Demographic characteristics and ocular needs of children attending child eye clinics in Cross River State, Nigeria: a retrospective analysis of clinical records

Abstract

ObjectivesTo describe the demographic characteristics and ocular needs of children attending four child eye clinics in Cross River State, Nigeria, to inform the development of a sustainable spectacle cross-subsidisation scheme.DesignRetrospective analysis of clinic records.SettingFour child eye clinics in Calabar, Ogoja, Ikom and Ugep, Cross River State, Nigeria, from 1 May 2017 to 30 June 2019.ParticipantsChildren who failed the vision screening in schools and visited assigned child eye clinics, and self-referred children from the community.Main outcome measuresChildren’s age, sex, residence, diagnosis, disease management, presenting and corrected visual acuity, history of spectacle wear and magnitude of refractive errors in spherical equivalent in the worse eye.ResultsOf all the 3799 records reviewed, data were available for 3774 children (mean age 10.6±4.35 years; 61.6% girls; 69.1% from urban settings); 30.8% (n=1162) of them had vision impairment. Of those children, 71.2% (n=827) were diagnosed with refractive error. For management, 48.6% (n=1833) were prescribed spectacles and 40.5% (n=1527) were prescribed ocular medications. Children prescribed spectacles were significantly more likely to be girls (68.0%, p<0.001), and older than 13 years of age (53.6%, p<0.001). The most common range of spherical equivalent (in the worse eye) was <−0.50 DS to +1.75 DS (51.6%, n=945), followed by >−0.25 DS to −3.00DS (39.7%, n=727). Non-refractive eye conditions such as cataract (33.3%) and corneal disorders (14.1%) contributed to almost half of the total blindness.ConclusionThe findings show that spectacles provisions and ocular medications are the primary and secondary needs for children who attended child eye clinics seeking eye care services. Further research is needed to understand parents’ willingness to pay for spectacles to set strategic multitier pricing for a sustainable cross-subsidisation scheme.

Caretakers’ stated willingness to pay for children’s spectacles in cross river state, Nigeria and its implication for a cross-subsidisation scheme: a cross-sectional study

“…Furthermore, based on our previous market research, we identified that the children who attended the four child eye health clinics were as follows: 40% affluent, 32% rural poor and 28% urban poor. [ 17 ] However, local stakeholders indicated that since the cessation of the free spectacle delivery programme, the proportion of rural and urban poor children purchasing spectacles from their clinic had reduced to 20%. Faderin et al [ 9 ] also reported the main constraint for spectacle uptake was non-affordability and economic barriers.…”

“…The many potential customers who can afford spectacles and the lack of competition also suggest a positive market potential for a cross-subsidisation scheme. Our previous study [ 17 ] at the local child eye clinics where the cross-subsidisation scheme was to be implemented also found that 9 in 10 children were first-time wearers. However, such a programme requires a long-term marketing and education scheme to gradually build sales growth seeing parents from the communities do not believe their child has a vision problem, [ 19 ] even though their child failed vision screening.…”

“…However, such a programme requires a long-term marketing and education scheme to gradually build sales growth seeing parents from the communities do not believe their child has a vision problem, [ 19 ] even though their child failed vision screening. In recent discussions with the Cross River State Eyecare Programme, the Department of Health identified a possible three-tier price structure within the cross-subsidisation scheme – low (₦2000 or US$5.0) for standard frames and lenses, mid (₦3600 or US$9.0) for upgraded frames and standard lenses, and high (₦4400 or US$11.0) for upgraded frames and lenses as reported by Yong et al [ 17 ] and Chan et al [ 18 ] Low-cost ready-made and clip-to-fit spectacles can be viable options for a lower-tier price without compromising the suggested quality standards for spectacles.…”

“…This scheme has been described in detail in a previous publication. [ 17 ] The scheme aims to (i) increase access to spectacles among the urban poor and rural poor, (ii) relieve the Ministry from the unsustainable donor-reliant free spectacles programme, and (iii) fully utilise the dispensing units to achieve economies of scale. Hence, a series of market research studies were conducted in 2019 to understand the demography profile and ocular needs of the children attending the local child eye clinics [ 17 ], factors affecting caretakers’ when purchasing their children’s spectacles [ 18 ], the reasons that prevented the caretakers from bringing their children from attending a follow-up eye exam [ 19 ] and the caretakers’ willingness to pay for their children’s spectacles (which is a the focus of this article).…”

“…[ 17 ] The scheme aims to (i) increase access to spectacles among the urban poor and rural poor, (ii) relieve the Ministry from the unsustainable donor-reliant free spectacles programme, and (iii) fully utilise the dispensing units to achieve economies of scale. Hence, a series of market research studies were conducted in 2019 to understand the demography profile and ocular needs of the children attending the local child eye clinics [ 17 ], factors affecting caretakers’ when purchasing their children’s spectacles [ 18 ], the reasons that prevented the caretakers from bringing their children from attending a follow-up eye exam [ 19 ] and the caretakers’ willingness to pay for their children’s spectacles (which is a the focus of this article). We found that nearly 50% of the 3799 children who visited an eye clinic in CRS needed and procured spectacles, and almost all of them (90%) were first-time buyer; [ 17 ] 60% were urban- and rural-poor children; [ 17 ] unaffordability of spectacles was the main reason for not pursuing follow-up examination after they failed vision screening [ 19 ]; and good frames and lenses were priority features for parents who could afford to buy spectacles for their children.…”