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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 16  |  Issue : 3  |  Page : 309-315

Effectiveness of awareness program on the knowledge, awareness, and perception of undergraduate paramedical and non-paramedical students toward eye donation - A cross sectional study


1 Department of Optometry, TMU, Moradabad, Uttar Pradesh, India
2 Department of Ophthalmology, TMU, Moradabad, Uttar Pradesh, India

Date of Submission09-Jul-2021
Date of Acceptance01-Sep-2021
Date of Web Publication30-Sep-2022

Correspondence Address:
Asst. Prof. Anjali Rani
Teerthanker Mahaveer University (TMU), Delhi Road, NH 24, Bagadpur, Moradabad, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijot.ijot_71_21

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  Abstract 


Introduction: Corneal transplantation is the only option to treat corneal blindness. However, the corneal procurement rate is much less than the requirement. Barriers to eye donation need to be studied. Aim: The aim of this study is to understand the knowledge, awareness, and perception toward eye donation and the determination of barriers to eye donation among university students and to conduct an awareness campaign and determination of its effectiveness. Methods: A cross-sectional study was conducted among 300 graduation students of paramedical and nonparamedical department with the help of questionnaire. An awareness program was carried out through PowerPoint presentation. Responses were elicited pre- and post-awareness program. Data were analyzed using the SPSS software version 16. Results: The findings suggest that knowledge and awareness were slightly higher among paramedical students but the willingness for eye donation was higher among nonparamedical students as compared to paramedical students. The prime source of information was doctors/optometrists and media. In both the groups, female and Hindu participants showed more willingness toward eye donation. Barriers to eye donation was the lack of awareness and inappropriate knowledge including various myths and superstitions. Knowledge, awareness, and willingness for eye donation pre- and post-awareness program was comparable between both the groups. Awareness program resulted in statistically significant increase in positive attitude and willingness toward eye donation in both the groups. Conclusion: Effective measures including awareness campaign need to be taken such as education on eye donation through which procurement of cornea can be increased and burden of corneal blindness can be minimized.

Keywords: Awareness, eye donation, knowledge, perception


How to cite this article:
Rani A, Adak P, Yadav RK, Chander A. Effectiveness of awareness program on the knowledge, awareness, and perception of undergraduate paramedical and non-paramedical students toward eye donation - A cross sectional study. Indian J Transplant 2022;16:309-15

How to cite this URL:
Rani A, Adak P, Yadav RK, Chander A. Effectiveness of awareness program on the knowledge, awareness, and perception of undergraduate paramedical and non-paramedical students toward eye donation - A cross sectional study. Indian J Transplant [serial online] 2022 [cited 2022 Nov 27];16:309-15. Available from: https://www.ijtonline.in/text.asp?2022/16/3/309/357613




  Introduction Top


Blindness is a critical public health issue globally. The WHO estimated that approximately 2.2 billion people have impaired vision or blindness, from which approximately 1 billion cases are those which could be prevented or has still to be addressed.[1] According to the WHO, 8.075 million blind population lives in India which is responsible for 20.5% of world's total blindness.[2] Globally, corneal disorders found to be a prominent cause of impaired vision and preventable blindness debts for 0.9% of total blindness in India after cataract.[3],[4] One of the strategy of NPCB includes eye donation for corneal transplantation, helps population with a compromised cornea regain sight.[3] NPCB nearby estimated 0.12 million corneal blind people in India, to which 20,000−25,000 population with corneal loss of sight are additional every year.[5] Half of these patients can get their vision revert by mean of corneal transplantation in which a damaged or infected cornea is supplanted by donated corneal tissue.[6],[7] At present, there is no alternative for human corneal tissue.[5],[7]

It is approximately 70 years of existence of first successful corneal transplantation in India; still enormous numbers of patients are waiting for corneal transplantation.[8] The assemblage and utilization of donated eyes come beneath the preview of Transplantation of Human Organs Act 1994. Organ shortage is indeed a universal problem, but Asia lags far behind the world and India lags extreme behind other countries even in Asia. Almost every person who dies naturally, or in an accident, is a possible donor. Furthermore, so many patients do not get a donor. Accomplishment depends on the utility of high-quality donor eyes for corneal transplant.[9] In addition, the cost of corneal transplantation and its insufficiency make it virtually not possible for the deprived to approach these medical remedies.[10] According to NPCB report, the corneal procurement rate was 63,256 corneas between April 01, 2016 to March 31, 2017, from which just 46% of cornea are utilized for vision restoration with a prominent ratio of 54% incompatible for corneal transplantation.[8] Based on the present ratio of appropriate corneas, we would require 277,000 corneal donations annually to execute 1,00,000 corneal grafting per annum in India which is nearly twenty times the number of donor eyes presently accessible in India.[11] In India, approximately 10 (9778,073) million people die every year, unfortunately the amount does not exceed several thousand.[8] Eye donation depends on those who wants to pledge for eye donation and on relatives who admire their pledge in the face of death.[12]

