|Year : 2014 | Volume
| Issue : 2 | Page : 73-75
Ocular injuries from the horsewhip: A 9 years retrospective study
Monsudi Kehinde Fasasi, AA Ayanniyi, ES Saka, FO Olatunji
Department of Ophthalmology, Federal Medical Center, Kebbi State, PMB 1126, Birnin Kebbi, Nigeria
|Date of Web Publication||10-Apr-2015|
Dr. Monsudi Kehinde Fasasi
Department of Ophthalmology, Federal Medical Centre, PMB 1126, Birnin Kebbi
Source of Support: None, Conflict of Interest: None
Background: Horsewhip is a thong made from animal hide and is commonly used among African population to strike commonly, erring children as a form of corporal punishment to correct wrong doings especially at homes and in schools'. This practice is against International law (1989, Convention on the Rights of the child, UN) which sought to protect children from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation. Its use is associated with a myriad of vision threaten conditions including ruptured globe.
Aim : The aim was to evaluate the prevalence and severity of eye injuries caused by horsewhip and recommend ways to reduce it.
Materials and Methods : A 9 years retrospective study of horsewhip ocular trauma was carried out. The following information were extracted from patient's medical records: Sociodemographic record, circumstance of trauma, extent of eye injury, visual acuity (VA) at admission and at the time of discharge. The data were analyzed with SPSS version 18.
Results: Horsewhip ocular injuries constituted 20 of a total number of 930 cases of ocular trauma seen during the study periods . There were 13 males and 7 females. Most patients were students 15 (75%). Left eye was mostly affected 11 (55%). Half of the injuries occurred at schools 10 (50%, 8 in Quranic and 2 in formal), followed by home 7 (35%). Cornea was the most affected part by the trauma 7 (35%). At the presentation to our hospital 11 (55%) had visual acuities of 6/18 or worse in the affected eye. The overall visual outcome of the patients as at the last hospital visit shows 50% attained a VA of 6/12 or better, and 50% had VA of 6/60 or worse.
Conclusion: Horsewhip ocular trauma is an important cause of ocular morbidity, and the importance of ocular health education as a form of preventive measure is underscored.
Keywords: Abuse, discipline, horsewhip, ocular injury, school
|How to cite this article:|
Fasasi MK, Ayanniyi A A, Saka E S, Olatunji F O. Ocular injuries from the horsewhip: A 9 years retrospective study. Afr J Trauma 2014;3:73-5
| Introduction|| |
Horsewhip [Figure 1] is a thong made from animal hide with different local names worldwide. In Nigeria, it is locally known as "Koboko" in Yoruba and Igbo languages and "Bulala" in Hausa language. In Africa it is commonly used by parents, guardians and teachers as a form of corporal punishment to correct wrong doings especially at home and schools (formal and Quranic schools). Horsewhip ocular trauma may results in anterior and posterior-segments eye complications just like any other blunt injury to the globe. During its use, horsewhip can mistakenly hit the eye of the offender leading to injuries ranging from nonvision threatening minor lid abrasion to total loss of vision (ruptured globe). In many Africa countries, it has become a norm ],[ and non-criminalization of such acts , have made it difficult to separate discipline from abuse. However, the practice of using horsewhip is against International law (1989, Convention on the Rights of the child, UN) which sought to protect children from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation.
The aim was to evaluate the hospital incidence and severity of eye injuries caused by horsewhip and to recommend ways to reduce it.
| Materials and Methods|| |
The folders of all patients who presented through the accident and emergency room or directly into the eye unit of the Federal Medical Center, Birnin Kebbi with ocular trauma from horsewhip lash between January 2005 and December 2013 were retrospectively reviewed. From each patient folder, the following details were extracted and entered into data sheet: Age, sex, circumstance of trauma, extent of eye injury and visual acuity (VA) at admission and at time of discharge. The data were analyzed with SPSS version 18 statistical software (SPSS Inc., Chicago, IL, USA) to determine simple descriptive statistics.
| Results|| |
Of 930 ocular trauma patients seen during the study period , 20 cases were due to horsewhip injury. There were 13 males and 7 females. Age range was 6 years to 23 years. [Table 1] shows sociodemographics, eye affected, place where the injury occurred and injury arrival time.
