Perceived barriers to eye care use among secondary school students with pinhole-improvable reduced visual acuity in two schools in Kampala, Uganda: a cross-sectional study

Uncorrected refractive error (URE) is a primary cause of visual impairment (VI). Although URE causes VI and increases the risk of amblyopia in school-going children, no studies have examined barriers to uptake of refractive eye-care services among secondary school students in Uganda. This study reports the perceived reasons for the poor uptake of refractive eye care services among students at two secondary schools in Kampala, Uganda.

A cross-sectional study was conducted in two secondary schools in Kampala between March 2019 and April 2019. Students' presenting distance visual acuities (DVA) were measured. Participants with a DVA worse than 6/9 were reassessed using a pinhole. Those not using spectacles or contact lenses who had pinhole-improvable reduced distance visual acuity suggestive of uncorrected refractive error were administered a structured questionnaire. Descriptive statistics were used to analyze the data. Chi-square tests were performed to assess the association between sex and the proportion of screened students with pinhole-improvable, reduced distance visual acuity suggestive of uncorrected refractive error.

407 students were screened for refractive errors. In total, 10.81% (44/407, 95% CI:8.15% to 14.20%) of screened students had pinhole-improvable reduced distance visual acuity suggestive of uncorrected refractive error (URE). Perceived barriers towards refractive eye-care use reported included fear of surgery (52.27%, 95% CI: 37.94% to 66.25%), unawareness of the available eye care services (50.00%, 95% CI: 35.83% to 64.17%) and not feeling comfortable with the indigenous practitioner to whom they had access (19/44,43.18%, 95% CI: 29.68% to 57.78%). Financial limitations were stated as an important barrier by 20.00% (5/25, 20.00%, 95% CI:95% CI: 8.86% to 39.13%) of participants who stated the most important barrier.

Among students who participated in screening at two secondary schools, a small subgroup had pinhole-improvable reduced distance visual acuity suggestive of an uncorrected refractive component. Exploratory questionnaire responses identified possible barriers related to awareness, perceptions of treatment, access, cost, and family or social influences. These findings require confirmation using refraction-based case definitions, probability sampling, and a culturally adapted and validated adolescent questionnaire.