The need of this study was the limited knowledge and awareness about eye donation resulting in the limited number of eye donations which imposes the economic burden on the individual and on the country. The current study was conducted to understand the knowledge, awareness, and perception of today's generation toward eye donation and to identify the barriers to eye donation, so that appropriate measures can be implemented. Furthermore, to educate the participants through awareness campaign and to evaluate its effectiveness among university students.


  Methods Top


Study design: Cross-sectional, descriptive questionnaire-based study

Study setting

This study was conducted among the university students over a period of 6 months from September to February 2020. Self-administered closed-ended questionnaire was designed on the basis of previous study to elicit the response from the participants after obtaining the informed consent.[11],[13] The questionnaire consisted of 22 questions with four sections including sociodemographic information of the respondent, questions regarding the knowledge, awareness, and perception toward eye donation. Participants were instructed to complete the preawareness questionnaire form. Consequent to completion of preawareness questionnaire, 10 min awareness program was carried out with the help of PowerPoint presentation on eye donation. Instantly, participants were asked to complete the same questionnaire form, postawareness program. Every session took roughly 30 min to conduct.

Participants

The final year, undergraduate students from paramedical and nonparamedical department of the university who submitted complete questionnaires were included in the study. Those subjects who were not interested or absent at the day of assessment or enrolled in any of the optometry programme were excluded from the study.

Sample size

Sample size was calculated by using the following formula: N = Z2α/2 PQ/E2 from a previous study.[12] Minimum calculated sample size was (N ≈ 253.139). On the basis of sample calculation, a total of 300 participants were enrolled in this study, 150 from paramedical and 150 from nonparamedical department.

Statistical methods

Data were entered into MS Excel. Descriptive statistics were used for the quantitative data. Inferential statistics were done using IBM SPSS version 16.0, Chicago. Z-test and Chi-square test were used for data interpretation, and P < 0.05 was considered statistically significant.

Declaration of patient consent

The patient consent has been taken for participation in the study and for publication of clinical details and images. Patients understand that the names and initials would not be published, and all standard protocols will be followed to conceal their identity.

Ethics statement

This study was approved by the ethical committee of university (Ref. No. PARA/02-2020/TMU dated on 20-05-2020). The study was performed according to the guidelines in Declaration of Helsinki.


  Results Top


Out of total 300 participants, majority 175 (58.3%) of participants were male. The mean age of participants was 20.14 ± 1.98 years. Hindus and Muslims comprised of 193 (64.3%) and 107 (35.7%), respectively, as shown in [Table 1].
Table 1: Demographic details


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Knowledge regarding eye donation

It has been found that 93 (62%) of paramedical and 91 (60.7%) of nonparamedical students knew that the eye is donated after death and significant improvement (P < 0.001) in the knowledge up to 144 (96%) was observed in both the groups, respectively, followed by awareness program. Ideal time for eye removal was known to 70 (46.7%) of paramedical students which was slightly higher than nonparamedical students 51 (34%) and postawareness program it was 141 (94%) among paramedical and 138 (92%) among nonparamedical students. Less than half of participants, 68 (45.3%) in paramedical and 31 (20.7%) in nonparamedical responded that the cornea is used for eye donation and postawareness program, significant increase (P < 0.001) was found in both the groups. Only 53 (35.3%) of paramedical and nonparamedical students answered that anyone can donate eyes regardless of their age and postawareness program, 132 (88%) of paramedical and 135 (90%) of nonparamedical students answered the same. A total of 89 (59.3%) of paramedical and 69 (46%) of nonparamedical participants knew that the patients having AIDS is not the eligible candidate for eye donation and postawareness program, it was 140 (93.3%) among paramedical and 137 (91.3%) among nonparamedical group. Paramedical 61 (40.7%) and nonparamedical students 34 (22.7%) knew the time utilized for eye removal and postawareness program, it was 126 (84%) in paramedical and 107 (71.3%) in nonparamedical students which was statistically significant (P < 0.001). Less than 1/4th of participants, 37 (24.7%) of paramedical and 24 (16.7%) of nonparamedical knew that only patients with corneal blindness can be benefitted from eye donation. Who should remove the donors eye were known to 80 (53.3%) of paramedical and 46 (30.7%) of nonparamedical students. 78 (52%) of paramedical and 67 (44.7%) of nonparamedical students knew about the changes that should be done in the deceased environment and postawareness program, it was 89.3% in paramedical and 79.3% in nonparamedical participants.

