Validity of recall absent schoolchildren to free eye health projects / Validade da reconvocação de escolares faltosos a exame ocular gratuito

PURPOSE: To analyze the results of recall absent schoolchildren to eye health projects. METHODS: Cross-sectional study. Visual screening was performed in schoolchildren attending 1st to 4th grades at public schools, from 7 to 10 years-old, to select and forward to complete ophthalmic evaluation. The projects were performed during weekends, at a public school, in the same municipality. Free transportation, food and eyeglasses were offered. A second opportunity of examination was offered to the students who were absent from the first call, with the same facilities. RESULTS: 51,509 schoolchildren had their vision tested, 14,651 (28.4%) were referred for ophthalmic examination. Of these, 8,683 (59.3%) attended the first call, 2,228 (37.3%) attended the recall and 25.5% of parents did not take their children to ophthalmic examination. The need for eyeglasses for children who attended the examination was 23.8% and 32.0% in the first opportunity and recall, respectively. The recall increased the coverage in 15.2% (59.3% to 74.5%). CONCLUSION: An expressive number of parents (25.5%) did not bring their children to be examined, even at a second opportunity of exam. The facilities offered: access, free examination, transportation and glasses. Children who were absent in the first opportunity and appeared at recall had a greater need for eyeglasses. Recall increased the coverage in 15.2% (59.3% to 74.5%) and it is not recommended when financial resources are limited.

OBJETIVO: Analisar os resultados da reconvocação de escolares faltosos a projeto de saúde ocular. MÉTODOS: Estudo transversal descritivo. Escolares de 7 a 10 anos de 1ª a 4ª séries do ensino fundamental foram triados nas escolas e encaminhados para exame oftalmológico completo. Os exames foram realizados durante fins de semana, em escola pública. Foram oferecidos transporte, alimentação e óculos gratuitos. Uma segunda oportunidade de exame foi oferecida aos faltosos, com as mesmas facilidades. RESULTADOS: Foram triados 51.509 escolares e encaminhados 14.651 (28,4%). Compareceram 8.683 crianças (59,3%) na primeira convocação. Os escolares faltosos (5.968) foram reconvocados e 2.228 (37,3%) compareceram à reconvocação, sendo que 25,5% dos pais não levaram seus filhos para exame. A necessidade de óculos, para crianças que compareceram ao exame, foi de 23,8% e 32,0%, na primeira convocação e reconvocação, respectivamente. A reconvocação aumentou a cobertura do projeto em 15,2% (59,3% to 74,5%). CONCLUSÃO: Um número expressivo de pais (25,5%) não leva seus filhos para exame, apesar das facilidades oferecidas de acesso, transporte, exame e óculos gratuitos. A necessidade de óculos foi maior nos escolares que compareceram à reconvocação que na primeira convocação. A reconvocação aumentou a cobertura de 59,3 para 74,5% e não está indicada quando os recursos financeiros são limitados.

Why are there defaulters in eye health projects?

PURPOSE: To identify barriers to attendance for eye examination of schoolchildren. METHODS: Cross-sectional study. Students in grades 1-4 in elementary school in Guarulhos (Brazil) were screened and referred for ophthalmic examination in 2006. Facilities offered in this project were: examination arranged during weekends, free transportation, spectacle donation and two different opportunities for exam. A questionnaire was applied, by interview, to a sample consisted of students' parents attended in a community project who missed the first call and attended the recall, to identify the reasons for non-attendance. RESULTS: The sample consisted of 767 parents or guardians, corresponding to an equal number of schoolchildren. Personal characteristics of the students: 49.2 percent male and 50.8 percent female, 60.2 percent of them had never received previous ophthalmologic evaluation. Reported reasons for no-show to the project: parents had not received appropriate orientation (35.6 percent), loss of working day (20.6 percent), illness (12.4 percent), had another appointment (10.0 percent). The need for eyeglasses was higher in the recall. CONCLUSIONS: A significant number of parents did not take their children for ophthalmological exams, even when a second opportunity was offered in projects with transportation facilities, free exams performed during weekends and spectacle donation. The main causes of absenteeism were lack of awareness and work. For 87.1 percent of the absenteeism cases, the difficulties could be overcome via improved structuring of the first call. A recall increases attendance coverage of target population by only 15.2 percent (59.3 to 74.5 percent). Notably, the eye exam campaign was the first exam for most of the absent students.

Evaluation of ‘vision screening’ program for three to six-year-old children in the Republic of Iran.

Background: Since 1996, vision screening of three to six-year-old children is conducted every year in Iran. We present outcomes of project review held in August 2006. Materials and Methods: Kindergarten teachers examined vision by using Snellen's illiterate ‘E’ chart. They used torchlight to detect strabismus. On a repeat test, if either eye had vision <20/30, the child was referred to the optometrist. A pediatric ophthalmologist examined and managed children with strabismus or amblyopia. Provincial managers supervised the screening program. The evaluator team assessed the coverage, yield, quality and feasibility, and cost-effectiveness of vision screening, as well as magnitude of amblyopia, and its risk factors. Result: In 2005, 1.4 million (67%) children were examined in all provinces of Iran. Opticians examined 90,319 (61%) children with defective vision that were referred to them. The prevalence of uncorrected refractive error, strabismus and amblyopia was 3.82% (95% CI 3.79 – 3.85), 0.39% (95% CI 0.38 – 0.40) and 1.25% (95% CI 1.24 – 1.26) respectively. Validity test of 7,768 children had a sensitivity of 74.5% (95% CI 72.7 – 76.3) and specificity of 97.2% (95% CI 96.7 – 97.7). The cost of amblyopia screening was US $ 1.5 per child. While the cost of screening and treating one child with amblyopia was US $ 245. Conclusion: A review of the vision screening of children in Iran showed it with screening and useful exercise and had a yield of 1:21. The coverage of vision screening was low and the management of children with amblyopia, low vision and refractive error needed strengthening.