. S Afr Med J 56: 599602.

  • 43.

    Von Hertzen L, Haahtela T, 2004. Asthma and atopy–the price of affluence? Allergy 59: 124137.

  • 44.

    Lambiase A, Minchiotti S, Leonardi A, Secchi A, Rolando M, Calabria G, Orsoni J, Zola E, Ferreri G, Aragona P, Reibaldi A, Chisari G, Bonini S, 2009. Prospective, multicenter demographic and epidemiological study on vernal keratoconjunctivitis: a glimpse of ocular surface in Italian population. Ophthalmic Epidemiol 16: 3841.

    • Search Google Scholar
    • Export Citation
  • 45.

    Ukponmwan CU, 2003. Vernal keratoconjunctivitis in Nigerians: 109 consecutive cases. Trop Doct 33: 242245.

  • 46.

    Divall SA, Radovick S, 2009. Endocrinology of female puberty. Curr Opin Endocrinol Diabetes Obes 16: 14.

  • 47.

    Tuft SJ, Dart JKG, Kemeny M, 1989. Limbal vernal keratoconjunctivitis: clinical characteristics and immunoglobulin E expression compared with palpebral vernal. Eye (Lond) 3: 420427.

    • Search Google Scholar
    • Export Citation
  • 48.

    Neumann E, Gutmann M, Blumankrantz N, Michaelson I, 1959. A review of four hundred cases of vernal keratoconjunctivitis. Am J Ophthalmol 47: 166172.

    • Search Google Scholar
    • Export Citation
  • 49.

    Tuft SJ, Cree IA, Woods M, Yorston D, 1998. Limbal vernal keratoconjunctivitis in the tropics. Ophthalmology 105: 14891493.

  • 50.

    Kocabeyoglu S, Bozkurt B, Bilen O, Irkec M, Orhan M, 2008. Serum allergen specific immunoglobulin E levels in patients with allergic conjunctivitis. Eur J Ophthalmol 18: 675679.

    • Search Google Scholar
    • Export Citation
  • 51.

    Mumcuoglu Y, Zavaro A, Samra Z, Lazarowitz Z, 1988. House dust mites and vernal keratoconjunctivitis. Ophthalmologica 196: 175181.

 
 
 

 

 

 

 

 

 

Vernal Keratoconjunctivitis in School Children in Rwanda and Its Association with Socio-Economic Status: A Population-Based Survey

View More View Less
  • Ophthalmology Department, Kabgayi Hospital, Muhanga, Rwanda; Ophthalmology Department, King Faisal Hospital, Kigali, Rwanda; Dermatology Department, King Faisal Hospital, Kigali, Rwanda; Department of Clinical Science, Institute of Tropical Medicine, Antwerp, Belgium; Department of Public Health, Ghent University, Belgium; Moorfields Eye Hospital, National Health Service Foundation Trust, London, United Kingdom; International Centre for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom; Clinical Biology Department, Ghent University Hospital, Belgium; Ophthalmology Department, Ghent University Hospital, Belgium

Vernal keratoconjunctivitis (VKC) is an allergic eye disease and an important cause of hospital referral among children in Africa and Asia. Hospital-based studies have suggested a role for parasites in its pathogenesis. To determine the prevalence and risk factors for VKC in Central Africa, we conducted a nested population-based case control study in Rwanda, involving randomly selected primary schools from different environments (rural/urban) and climate. A prevalence of VKC of 4.0% (95% confidence interval 3.3–4.7%) was found among 3,041 children studied (participation rate 94.7%). The intestinal parasitic burden was not related to VKC. Besides hot dry climate (odds ratio [OR] = 1.5, P = 0.05) and male gender (OR = 1.7, P = 0.005), multivariate analysis identified higher economic status as a risk for VKC (OR = 1.4, P = 0.005). The effect on VKC of higher economic status appears not to act through differences in parasitic intestinal load.

Author Notes

*Address correspondence to Stefan De Smedt, Leopoldstraat 34, 2800 Mechelen, Belgium. E-mail: dr.stefan.desmedt@gmail.com

Financial support: This study was possible thanks to financial support from FRO (Belgian Funds for Research in Ophthalmology), Light for the World Belgium, CBM-International, and PHADIA NV/SA (Brussels, Belgium) and the active participation in the field work of the Kabgayi Eye Unit personnel.

Authors' addresses: Stefan De Smedt and Philippe Kestelyn, Ophthalmology Department, Ghent University Hospital, Belgium, E-mails: stefan.desmedt@ugent.be and philippe.kestelyn@ugent.be. John Nkurikiye and Arjan Hogewoning, Ophthalmology Department, King Faisal Hospital, Kigali, Rwanda, E-mails: jeankur@yahoo.co.uk and arjanhogewoning@yahoo.com. Yannick Fonteyne, Leopoldstraat 36, 2800 Mechelen, Belgium, E-mail: stds@telenet.be. Marjan Van Esbroeck, Department of Clinical Science, Institute of Tropical Medicine, Antwerp, Belgium, E-mail: mvesbroeck@itg.be. Dirk De Bacquer, Department of Public Health, Ghent University, Belgium, E-mail: dirk.debacquer@ugent.be. Stephen Tuft, Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK, E-mail: s.tuft@ucl.ac.uk. Clare Gilbert, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, UK, E-mail: clare.gilbert@lshtm.ac.uk. Joris Delanghe, Clinical Biology Department, Ghent University Hospital, Belgium, E-mail: joris.delanghe@ugent.be.

Reprint requests: Stefan De Smedt, Leopoldstraat 34, 2800 Mechelen, Belgium, E-mail: dr.stefan.desmedt@gmail.com.

Save