Strangely, disbelief regarding eye donation was higher among paramedical students than the nonparamedical students. Fortunately, majority of participants, 144 (94%) of nonparamedical and 127 (84.7%) of paramedical student disagreed that those who donate their eyes may be born blind in their next birth. Similarly, 133 (88.7%) of paramedical and 97 (64.7%) of nonparamedical students disagreed that because of eye donation they may not go to the heaven after death and a significant improvement (P = 0.001) in the positive response was found among paramedical students while the improvement was statistically insignificant (P = 0.44) among nonparamedical students [Table 2].
Table 2: Knowledge regarding various aspects of eye donation


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Awareness regarding eye donation

It has been found that the majority of participants, 145 (96.7%) of paramedical and 141 (94%) of nonparamedical students were aware of eye donation. Eyes cannot be donated while alive was answered by 47 (31.3%) of paramedical and 39 (26%) of nonparamedical student and postawareness program, it was 125 (83.3%) in paramedical and 87 (58%) in nonparamedical students. The fact that donor's family does not get any money for eye donation was known by 46 (30.7%) of paramedical and 53 (35.3%) of nonparamedical students. Only 34 (22.7%) of paramedical and 32 (21.3%) of nonparamedical students knew about the confidentiality of donor's details. It has been found that 73 (48.7%) of paramedical students were aware of eye bank in their locality which was slightly higher than nonparamedical students 38 (25.3%) while postawareness program, it was known by 143 (95.3%) of paramedical and 131 (87.3%) of nonparamedical students. Unfortunately, only 64 (42.7%) of paramedical and 57 (38%) of nonparamedical students were aware of eye bank in their hospital which showed significant improvement (P < 0.001) postawareness program in both the groups, respectively. Paramedical students 88 (58.7%) were slightly more aware of the inadequate eye donations in India than nonparamedical students 75 (50%) [Table 3].
Table 3: Awareness regarding various aspects of eye donation


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[Figure 1] shows that the prime source of information on eye donation was doctors and optometrists 74 (49.3%) among paramedical students followed by social media 43 (28.7%), posters and conferences 17 (11.3%), relatives and family members 16 (10.7%). However, social media 76 (50.7%) was the main source of information among nonparamedical students followed by doctors and optometrists 30 (20%), relatives and family members 26 (17.3%), and posters and conferences 18 (12%).
Figure 1: Various sources of information for eye donation

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Perception regarding eye donation

As shown in [Table 4], only 46 (30.7%) of paramedical students were willing to donate their eyes and 41 (27.3%) were willing to donate their near ones eye. While among nonparamedical participants, 56 (37.3%) students were willing to donate their eyes and only 41 (27.3%) were willing to donate their near ones eye. There was statistically significant increase (P = 0.001) in the willingness for eye donation postawareness program in both the groups.
Table 4: Willingness for eye donation


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This study showed that among paramedical participants, only 30 (30%) of male and 16 (32%) of female were willing to donate their eyes. According to religion, majority of participants who showed willingness for eye donation was Hindus, 31 (42.5%) followed by Muslim participants 15 (19.5%). Postawareness program, willingness increased to 55 (55%) in males and 30 (60%) in females. In nonparamedical participants, females 29 (38.7%) were more willing to donate their eyes than male 27 (36). Hindu's 49 (40.8%) showed more willingness than Muslim participants 07 (23.3%). Postawareness program, it has been observed the change in the perception regarding eye donation was also higher among female and Hindu participants, as shown in [Table 5].
Table 5: Willingness towards eye donation relative to gender and religion


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[Figure 2] shows that the main barrier to eye donation among paramedical students was others 43.2% followed by the lack of awareness 24.8%, objection by family 24%, delay funeral 4.8%, and face disfigurement 3.2%. Similarly, the prime barrier among nonparamedical student was others 46.6% followed by objection by family 27.1%, lack of awareness 18.6%, and delay funeral 3.4% and face disfigurement 3.4%.
Figure 2: Different barriers to eye donation

