title: Two strategies for correcting refractive errors in school students in Tanzania: randomised comparison, with implications for screening programmes.
abstract: 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.
authors.affiliation: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK. susanne.wedner@gmx.net
authors.forename: S
authors.initials: S
authors.lastname: Wedner
authors.forename: H
authors.initials: H
authors.lastname: Masanja
authors.forename: R
authors.initials: R
authors.lastname: Bowman
authors.forename: J
authors.initials: J
authors.lastname: Todd
authors.forename: R
authors.initials: R
authors.lastname: Bowman
authors.forename: C
authors.initials: C
authors.lastname: Gilbert
mesh_terms: 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