Prevalence of Eye Diseases among Learners in Kafue District, Zambia

Objective: To determine the pattern and magnitude of eye diseases among the primary and secondary schools' learners in Kafue District in Zambia.Method: A cross-sectional survey of all 73 primary and secondary schools in Kafue.Results: A total of 18,713 enrolled in the study. The prevalence of eye diseases was 20.9% accounting for 17.0% allergic conjunctivitis followed by refractive 3.3%, and least was retinal disorder at 0.01%. Urban dwellers were affected more than their rural counterparts.Conclusion: The survey found a high prevalence of eye diseases among the  learners in Kafue District with allergic conjunctivitis being the most prevalent cause followed by significant refractive errors

Can we scale up a comprehensive school-based eye health programme in Zambia?

BACKGROUND: Globally, 19 million children have preventable vision impairment simply because refractive and eye health services are inaccessible to most of them. In Zambia, approximately 50,000 school children need spectacle provision. The School-based Eye Health Programme (SEHP) has been identified worldwide as a proven strategy to address childhood blindness. Given its great benefits, the Zambian government intends to scale up the programme. This scalability assessment aims to identify and evaluate the essential components of an effective SEHP, determine roles, assess existing capacities within user organisations, identify environmental facilitating and inhibiting factors, and estimate the minimum resources necessary for the scaling up and their proposed scale-up strategies. METHODS: Five elements (innovation, user organisation, resource team, environment, and strategies for horizontal and vertical scaling-up) were assessed guided by the ExpandNet-WHO Nine Steps for Developing a Scaling-Up Strategy. Literature review on proven strategies to reduce childhood blindness and the credibility of SEHP implemented in resource-limited settings, document review on the pilot project, questionnaires, and stakeholders’ interviews were conducted to collect data for this assessment. Subsequently, twenty questions in the Worksheets for Developing a Scaling-up Strategy were used to report the assessment outcome systematically. RESULTS: Additional components of SEHP incorporated in Zambia’s model enhanced the innovation’s credibility and relevance. The resource team was relatively competent in the pilot project, and the same team will be employed during the scaling-up. Potential change in political parties, the lack of supply chain, and unstable financial support were identified as inhibiting factors. The objectives of SEHP were aligned with the National Eye Health Strategic Plan 2017–2021, which supports the institutionalisation of the SEHP into the existing School Health and Nutrition Programme. For the pace of expansion, replicating SEHP to another district rather than a province will be more realistic. CONCLUSION: Scaling up a comprehensive SEHP in Zambia is feasible if sufficient funding is available. Additionally, the pace must be adapted to the local context to ensure that every component within the SEHP is intact. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08350-2

Vision Screening of Learners by Teachers in Kafue District in Zambia as a Strategy to Address the Challenges of Childhood Blindness

Background: Early detection and treatment of eye diseases in children is critical in combating childhood blindness. Innovative community-based strategies such as training of teachers in vision screening need to be developed for effective utilisation of the available human resources as well as to counter the challenges of inequitable distribution of trained eye health human resourcesas well as the limited access of quality eye health care services to the majority of our population. Aim: To evaluate the effectiveness of using teachers as the first level of vision screeners.Materials and Methods: Teacher training programmes were conducted for schoolteachers to educate them about childhood eye diseases and the significance of their early detection. The teachers trained for the school vision screening were from all government, private and community schools located in Kafue District. The teachers then conducted vision screening of learners in their schools.Subsequently, the mobile eye health teams visited the schools for the re-evaluation of learners identified with poor vision. All learners identified with refractive errors had refraction performed on them and spectacles prescribed. The mobile eye health teams referred learners requiring a further ophthalmic evaluation to the University Teaching Hospitals – Eye Hospital which was the base hospital for the programme. The assessment included calculation of true positives, false positives, true negatives and false negatives.Results: One hundred and fifty-four (154) teachers from 73 primary and secondary schools underwent training in vision screening. The teachers screened 18,713 learners and reported eye diseases in 2,818 (15.1%) children. However, the mobile eye health teams examined 5,958 learners who included 2,818 referrals from teachers and 3,140 rescreened learners. The mobile eye health teams confirmed eye problems in 2,818 learners screened by the teachers and further diagnosed more eye problems in 999 learners giving a total of 3,817 learners with eye problems. Thus, the teachers were able to correctly identify eye problems (true positives) in 100.0% (2,818/2,818) of learners. The teachers could not identify eye problems in 999 learners giving false negatives were 26.2% (999/3,817).Conclusion: Considering the high true positive value and the comprehensive coverage provided by the survey, vision screening in schools by teachers is an effective method of identifying learners with eye problems and poor vision early. This strategy could be valuable in reducing the workload of the eye health care staff. Keywords: Vision screening, true positives, false negatives, screening, predictive value, childhood blindnes