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Overall, it has been found that the knowledge and awareness before awareness program showed statistically insignificant difference (P = 0.46) and (P = 0.63), respectively, between the paramedical and nonparamedical students, although it was slightly higher in paramedical students than nonparamedical students while the willingness for eye donation was slightly higher in nonparamedical students than paramedical students which was also statistically insignificant (P = 0.37), as shown in [Table 6].
Table 6: Difference between the parameters of paramedical and nonparamedical students


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However, in both the groups, statistically significant increase in the positive response and willingness was observed postawareness program. The willingness for eye donation was higher among nonparamedical than paramedical students and postawareness program, positive attitude toward eye donation was also found to be increased more in nonparamedical students as shown in [Table 7].
Table 7: Effectiveness of awareness program


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  Discussion Top


In this study, 62% students in paramedical and 60.7% in nonparamedical knew that the eyes can be donated after death while the study conducted by Sadana et al. among medical students showed that 98% participants knew about the donation of eyes after death.[10] Ideal time for the removal of the eye was known to 46.7% of paramedical and 34% of nonparamedical students in the present study which was lower than the proportions found in the study conducted by Bano et al. which was 95% in medical students and 86.4% in nursing student.[14] This study showed that 45.3% of paramedical and 20.7% of nonparamedical students knew about the part of eye used for donation which was higher as compared to study conducted by Jena et al. (10%) in nursing students.[15] Only 35.3% participants in both group knew that anyone can donate eyes regardless of their age which was much lesser as compared to the study carried out by Vidusha and Manjunatha (74.3%).[5]

In our study, 59.3% of paramedical and 46% of nonparamedical students knew that patients infected with AIDS are not eligible for eye donation which was closed to the proportion observed in the study conducted by Sadana et al. (51.75%) and Jena et al. (55%).[10],[15] A study conducted by Kumar and Naik suggested that 40% undergraduate medical students were aware about the time utilized for this procedure while in almost similar to the current findings paramedical (40.7%) and nonparamedical students (22.7%).[13] In this study, only paramedical (24.7%) and nonparamedical students (16.7%) answered that only patient with corneal blindness can be benefitted from eye donation which was much lower as compared to the study accompanied by Arya et al. (78%).[11] In the current study, donor eye should be removed by the eye bank specialist was known to paramedical (53.3%) and nonparamedical students (30.7%) which is similar to the study conducted by Kumar et al. (51.2%).[12] Paramedical (78%) and nonparamedical students (44.7%) knew about the changes that should be done in the deceased environment which was similar to the study conducted by Kumar and Naik (77%) knew that eyes should be kept closed after donors death.[13]

In the study conducted by Bano et al., 100% medical and 93.6% nursing students had heard about the eye donation which was almost similar to the present study as 96.7% of paramedical and 94% of nonparamedical students had awareness about eye donation.[14]

Only 31.3% of paramedical and 26% of nonparamedical students responded that eyes cannot be removed from living person for donation while the study conducted by Tigga et al. in which more than half of participants, 67.93% nurse and 62.68% paramedics knew about it and 69.5% nurses and 23.9% paramedics had awareness regarding the selling and buying of donor eye while in our study, 30.7% in paramedical and 35.3% in nonparamedical group were aware of the same. Tigga et al. found that 20.89% paramedics knew about the confidentiality of the donor's detail which was similar to this study.[4] In the current study, 48.7% of paramedical and 25.3% of nonparamedical students were aware of nearby eye bank when compared to the study conducted by Vidusha and Manjunatha showed that 42.4% medical students were aware of the nearby eye bank.[5] Deficiency of donor's eye in India was known to 58.7% of paramedical and 50% of nonparamedical students in our study which was much lower than the proportions of study conducted by Vidusha and Manjunatha (97.2%).[5]

The prime source of information on eye donation was doctors and optometrists in 49.3% paramedical and social media in 50.7% nonparamedical students. Similarly, mass media remains the main source of information in the study conducted by Sadana et al. (64.75%).[10]

In our study, even less than half, 30.7% of paramedical and 37.3% of nonparamedical students were willing to donate their eyes while 27.3% student in both groups were willing to donate their close relative eyes which was nearly same to the study conducted by Kumar et al. which showed that 46.8% participants were willing to donate their eye and 22% their relative's eye.[12]

In this study, female participants were more willing to donate their eyes as compared to males which was supported by the outcomes of study conducted by Singh et al.[6] In the present study, 42.5% of Hindus and 19.7% of Muslim participants in paramedical group and 40.2% of Hindu's and 22.2% of Muslims in nonparamedical group were willing to donate their eyes. The current findings suggest that Muslim population were less interested in donating their eyes as compared to Hindu's population supported by the study conducted by Maiya et al. found that Hindu's (61.7%) and Muslims (30.1%) were willing to donating their eyes.[16]

