GLOBAL ISSUES
Two strategies for correcting refractive errors in school students in Tanzania: randomised comparison, with implications for screening programmes
1 International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
2 Ifakara Health and Development Research Centre, Ifakara, Tanzania
3 Tanzanian Society for the Blind, Dar es Salaam, Tanzania
4 Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK
5 CCBRT Hospital, Dar es Salaam, Tanzania
Correspondence to:
S Wedner, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; susanne.wedner{at}gmx.net
Purpose: To compare whether free spectacles or only a prescription for spectacles influences wearing rates among Tanzanian students with un/undercorrected refractive error (RE).
Methods: Design: Cluster randomised trial.
Setting: 37 secondary schools in Dar es Salaam, Tanzania.
Participants: Distance visual acuity was measured in 6,904 year-1 students (90.2% response rate; median age 14 years; range 11–25 years) using a Snellen E-chart. 135 had RE requiring correction.
Interventions: Schools were randomly allocated to free spectacles (arm A) or prescription only (arm B).
Primary outcome: Spectacle use at 3 months.
Results: The prevalence of un/undercorrected RE was 1.8% (95% CI: 1.5 to 2.2%). At 3 months, 27/58 (47%) students in arm A were wearing spectacles or had them at school compared with 13/50 (26%) in arm B (adjusted OR 2.4, 95% CI 1.0 to 6.7). Free spectacles and myopia were independently associated with spectacle use.
Conclusions: The low prevalence of un/undercorrected RE and poor uptake of spectacles, even when provided free, raises doubts about the value of vision-screening programmes in Tanzanian secondary schools. Policy decisions on school vision screening in middle- and low-income countries should take account of the cost-effectiveness as well as competing demands for scarce resources.
Funding: British Council for the Prevention of Blindness (BCPB).
Competing interests: None.
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