Two strategies for correcting refractive errors in school students in Tanzania: randomised comparison, with implications for screening programmes.
OBJECTIVE
To compare whether free spectacles or only a prescription for spectacles influences wearing rates among Tanzanian students with un/undercorrected refractive error (RE).


METHODS



METHODS
Cluster randomised trial.


METHODS
37 secondary schools in Dar es Salaam, Tanzania.


METHODS
Distance visual acuity was measured in 6,904 year-1 students (90.2% response rate; median age 14 years; range 11-25 years) using a Snellen E-chart. 135 had RE requiring correction.


METHODS
Schools were randomly allocated to free spectacles (arm A) or prescription only (arm B).


METHODS
Spectacle use at 3 months.


RESULTS
The prevalence of un/undercorrected RE was 1.8% (95% CI: 1.5 to 2.2%). At 3 months, 27/58 (47%) students in arm A were wearing spectacles or had them at school compared with 13/50 (26%) in arm B (adjusted OR 2.4, 95% CI 1.0 to 6.7). Free spectacles and myopia were independently associated with spectacle use.


CONCLUSIONS
The low prevalence of un/undercorrected RE and poor uptake of spectacles, even when provided free, raises doubts about the value of vision-screening programmes in Tanzanian secondary schools. Policy decisions on school vision screening in middle- and low-income countries should take account of the cost-effectiveness as well as competing demands for scarce resources.
D000293:Adolescent; D000328:Adult; D002648:Child; D005139:Eyeglasses / Q000706:statistics & numerical data / Q000600:supply & distribution*; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data; D015995:Prevalence; D015397:Program Evaluation; D012030:Refractive Errors / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D012572:School Health Services / Q000458:organization & administration*; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology; D015351:Vision Screening / Q000458:organization & administration*; D014792:Visual Acuity