The prime barrier to willingness of eye donation in this study was others in paramedical (43.2%) and nonparamedical students (46.6%) which may include their personal issues or religious issues. In a study conducted by Kumar and Naik, main reason was 16% objection by family and 16% delay funeral and other religious rights after death.[13]

In this study, we found that knowledge and awareness regarding eye donation was higher in paramedical students still willingness for eye donation was less as compared to nonparamedical group it may be due to the reason that in paramedical group, majority of students were Muslims while in nonparamedical group, majority of participants were Hindu's as present study and some other studies showed that Muslims were less willing to donate their eyes for religious reasons: There are different opinions about whether Muslim religion forbids donation of eyes.[17]

In this study, awareness program was found to be very effective in improving the knowledge, awareness, and willingness regarding eye donation in both the groups.


  Conclusion Top


The corneal transplants done in India is far-off not as much of than the genuine requirement. Reason is the inappropriate knowledge and lack of awareness about eye donation among the population. There is a significant need of educating not only the general population but also the students about eye donation by clearing their misconceptions about the eye donation. Adolescence can play a significant role in raising the procurement rate of cornea as they are the potential donor and it is the developmental period of their attitudes and benevolent skills and commitment to voluntary activities can motivate the public. Classroom education programs can be important step for educating the students for eye donation. Not only eye donation but also organ donation should be the part of student curriculum so that they can understand the need of eye donation. It will help to convince them for eye donation then they will be able to convinced and educate other people in the society, their family members, and relatives on this important topic. Awareness programs should be organized regularly through the posters, workshops, and conferences among students. Effectiveness of awareness program can be clearly seen in this study. Community camps can be a useful way of educating the people. In the today's modern world, mass media is the important source through which awareness about eye donation can be raised very easily. All health-care professionals should be aware of eye donation because they are in direct contact with patients. They can educate and motivate the potential donor's about eye donation and can also help in the hospital retrieval eye donations. There is a need of modifications in Indian legislation like other country to boost the eye donation by introducing the “presumed consent” concept. These are the important steps through which procurement of cornea can be increased and the burden of corneal blindness can be diminished.

Limitations

  • Less sample size
  • Only university students were taken
  • Postassessment was done only on the same day of awareness campaign. It should be repeated again after few months.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Gupta PC, Duggal M, Jamir L, Sharma D, Kankaria A, Sathyanath S, et al. Knowledge and attitude toward corneal donation among high school children in Northern India. Cornea 2017;36:611-6.  Back to cited text no. 3
    
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National Organ Transplant Programme, Directorate General of Health Services; 2016. Available from: https://dghs.gov.incontent/1528_3_Nationalprogrammeforpreventionandmanagement.aspx. [Last accessed on 2021 Oct 24].  Back to cited text no. 9
    
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Sadana A, Sushma M, Lekha KC, Dudala SR, Prabhu GR, Reddy KA. Assessment of knowledge and attitude regarding eye donation among undergraduate medical students, Tirupati. Int J Med Pharm Sci 2014;04:16-24.  Back to cited text no. 10
    
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Arya SK, Gupta N, Malik A. Eye donation awareness among medical and paramedical staff in a medical institute. Nepal J Ophthalmol 2014;6:177-84.  Back to cited text no. 11
    
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Kumar S, Shukla US, Agarwal P. Awareness and knowledge on eye donation among students at Bhopal. Natl J Community Med 2012;3:685-9.  Back to cited text no. 12
    
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Kumar MP, Naik BS. To assess the knowledge of the undergraduate medical students regarding eye donation. Int J Res Health Sci 2013;1:235-8.  Back to cited text no. 13
    
14.
Bano M, Awasthi S, Arya A, Rawat CM. Assessment and comparison of perception of eye donation and some aspects of eye health care among the medical and nursing students: A cross-sectional comparative study in Uttarakhand state. Nat J Res Community Med 2019;8:131-6.  Back to cited text no. 14
    
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Jena P, Jena D, Kar M, Jena P, Nayak R. A study on knowledge regarding eye donation among first year nursing students of a nursing school and college of Berhampur, Odisha. Int J Res Med Sci 2017;5:4942-5.  Back to cited text no. 15
    
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Maiya GR, Kiran KG, Badiger S. Assessment of awareness and perception regarding eye donation among selected patients attending field practise area of a tertiary care hospital in Mangalore: A cross-sectional study. Int J Community Med Public Health 2018;5:2920-5.  Back to cited text no. 16
    
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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