TY - JOUR T1 - Two strategies for correcting refractive errors in school students in Tanzania: randomised comparison, with implications for screening programmes JF - British Journal of Ophthalmology JO - Br J Ophthalmol SP - 19 LP - 24 DO - 10.1136/bjo.2007.119198 VL - 92 IS - 1 AU - S Wedner AU - H Masanja AU - R Bowman AU - J Todd AU - R Bowman AU - C Gilbert Y1 - 2008/01/01 UR - http://bjo.bmj.com/content/92/1/19.abstract N2 - 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. ER -