School-based vision screening for early detection of refractive errors among children aged 5-14 years in Mathare and Kibera, Nairobi, Kenya

Didan M. Amollo; Dorcus Maina; Felix B. Odhiambo; Khumbo Kalua

doi:10.18203/2394-6040.ijcmph20264049

Authors

Didan M. Amollo Department of Community Health, School of Public Health, Amref International University, Nairobi, Kenya
Dorcus Maina Department of Community Health, School of Public Health, Amref International University, Nairobi, Kenya
Felix B. Odhiambo Department of Community Health, School of Public Health, Amref International University, Nairobi, Kenya
Khumbo Kalua School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, Canada

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20264049

Keywords:

Children, Informal settlements, Kenya, Myopia, Refractive errors, School-based vision screening

Abstract

Background: Uncorrected refractive errors are a major cause of avoidable visual impairment among school-aged children, yet many children in underserved urban settings remain undiagnosed. This study evaluated school-based vision screening for early detection of refractive errors among children aged 5-14 years in Mathare and Kibera, Nairobi, Kenya.

Methods: A descriptive analytical cross-sectional study using a mixed-methods approach was conducted from 17^th April to 30^th May 2026 in seven selected primary schools. A total of 1,050 children underwent visual acuity screening and confirmatory refraction where indicated. Quantitative data were analyzed using descriptive statistics, chi-square tests and logistic regression in STATA 17. Qualitative data from focus group discussions and key informant interviews were analyzed thematically.

Results: Overall, 201 children had refractive errors, representing 19.1% of those screened (95% CI: 16.9-21.6). Myopia was the predominant refractive error (86.1%), followed by hyperopia (12.9%) and astigmatism (1.0%). Refractive error proportions differed significantly across schools (p=0.001). Public school attendance was associated with lower odds of refractive error compared with private school attendance (OR=0.64, 95% CI: 0.42-0.98; p=0.040), while increasing age was associated with higher odds (OR=1.07, 95% CI: 1.01-1.14; p=0.032). Key barriers to referral uptake included cost, limited awareness, stigma, weak follow-up systems and transport constraints.

Conclusions: School-based vision screening was feasible and identified a substantial burden of previously undiagnosed refractive errors. Integration of routine eye screening into school health services, strengthened referral systems and affordable spectacles are needed in informal settlements.

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