Visual acuity problems, access to care, and related academic performance among primary school students in Tanzania: a mixed methods study.

Adolescents in lower-resource countries face a high burden of eye health problems. This study in Tanzania aimed to 1) estimate the prevalence of distance vision impairment among young adolescents, 2) describe academic performance by distance visual acuity status, and 3) examine facilitators and barriers to school-facilitated vision screenings and receiving eye care. Participants (primary school students in Standard 7) in the intervention arm of the Vijana Tambua Afya, translated as "Youth Health Check," clinical trial (n=509) attended school-facilitated, clinic-based health check-ups that included distance vision screening (presenting acuity). Data included adolescent surveys, medical record extraction, and Primary School Leaving Examination scores. Semi-structured interviews with parents and focus groups with school and clinic staff were conducted. Analyses included descriptive statistics and qualitative thematic analysis. Overall, based on their worse eye, 6.9% of students had mildly- reduced vision and 4.3% had impaired vision on screening. 71.9% of students with mildly reduced or impaired vision scored a C or lower on the PSLE compared to 59.9% with normal vision. Less than 10% of students referred received follow-up care. School-based vision screenings were deemed largely successful by clinicians and teachers, but there were challenges related to follow-up care including referral linkages, households' financial barriers to vision care, and insufficient parental knowledge on the importance of timely pediatric eye care. Given the prevalence of visual impairment and its potential link to academic performance, governments should consider requiring school-based distance vision screenings. Further research on screening implementation strategies and strengthening follow-up care is needed.