Spectacle Compliance and Its Determinants in a School Vision Screening Pilot in Botswana

ABSTRACT

Purpose: The effectiveness of school eye health programmes relies on many factors, including compliance with spectacle wear. The objectives of this study were to determine spectacle compliance in a school vision screening pilot programme in Botswana, and investigate factors predictive of compliance.

Methods: The study was an observational, cross-sectional follow-up of a pilot school screening programme. Unannounced compliance checks were completed after 3–4 months in a convenience sample of 19 schools. Sex, age, school level, visual acuity, and refractive error were analysed using logistic regression to investigate factors predictive of compliance.

Findings: Compliance data were recorded for 193/286 (67.5%) children; 62.2% were female and the median age was 15 years (interquartile range 12–17 years). 60.1% of the sample were compliant with spectacle wear. Girls were more likely to be compliant than boys (adjusted odds ratio (aOR) = 2.32, 95% confidence interval (CI) 1.03–5.27). Children at primary and junior secondary school were more likely to be complaint than senior secondary school children (aOR = 16.96, 95% CI 5.60–51.39; and aOR = 3.39, 95% CI 1.39–8.22, respectively). Children with binocular uncorrected visual acuity (UCVA) of 6/7.5 to 6/12 were 2.76 (95% CI1.05–7.23) times more likely to be compliant than children with binocular UCVA of 6/6.

Conclusion: Compliance was higher in Botswana than previous African studies; however, improvement in this area would increase the effectiveness of the programme. Further investigation into barriers to spectacle wear affecting boys and older children is warranted. A prescribing protocol to avoid low prescriptions – especially where binocular UCVA is 6/6 – is desirable.

Acknowledgments

Funding for data collection was provided by London School of Hygiene & Tropical Medicine (LSHTM) MSc student awards and Fiona’s Eye Fund (Scottish Charity SC039601). Logistic support for data collection was provided by the Botswana Ministry of Education, via Education Officer Mr Faruk Maunge and a Ministry vehicle and driver. Thank you also to Ryan Littman-Quinn and the Peek Botswana organisation for logistic support and permission to access pilot programme data. Electronic data solutions were provided by LSHTM Open Data Kit (odk.lshtm.ac.uk). I am grateful for additional statistical support provided by Dr David Macleod, LSHTM.

Sources of other support

The Botswana Ministry of Education provided use of a regional education officer and a Ministry vehicle and driver to facilitate school visits.

London School of Hygiene & Tropical Medicine Open Data Kit group supplied Google Nexus tablets for data collection.

Conflicts of interest

No conflicts of interest amongst the authors.

Additional information

Funding

This study was funded by Fiona’s Eye Fund, Scottish Charity SC039601; London School of Hygiene & Tropical Medicine (LSHTM) – Hooper Scholarship; MSc Trust Fund and Faculty of Infectious and Tropical Diseases bench fees. Research was completed as planned without limitations from funders and the authors retained full control of primary data.