Visual acuity problems among primary school students in Tanzania: a mixed methods study

Introduction – Globally, adolescents in low-income countries face a disproportionately high burden of eye health problems. The aims of this study are to 1) estimate the prevalence of distance visual acuity problems among young adolescents in Tanzania, 2) explore the relationship between distance visual acuity and academic performance, 3) examine the facilitators and barriers to school-facilitated vision screenings, and 4) examine the facilitators and barriers to receiving critical eye care. Methods – As part of the intervention arm in the VITAA randomized clinical trial, Tanzanian students in Standard 7 went on school-facilitated “field trips” to local health clinics to receive a health check-up which included a distance visual acuity test [Snellen eye chart]. Data for adolescents included exit surveys, medical chart extraction, and academic performance as measured by the Primary School Leaving Examination (PSLE), an end-of-year test required for Standard 7 students. Focus group discussions were conducted with school and clinic staff and a thematic analysis was used. Results – Overall, 6.9% of students had moderately reduced vision and 4.3% of students had poor vision. Among those with normal vision, 59.9% had a C or lower on the PSLE; among those with moderately reduced vision, it was 68.6%; and among those with poor vision, it was 77.3%. Less than 12% of students referred received follow-up care. Clinic and school staff indicated that school-based vision screenings were largely successful, but extraneous factors often made it difficult for nurses to administer the screening. There was also a disconnect in referral linkages, and some parents experienced financial barriers to follow-up care for their children and lacked education on the importance of timely pediatric eye care. Discussion – Given the prevalence of visual acuity problems and the relationship with academic performance, the Tanzanian government should consider requiring schools to conduct distance vision screenings. Further research on the best implementation strategies is still needed.