ArticlePLOS global public health2026
Individual and school-level factors associated with suspected pediatric eye disorders and referral adherence in an enhanced school-based vision screening program in Ghana.
Article in PLOS global public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Evidence 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. We conducted a cross-sectional study using data from an ESVSP to detect suspected eye disorders in school-children aged 4-22 years. Outcomes were the presence of suspected 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). We analyzed data for 1,123 children screened and 299 referred. The average age was 10.2 (±2.6) years. Overall, 34.0% (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 suspected 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). In this pilot school-based program, school context and SES (an individual-level factor) were associated with suspected pediatric 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.
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