title: Comparison of refractive error and visual impairment between Native Iban and Malay in a formal government school vision loss prevention programme.
abstract: BACKGROUND
  The epidemiological study of vision problems is important for developing national strategies for the prevention of visual impairment. There was a lack of information regarding vision problems among school children in East Malaysia. The purpose of this study was to compare the refractive errors and degrees of visual impairment between Native Iban and Malay school children who participated in a formal government vision loss prevention programme conducted in a rural area of Betong Division, Malaysia.
  
  
  METHODS
  In total, 293 Native Iban and Malay school children (Standard 1, Standard 6, and Form 3) received refractive assessments by an optometrist after failing tests in the formal government school vision screening programme in 2008. A criterion for referral was a visual acuity of 6/9 or worse in either eye. Assessments of the refractive errors of the children were performed using dry retinoscopy and subjective refraction techniques at community clinics.
  
  
  RESULTS
  The overall prevalences of refractive error and visual impairment among the sampled populations were 47.7% and 3.5%, respectively. Approximately 97.1% of reported cases were myopia. The Malay sample population was found to be more myopic than the Native Iban population (U = 8240.50, P < 0.05, r = 0.14), but no significant association was found between myopia and ethnicity (χ(2) = 2.66, P > 0.05). Both Native Iban and Malay children in education levels higher than Standard 1 were more likely to have myopia (P < 0.05). Myopia was found to be more likely to affect females than males at a statistically significant level among Native Iban children (χ(2) [1.N = 170] = 6.279, P < 0.05, odds ratio = 2.327, 95% CI = 1.184-4.575). There was no statistically significant association between visual impairment and ethnicity (χ(2) = 1.60, P > 0.05). Approximately 94.1% of children with refractive errors suffered from having either the wrong prescription (7.8%) or having uncorrected refractive errors (92.2%).
  
  
  CONCLUSIONS
  The Native Iban population was found to be less myopic than the Malay population despite having a similar frequency of myopia. The proportion of children with myopia increased with the level of education in both ethnicities. A high percentage of untreated refractive error problems among Native Iban and Malay children in the Betong Division indicates that there is a need for government intervention for the purpose of economic and healthcare improvements.
authors.affiliation: Department of Optometry, 17th Floor, Faculty of Health Sciences, Universiti Teknologi MARA Puncak Alam Campus, 42300 Puncak Alam, Selangor, Malaysia.
authors.forename: Nurul Farhana Abu
authors.initials: NF
authors.lastname: Bakar
authors.forename: Ai-Hong
authors.initials: AH
authors.lastname: Chen
authors.forename: Abdul Rahim Md
authors.initials: AR
authors.lastname: Noor
authors.forename: Pik-Pin
authors.initials: PP
authors.lastname: Goh