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Background Vernal Keratoconjunctivitis (VKC) is an increasing concern among patients with ocular allergy in Africa but its magnitude is not known in our set-up. A number of factors have been identified as associated with VKC although discrepancies exist across regions. Moreover, some of them may be modifiable and knowing specific factors in our setting could guide preventive measures to reduce the burden of VKC in our communities. Objective To determine the prevalence and factors associated with VKC among children presenting with ocular allergy at Ruharo Eye Centre (REC), Southwestern Uganda. Methods This was an analytical hospital-based cross sectional study, conducted at REC. The study population comprised all children below 16 years with ocular allergy attending REC during the period of data collection and targeted all children diagnosed with Vernal Keratoconjunctivitis. We collected data on socio-demographics, behaviors, medical history as well as symptoms related to VKC on all consenting patients and then conducted a full eye examination. The prevalence of VKC among patients presenting with ocular allergy at REC was expressed as a proportion of patients with VKC out of all the patients with allergic presentations enrolled in the study. We used logistic regression to establish potential factors associated with VKC. Results A total number of 366 consecutive patients with ocular allergy who met the inclusion criteria were recruited and Vernal Keratoconjuctivitis was present in 202 children in total, giving a prevalence of 55.7% (95% CI 50.5-60.7). The majority of VKC patients were Males (63.8%) and the mixed form of VKC was the commonest (57.9%) with involvement of both limbal and tarsal conjunctiva. Six patients with VKC (3%) were visually impaired. Multivariate analysis identified male sex (AOR: 2.6 [95% CI: 1.66 – 4.23]), rural residence (AOR: 2.2 [95% CI: 1.29 – 3.65]), primary and tertiary education levels of the head of household (AOR: 2.5 [95% CI: 1.45 – 4.33]), (AOR: 2.4 [95% CI: 1.31 – 4.73], identifiable trigger allergen (AOR 5.1 [95% CI: 1.39 – 18.85]) as well as known reaction to food or drink (AOR: 2.8 [95% CI: 1.22 – 6.33]) as factors which showed independent significant association with VKC. Conclusion The prevalence of VKC in children at Ruharo Eye Centre is high. Factors associated with VKC were: male sex, rural residence, primary and tertiary education level of the head of household, identifiable trigger allergen as well as known reaction to food or drink. Preventive measures can be directed toward modifiable factors in order to reduce the risk of VKC.

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