Pakistan – Successful screening and management of visual refractive errors in rural schools

BACKGROUND: Visual refractive errors among school-aged children limit their learning abilities, education and their confidence. Plan International, a child-centered humanitarian organization, implemented a pilot School Eye Health Programme in 2005 in 27 rural primary and elementary schools. A 3% prevalence rate of refractive error was found. THE INITIATIVE: The pilot project was scaled in 2006 to cover all schools in the sub-district of Chakwal (tot pop 550,000). In close collaboration with the government and a local NGO, training modules and examination/screening kits were developed and provided to schoolteachers. A schoolteacher accompanied the students found positive at the screening to a referral hospital. An ophthalmologist re-examined all referred girls and boys and those having refractive error were provided free glasses. Out-of-school children were also screened through trained government field workers. RESULTS: During 2006-8, 131,703 children were screened by school-teachers and 12,555 were referred to the hospital. 7,631 children were provided free glasses of their choice. The prevalence of refractive error was 5.79% and it was higher in girls than boys. Schoolteachers' participation in the eye-screening program helped them understand that its correction enhanced the children's school performance. Children having glasses were more confident; few drop outs of children corrected for refractive error were observed and children began participating in extra-curricular activities. CONCLUSIONS. Annual school eye screening should be done in all schools, given its cost-effectiveness. This program is being replicated in the Vehari district with the support of the NGO Sight Saver.