A cross-sectional study from Northern Uganda has highlighted a striking burden of conjunctivitis among patients presenting to a regional eye clinic, while reinforcing the importance of person-to-person transmission as a potentially modifiable risk factor.
Researchers from Gulu University and collaborating institutions evaluated 423 patients attending the Eye Clinic at Gulu Regional Referral Hospital between August and September 2024. Conjunctivitis was diagnosed clinically by ophthalmic clinical officers and verified by an ophthalmologist, with participants also providing information on demographic, socioeconomic, clinical, and healthcare-related factors.
Overall, 298 patients – 70.4 percent of the cohort – were diagnosed with conjunctivitis. The study authors stress, however, that this figure represents the proportion of patients attending the eye clinic rather than the prevalence of conjunctivitis in the wider Northern Ugandan population. The convenience sampling approach and clinic-based setting mean the findings should not be extrapolated to the community as a whole.
The investigators used modified Poisson regression to identify factors independently associated with disease. After adjustment, recent exposure to somebody known to have conjunctivitis was the only factor associated with increased prevalence, corresponding to a 13 percent increase compared with patients without such exposure.
Age also appeared important. Patients aged 40 years or older had a 27 percent lower prevalence of conjunctivitis than children aged 0–11 years. The researchers note that younger children may experience greater exposure to infectious agents in school and childcare environments, alongside more frequent hand-to-eye contact and less-established hygiene practices.
Two more unexpected associations emerged. Recent eye injury or surgery was linked to a lower prevalence of conjunctivitis, while chronic illness was also associated with a reduction. The study authors suggest that greater interaction with healthcare services, postoperative hygiene advice, prophylactic treatment, and more frequent ophthalmic monitoring could contribute to these findings. Importantly, they caution that surveillance bias or differences in healthcare access may provide an alternative explanation rather than any true biological protective effect.
The study was conducted several months after an acute hemorrhagic conjunctivitis outbreak in Uganda in March 2024. Although residual transmission may have contributed to the unusually high proportion of cases seen at the clinic, the researchers did not collect sufficient outbreak-specific data to test this possibility, noting that this link should be “regarded as speculative.”
Other limitations include the cross-sectional design, clinical rather than laboratory-confirmed diagnoses, and the absence of differentiation between bacterial, viral, allergic, and environmental conjunctivitis.
The study authors argue however that the findings point toward practical interventions – particularly hygiene education, rapid identification of cases, and temporary isolation measures in schools, workplaces, and other settings where outbreaks could occur. They also call for prospective, laboratory-confirmed studies to characterize conjunctivitis subtypes and their specific risk factors in the region, as well as integrating routine screenings into pre-existing chronic disease management programs.
