Abstract
Background: Global estimates suggest there are almost 19 million visually impaired children worldwide, the major cause being uncorrected refractive error (RE). Aim: To assess the prevalence of visual impairment (VI) and RE among Sudanese school-aged children. Setting: Eight randomly selected primary schools from 21 districts in South Darfur State of Sudan were involved.
Methods: A school-based cross-sectional study of RE and VI in primary schoolchildren from grades 1 to 8 (children aged 6-15 years) was investigated. A Refractive Error Study in Children (RESC) protocol was implemented to determine the prevalence of RE and VI in these school-aged children. Participants were enrolled through stratified multistage cluster sampling of four all-male and four all-female primary schools from South Darfur State of Sudan. Examination procedures followed the RESC protocol, which included visual acuity (VA) measurements, binocular vision assessments, retinoscopy and autorefraction under cycloplegia, as well as examination of the external eye, anterior-segment, media and fundus.
Results: A total of 1775 children were invited to participate in the study and 1678 were examined resulting in a participation rate of 94.5%. The findings indicated that the prevalence of uncorrected, presenting and best-corrected VA of 6/12 or worse was 6.4% (95% confidence interval [CI], 4.9-7.9), 4.4% (95% CI, 2.9-5.9) and 1.2% (95% CI, 0.3-2.7) respectively. RE was the cause of VI in 57% of participants, retinal disorders in 13.1%, amblyopia in 5.6%, corneal opacity in 0.9%, cataract in 3.7%, with the causes of reduced vision undetermined in 10.3% and various other causes contributed 9.3%. External and anterior-segment abnormalities were observed in 10.2% of children. This was mainly allergic conjunctivitis (5.3%) followed by bacterial and viral conjunctivitis (4.2%). The prevalence of myopia (>=vertical bar-0.50 D vertical bar) in one or both eyes was 6.8% (95% CI, 5.3-8.3), hypermetropia (>= 2 D) was noted in 1.9% (95% CI, 0.4-3.4) and astigmatism (>=vertical bar-0.75 D|) prevailed in 2.5% (95% CI, 1.0-4.0). Prevalence of VI among school-aged children were associated with the children's age and grade levels (p = 0.00) but was not correlated with gender (p = 0.224). Prevalence of RE among school-aged children was significantly correlated with age and grade levels (p = 0.00). No significant correlation was found between gender and prevalence of RE (p = 0.833). The prevalence of VI because of myopia was associated with increasing grade levels and also the childhood age (p = 0.023), but there was no significant difference in the prevalence of VI because of myopia between male and female children.
Conclusion: Uncorrected RE was a major cause of VI among children in the South Darfur State. There is thus a critical need for developing a comprehensive child eye care plan focusing on the reduction of uncorrected RE through collaboration between key stakeholders and government.