Visual profile of students in integrated schools in Malawi

Blindness and visual impairment are very common in African countries and are often loosely linked to inadequate resources. We designed this study to assess clinical visual and ocular characteristics of children in three integrated schools in Malawi, so that students needing low vision services or those with correctable refractive error will be identified.

We included 95 students, who underwent a detailed optometric examination. The assessment included distance visual acuity measurement in logMAR notation, near visual acuity, oculo-motor assessment, pupillary assessment and anterior as well as posterior segment evaluation. Non-cycloplegic refraction was done in all the participants.

Mean age of students was 13.84 ±4.61 years. Almost 90 per cent of students had presenting visual acuity worse than logMAR 0.54. Visual acuity improved significantly after refractive correction by more than two logMAR lines in 31.8 per cent (p < 0.0001). Refractive error was very common (36.5 per cent) and the most common causes of visual impairment were lenticular (21.2 per cent), corneal (20.0 per cent) and albinism (15.3 per cent). One-tenth (10.5 per cent) of the students were wrongly enrolled in the schools, even though they did not have visual impairment. The compliance to spectacles wear was very poor (37 per cent). An adequate refractive correction improved visual acuity in more than a third (36.5 per cent) of the students. Students benefited from spectacle magnifiers (18.8 per cent), handheld magnifiers (4.7 per cent) and telescopes (5.9 per cent). Mobility canes were advised for 36.5 per cent of the students.

Nine out of ten students in three integrated schools in Malawi had visual impairment and 41 per cent had low vision. Inappropriate placement in the integrated schools and poor spectacle compliance are very common. Well accepted optical and non-optical devices could improve visual performance in visually disabled children, for which public awareness and parental education is important.