Assessing the Accuracy and Feasibility of a Refractive Error Screening Program Conducted by School Teachers in Pre-Primary and Primary Schools in Thailand

Abstract

IntroductionAs part of the development of a system for the screening of refractive error in Thai children, this study describes the accuracy and feasibility of establishing a program conducted by teachers.ObjectiveTo assess the accuracy and feasibility of screening by teachers.MethodsA cross-sectional descriptive and analytical study was conducted in 17 schools in four provinces representing four geographic regions in Thailand. A two-staged cluster sampling was employed to compare the detection rate of refractive error among eligible students between trained teachers and health professionals. Serial focus group discussions were held for teachers and parents in order to understand their attitude towards refractive error screening at schools and the potential success factors and barriers.ResultsThe detection rate of refractive error screening by teachers among pre-primary school children is relatively low (21%) for mild visual impairment but higher for moderate visual impairment (44%). The detection rate for primary school children is high for both levels of visual impairment (52% for mild and 74% for moderate). The focus group discussions reveal that both teachers and parents would benefit from further education regarding refractive errors and that the vast majority of teachers are willing to conduct a school-based screening program.ConclusionRefractive error screening by health professionals in pre-primary and primary school children is not currently implemented in Thailand due to resource limitations. However, evidence suggests that a refractive error screening program conducted in schools by teachers in the country is reasonable and feasible because the detection and treatment of refractive error in very young generations is important and the screening program can be implemented and conducted with relatively low costs.

Interventions to improve school-based eye-care services in low- and middle-income countries: a systematic review

“… 19 – 66 Identified articles were from 13 countries spanning five World Health Organization (WHO) Regions including Africa (eight studies), the Americas (10 studies), the Eastern Mediterranean (one study), South-East Asia (18 studies) and the Western Pacific (11 studies). Identified articles comprised 19 school-based eye-care programme evaluations, 19 – 33 , 62 – 64 , 66 16 studies investigating spectacle compliance associations, 34 – 48 , 65 eight studies exploring the quality of various eye-care screening personnel, 49 – 56 four studies evaluating the effectiveness of eye health promotion, 57 – 60 and one study that included both spectacle compliance and the quality of screening personnel 61 . When appraised for quality, 15 we classified 18 studies as being of high quality, 20 as medium quality and 10 as low quality.…”

“…As the availability of eye-care specialists can be limited in school settings, particularly in low- and middle-income countries, studies have investigated the use of teachers, nurses, certified medical assistants and key informants for the provision of screening and basic eye-care for children 20 , 21 , 29 , 51 – 54 , 56 , 58 , 60 , 62 . Several studies found that training teachers in vision screening enabled the provision of a good-quality 51 , 53 , 56 and cost–effective service, 53 while facilitating the opportunity to motivate spectacle use among students 54 . Two studies reported that the use of teachers as vision screeners did not create significant burdens on normal workloads, and in fact enhanced rapport with children and parents 50 , 56 .…”

“…Several studies found that training teachers in vision screening enabled the provision of a good-quality 51 , 53 , 56 and cost–effective service, 53 while facilitating the opportunity to motivate spectacle use among students 54 . Two studies reported that the use of teachers as vision screeners did not create significant burdens on normal workloads, and in fact enhanced rapport with children and parents 50 , 56 . Evidence from Brazil, 27 Nepal 49 and Timor-Leste 21 highlighted the benefits of school-based vision screening performed by trained nurses or certified medical assistants.…”

“…Studies assessing the feasibility of school-based eye-care interventions, such as the targeting of trachoma in the United Republic of Tanzania, 58 vision screening in Peru, 30 South Africa 29 and Thailand, 56 and the provision of free spectacles in China, 39 noted that success was dependent on multidisciplinary support from health and education ministries. The level of collaboration between ministries may either facilitate 20 , 28 , 30 , 58 or inhibit 62 the coordination and success of interventions at the school level.…”

“…An example from a trachoma intervention in Tanzanian schools outlined that, while elimination of trachoma was prioritized in health policies, it also needed to be incorporated into education curriculums if progress was to be made 58 . Since achieving shared responsibility of the monitoring and execution of policies targeting eye health is considered important in the success of school-based eye-care interventions in low- and middle-income countries, partnerships between ministries and nongovernmental or private organizations are considered crucial 21 , 30 , 52 , 56 , 62 …”