Priorities in school eye health in low and middle-income countries a scoping review

Abstract

School eye health (SEH) has been on the global agenda for many years, and there is mounting evidence available to support that school-based visual screenings are one of the most effective and cost-efficient interventions to reach children over five years old. A scoping review was conducted in MEDLINE, Web of Science, PubMed, and CINHAL between February and June 2023 to identify current priorities in recent literature on school eye health in low- and middle-income countries (LMICs). Selection of relevant publications was performed with Covidence, and the main findings were classified according to the WHO Health Promoting Schools framework (HPS). A total of 95 articles were included: cross-sectional studies (n = 55), randomised controlled trials (n = 7), qualitative research (n = 7) and others. Results demonstrate that multi-level action is required to implement sustainable and integrated school eye health programmes in low and middle-income countries. The main priorities identified in this review are: standardised and rigorous protocols; cost-effective workforce; provision of suitable spectacles; compliance to spectacle wear; efficient health promotion interventions; parents and community engagement; integration of programmes in school health; inter-sectoral, government-owned programmes with long-term financing schemes. Even though many challenges remain, the continuous production of quality data such as the ones presented in this review will help governments and other stakeholders to build evidence-based, comprehensive, integrated, and context-adapted programmes and deliver quality eye care services to children all over the world.

Fig. 1. WHO’s Health-Promoting Schools framework adapted to school-eye health*.

This figure illustrates the eight components of HPS for integrated school-based eye health services: 1—government policies : national scaling, sustainability; 2—school policies : integration in school health programmes; 3—school governance and leadership: school directions, teachers and students’ leadership; 4—school and community partnerships: community involvement; 5—school curriculum : health promotion, myopia prevention; 6—school social–emotional environment : students’ and parents’ perceptions; 7—school physical environment: classrooms, digital device used; and 8—school health services: screening protocols and techniques, outcomes (spectacles provision, compliance, academic performance and new technologies). *Adapted from World Health Organization. Health Promoting Schools (2021) [9].

Fig. 2. PRISMA chart.

PRISMA chart for school-eye health scoping review.

Fig. 3. Number of selected publications sorted by HPS main themes.

SEHP school eye health programmes, M&E monitoring and evaluation, VA visual acuity, RE refractive error.

Fig. 4. Priorities in school-eye health for low–middle-income countries.

Themes from literature on SEH are presented based on some of the main HPS framework components: school-based services, social–emotional environment, school curriculum, community partnerships, government policies and resources. M&E monitoring & evaluation.