Academic journal article Bulletin of the World Health Organization

Interventions to Improve School-Based Eye-Care Services in Low- and Middle-Income Countries: A Systematic review/Interventions Visant a Ameliorer Les Services D'ophtalmologie En Milieu Scolaire Dans Les Pays a Revenu Faible et Intermediaire: Une Revue systematique/Intervenciones Para Mejorar Los Servicios De Atencion Oftalmologica En Escuelas De Paises Con Ingresos Entre Bajos Y Medios: Una Revision Sistematica

Academic journal article Bulletin of the World Health Organization

Interventions to Improve School-Based Eye-Care Services in Low- and Middle-Income Countries: A Systematic review/Interventions Visant a Ameliorer Les Services D'ophtalmologie En Milieu Scolaire Dans Les Pays a Revenu Faible et Intermediaire: Une Revue systematique/Intervenciones Para Mejorar Los Servicios De Atencion Oftalmologica En Escuelas De Paises Con Ingresos Entre Bajos Y Medios: Una Revision Sistematica

Article excerpt

Introduction

Vision impairment and blindness in children can have negative consequences on their health, education and prospects, (1-4) which in turn can affect the nation's broader economic prosperity. (5,6) Globally, an estimated 19 million children are blind or vision impaired, (7) with the majority of vision impairment being preventable or treatable. (8) The highest burden of blindness is experienced by children in low-income countries, where the prevalence is estimated to be 0.9 per 1000 children compared with 0.7 per 1000 and 0.4 per 1000 children in middle- and high-income countries, (9) respectively; this suggests there are fewer services or else increased barriers to accessing services in low-income countries. (8)

School-based eye-care interventions have the potential to provide high-quality and cost-effective services (10) that allow the early detection of eye diseases and prevention of blindness, particularly for children living in remote locations. (11) Identifying methods of improving and strengthening school-based eye-care interventions, particularly in low- and middle-income countries, is therefore important.

We conducted a systematic review and qualitative analysis to identify and understand methods by which eye-care services for schoolchildren in low- and middle-income countries could be improved. Our analysis was guided by the availability, accessibility, acceptability and quality conceptual framework as presented in the United Nations Committee on Economic, Social and Cultural Rights, General Comment No. 14, The Right to the Highest Attainable Standard of Health. (12)

Methods

Systematic search

We registered our search on the International prospective register of systematic reviews (CRD42018090316) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (13) when identifying studies assessing interventions that improve schoolchildren's access to eye-care services.

This review set out to include all studies evaluating the impact of school-based eye-care interventions in countries that were categorized as low- and middle-income countries in 2017. (14) Eligible studies were those that: (i) evaluated the delivery of a school-based eye-care programme through vision screening, refractive services or health promotion activities; (ii) reported the evaluation results as either spectacle compliance rates, quality of vision screening processes, quality of vision screening personnel, or changes in knowledge or attitudes due to health promotion; or (iii) provided other quantitative or qualitative results from follow-up evaluations of school-based eye-care interventions. We included cross-sectional epidemiological surveys, prospective observational studies, qualitative studies, economic evaluations and randomized controlled trials.

Studies were excluded if: (i) they were not conducted in low-and middle-income countries; (ii) the described intervention did not include schoolchildren; or (iii) they did not report data from follow-up evaluation. We also excluded meeting abstracts, conference papers, editorial discussions, books, theses and studies without primary data collection. Systematic reviews that we detected in the initial search were screened to identify any studies initially missed; they were not included in the analysis, however.

We searched the online databases CINAHL, Embase[R], ERIC, MEDLINE[R], ProQuest, PubMed[R] and Web of Science[TM] for articles published between January 2000 and May 2018, using the search terms in Box 1. No language restrictions were placed on the search, but since search terms were in English we only retrieved English abstracts. We imported citations into Covidence software (Veritas Health Innovation, Melbourne, Australia), where two authors independently reviewed titles and abstracts. If the article could not be excluded based on abstract or title, it was included for full-text review. …

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