There is no plan for a national child eye care programme or existing human resource infrastructure to address the immediate challenge of child eye health in Mozambique. Furthermore, the prevalence and incidence of refractive error, visual impairment (VI) and child blindness (CB) in Mozambique is unknown. VI and CB have devastating personal, developmental, economic and other implications for the child, the family, the community and indeed, the nation. This study aims to design, implement and evaluate a school based paediatric vision screening service, to identify those in need of eye health services, among Mozambique’s 11,561,000 children.

Methods

Primary School Screening took place in three schools in Nampula, Mozambique in September 2010 and March 2011. The children’s vision was screened by an optometry student, optometrist or teacher with a Log MAR 0.3 line at 4 Meters. Ophthalmoscopy was performed on all children. Children who failed to read all 5 letters monocularly had their visual acuity examined on a standard Log Mar chart. If they failed to see the 0.3 line on the standard chart they had a full refraction on site. Children who required refraction were refracted on site. Those needing ophthalmological assessment were referred to Nampula Central Hospital, Ophthalmology Unit.

Results

These studies found that there is a cohort of students attending school in Nampula who are in need of eyecare service provision. Refractive Error was present among this population tested in these studies but none of the children observed wore spectacles.The training received by these teachers was very brief but teachers appear to have an adequate level of education and interest to undertake vision screening in children. The ideal teacher profile for Vision Officers within schools is trainee teachers who can be taught the basics of vision screening and eye health through their existing studies.

The results of this study will inform a regional pilot teacher screening project for Nampula, which will include the addition of “Vision Screening” to teacher training modules at Pedagogical Universities in Nampula, Mozambique, as part of a plan to develop a national child eye care programme for Mozambique.

Methods: Primary School Screening took place in three schools in Nampula, Mozambique in September 2010 and March 2011. The children’s vision was screened by an optometry student, optometrist or teacher with Log MAR ETDRS letters at 4 Meters. Ophthalmoscopy was performed on all children by qualified optometrists. Children requiring refraction were refracted on site, those needing ophthalmological assessment were referred to the ophthalmologist in Nampula Central Hospital.

Results: 770 children were screened in total. The ocular abnormality detection rate was 10.65%, and included 7.40% of children requiring spectacle provision, and the remaining 3.25% requiring referral to the Ophthalmology Unit. The distribution of myopia, hyperopia and astigmatism among children provided spectacles was 28.57%, 12.5% and 58.93% respectively, and overall prevalence in the study sample was 2.21%, 0.91% and 4.29% respectively. Referrals for ocular health abnormalities included, cataract (26.92%), ptosis (23.08%), glaucoma (15.38%). All teachers interviewed are eager to participate in a vision screening programme. Two Primary School Teachers were trained in vision screening. Teachers scored 100% case detection agreement with optometrists and student optometrists, with no noted false positive or false negative referrals. Conclusions: Teachers appear to have an adequate level of education and interest to undertake vision screening in children. This study will inform a regional pilot teacher screening project for Nampula, which will include the addition of “Vision Screening” to teacher training modules at Universidade Pedagogica, Nampula, as part of a plan to develop a national child eye care programme for Mozambique.