Publication: Visual Acuity Screening By by School Teachers in Far West Nepal: A randomized trial of alternate screening models
Date
2025
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
Studies have not examined alternate school visual acuity screening methods in Nepal
in terms of accuracy and cost.
Objective
To validate recent evidence from India of the effectiveness and cost of alternate
school visual acuity screening models involving all class teachers (ACTs) versus a few
selected teachers (STs).
Method
This was a prospective cluster randomized controlled study. The sample size was
5000 students. Five schools were randomly selected for the all-class teachers or
intervention arm and four schools for selected teachers or standard arm. Teachers
from both arms were trained to identify children aged 6 years and above with Snellen
visual acuity 6/9 or worse in either eye as well as obvious ocular abnormalities and
refer them to an ophthalmic team. The screen positive and negative children as well
as cost for screening were calculated in STATA software (version 11.0; StataCorp,
Texas, USA).
Result
All class teachers (80 teachers) screened 3713 children and STs (9 teachers) screened
2064 children aged 6 to 15 years. All class teachers had better sensitivity, 95.1%
(95% CI: 91.9-98.2) and specificity, 92.8% (95% CI: 92.0-93.6) compared to selected
teachers: sensitivity, 73.2% (95% CI: 64.4-82.0) and specificity, 85.3% (95% CI: 83.8-
86.7). The cost of screening per child with refractive error and or other ocular
abnormalities was $3.05 for all class teachers and $ 5.29 for selected teachers.
Conclusion
A school vision screening involving all class teachers in Nepal was more accurate than
selected teachers in identifying refractive error and or other ocular abnormalities at
approximately 60% of the cost.
KEY WORDS
Accuracy and cost, School, Screening, Teachers, Visual acuity
Description
Awasthi S,1 Reddy PA,2,3 Bassett KL4,5
1Geta Eye Hospital
Kailali, Nepal
2Centre for Public Health
Queen’s University
Belfast, United Kingdom
3Seva Foundation
Berkeley, California, USA
4University of British Columbia
Vancouver, BC, Canada
5Seva Canada
Vancouver, BC, Canada
Keywords
Accuracy and cost, School, Screening, Teachers, Visual acuity