Implementing a School Vision Screening Program in Botswana Using Smartphone Technology.

Purpose: Child eye health is a significant public health issue in low- and middle-income countries, such as Botswana, and the need for eye care requires a well-integrated and innovative approach. Traditional vision screening tools are costly, difficult to transport, and reliant on highly trained eye care professionals. Novel smartphone-based vision screening technologies, however, are low cost, portable, and easily operated by trained novice users. Peek Vision is a mobile health (m-Health) organization that creates smartphone applications that screen for visual acuity, generate referrals to eye care professionals, and send phone notifications to those being screened. Methodology: In 2016, the government of Botswana partnered with local and international stakeholders to implement Peek vision screening in a subset of schoolchildren. From June to December of 2016, teachers, health assistants, nurses, and other volunteers in 49 schools in the Goodhope Subdistrict utilized Peek applications to screen schoolchildren, using acuity <6/12 in the better eye as a threshold for visual impairment. Results: Among 12,877 children screened, the application identified 16% (2,065/12,877) as screening positive for visual impairment, and these students were referred for optometric care. Ultimately, 96% (1,985/2,065) attended optometry triage camps, during which 42% (835/1,985) were provided with spectacles, 5% (94/1,985) received ophthalmic medications, and 3% (63/1,985) were referred for ophthalmic care. These findings underscore the need for comprehensive vision screening in schoolchildren in Botswana. Furthermore, the successful implementation of Peek smartphone applications illustrates the potential of m-Health technology for enacting comprehensive vision screening programs at a national level in Botswana and other similar countries.

Spectacle Compliance and Its Determinants in a School Vision Screening Pilot in Botswana.

PURPOSE: The effectiveness of school eye health programmes relies on many factors, including compliance with spectacle wear. The objectives of this study were to determine spectacle compliance in a school vision screening pilot programme in Botswana, and investigate factors predictive of compliance. METHODS: The study was an observational, cross-sectional follow-up of a pilot school screening programme. Unannounced compliance checks were completed after 3-4 months in a convenience sample of 19 schools. Sex, age, school level, visual acuity, and refractive error were analysed using logistic regression to investigate factors predictive of compliance. FINDINGS: Compliance data were recorded for 193/286 (67.5%) children; 62.2% were female and the median age was 15 years (interquartile range 12-17 years). 60.1% of the sample were compliant with spectacle wear. Girls were more likely to be compliant than boys (adjusted odds ratio (aOR) = 2.32, 95% confidence interval (CI) 1.03-5.27). Children at primary and junior secondary school were more likely to be complaint than senior secondary school children (aOR = 16.96, 95% CI 5.60-51.39; and aOR = 3.39, 95% CI 1.39-8.22, respectively). Children with binocular uncorrected visual acuity (UCVA) of 6/7.5 to 6/12 were 2.76 (95% CI1.05-7.23) times more likely to be compliant than children with binocular UCVA of 6/6. CONCLUSION: Compliance was higher in Botswana than previous African studies; however, improvement in this area would increase the effectiveness of the programme. Further investigation into barriers to spectacle wear affecting boys and older children is warranted. A prescribing protocol to avoid low prescriptions - especially where binocular UCVA is 6/6 - is desirable.