Individual and School-Level Factors Associated with Pediatric Eye Disorders and Referral Adherence in an Enhanced School-Based Vision Screening Program in Ghana

BackgroundEvidence on how social and school-level contexts shape pediatric vision screening outcomes is limited, particularly in sub-Saharan Africa. We examined the association between individual and contextual factors and vision screening outcomes in a pilot enhanced school-based vision screening program (ESVSP) in Kumasi, Ghana. MethodsWe conducted a cross-sectional study using data from an ESVSP to detect eye disorders in school-children aged 4 to 22 years. Outcomes were the presence of eye disorders and referral adherence. Exposure variables were individual [(age, sex, socioeconomic status (SES)], and contextual [school type (public vs private)] factors. Logistic regression was used to estimate unadjusted (OR) and adjusted (aOR) odds ratios with 95% confidence intervals (CI). ResultsWe analyzed data for 1,123 children screened and 299 referred. The average age was 10.2 ({+/-}2.6) years. Overall, 34% (n=382) had suspected eye disorders, and 32.8% (n=98) adhered to the referral. After adjusting for key variables, children attending public (32.2%) compared to private (67.8%) schools had 45% lower odds of identified eye disorders (aOR= 0.55; 95% CI 0.37, 0.83). Children with low (13.3%) compared to high (28.6%) SES had 70% lower odds of referral adherence (aOR= 0.30; 95% CI 0.12, 0.80). ConclusionIn this pilot school-based program, school context and socioeconomic status were associated with suspected pediatric vision and eye disorders, and referral adherence, respectively. These findings highlight equity-relevant gaps in referral adherence and underscore the need for context-specific strategies to strengthen referral pathways in low-resource settings.