Majority of the patients were below 16 years of age. Most patients 15 (75%) were students. Left eye (LE) was mostly affected 11 (55%). Most of the injuries occurred at schools 10 (8 in Quranic and 2 in formal), followed by home 7 (35%). Cornea was the most affected part by the trauma 7 (35%). Half of the injuries were Grade 1 penetrating eye injury and the remaining half was blunt trauma. The injury from the horsewhip mainly occurred during weekdays (Mondays and Tuesdays) 90%. Most of the patients 18 (90%) had applied topical eye medications bought without a prescription before presenting at our hospital and most patients 15 (75%) presented 4 h and above after the injury. At the presentation to our hospital 11 (50%) had visual acuities of 6/18 or worse. Overall visual outcome of the patients as at last hospital visit shows that 50% attained VA of 6/12 or better, and 50% had VA of 6/60 or worse. [Table 2] shows VA at presentation and at last hospital visit. Corneal abrasion 7 (20%) and traumatic mydriasis 7 (20%) were the main complications seen. [Figure 2] shows ocular features of horsewhip trauma at presentation. Operations performed were mainly lid laceration repair and anterior chamber wash-out (one each). Most of the patients 16 (80%) were treated as outpatient.
|Figure 2: Ocular effect of horsewhipped seen in the patients at presentation|
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| Discussion|| |
In African population, horsewhip usage is a traditional way of discipline. Although, during its use the eyes of the offenders are not targeted, but due to struggling of the offender (because of fear) the offender's eye may be mistakenly hit. However, horsewhip usage is aim at discipline the offender it could be regarded as an abuse on the right of children which goes against international laws in which Nigeria is signatory.
Mechanism of ocular trauma following horsewhipping is likely to be a sheer blunt force from the round end of the horsewhip. Since there are many types of horsewhip have different ends. The two ended horsewhip are likely to cause more damage than the one ended point. Furthermore the ocular effects also likely depend on the force applied by the user of horsewhip during its use and her distance from the offender's eye. It is expected that the closer the user, the more severe the ocular injury and verse visa. Because of their relatively aggressive nature, the male school children were more affected in our study. This was in agreement with previous studies ,, of ocular trauma. Majority of the ocular trauma occurred in Quranic schools (40%) this was expected because most of the Islamic school teachers use horsewhip as corporal punishment for latecomers and to encourage attentiveness in their studies. Majority 18 (90%) of the people affected with this trauma were within 6-16 years of age, this was in agreement with previous study from this hospital on ocular trauma,  but differs from that reported by Okoye,  who found that 65.9% ocular trauma were within age of 16-65 years. The difference may be due to different sociocultural background of the study areas and also due to the fact that our study was mainly on ocular trauma due to horsewhip while Okoye study was on ocular trauma from all causes.
Although both eyes can be affected by horsewhip, in our study LE (left eye) were mostly affected (55%). This is different from previous ocular studies in Nigeria ,, and Malaysia  where right eyes were mostly affected. This finding may be due to the possibility of the right hand dominant in most of the teachers. Majority of the patients have used topical eye medications bought across the counter without prescription before presenting to our hospital (90%) this was in agreement with previous studies in the developing countries. ,, Most patients presented 4 h and above after the injury 15 (75%) this was similar to previous ocular trauma study by Omolase et al.  from Nigeria but contrasts to Monsudi and Ayanniyi  and Babar et al.  from Nigeria and Pakistan respectively. Despite late presentation by the patients, 10 (20%) still had VA of 6/60 or worse as at the last hospital visit due to corneal scarring and retinal detachment (5 each). This high frequency 5 (40%) of severe ocular injury (corneal laceration and retinal detachment) found in our study coupled with inadequate modern facilities to treat them explain the long-term complication of ocular trauma in children in our environment.
| Conclusion|| |
Horsewhip ocular trauma is an important cause of ocular morbidity; hence its use as a form of corporal punishment should be banned in all schools. Furthermore, health education about ocular complications of horsewhipping should be intensified in the public.
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[Figure 1], [Figure 2]
[Table 1], [Table 2]