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Self-adjustable Spectacle Wearing Compliance and Associated Factors among Rural School Children in Ghana

Ilechie, Alex Azuka, OD, PhD1*; Abokyi, Samuel, OD, MPhil2; Boadi-Kusi, Samuel, OD, PhD1; Enimah, Eugene, OD1; Ngozi, Ezinne, OD, MSc3

Optometry and Vision Science: June 2019 - Volume 96 - Issue 6 - p 397–406
doi: 10.1097/OPX.0000000000001382

SIGNIFICANCE Self-adjustable spectacles are increasingly being used in refractive service delivery programs in developing countries. Despite the success of self-refraction as a refraction technique, compliance with actual wear of adjustable spectacles has not been evaluated. Findings in this study have significant programmatic implications for the effectiveness and sustainability of this mode of correction in developing countries.

PURPOSE The purpose of this study was to assess compliance with wearing of adjustable spectacles and factors associated with compliance in pre-teen schoolchildren at 6 months after spectacles were dispensed.

METHODS A cohort of 86 children aged 6 to 12 years with presenting vision worse than or equal to 6/12 in the better eye that could be improved to better than or equal to 6/7.5 by subjective refraction and who were identified from a randomized sample of 18 primary schools in the coastal areas of Cape Coast in Ghana received free FocusSpecs adjustable spectacles after successfully completing self-refraction and cycloplegic subjective refraction. Follow-up examination to assess compliance and to determine reasons for noncompliance was conducted at 6 months after spectacle provision. Logistic regression models assessed factors associated with spectacle wear compliance (95% confidence intervals [CIs]).

RESULTS Spectacle wear compliance was 33.7% (95% CI, 31.3 to 36.1%); an additional 29% had their spectacles with them but were not wearing them. The major reasons given by the children for noncompliance were “loss” (32%; 18/57) and “breakage” (23%; 13/57). Modest compliance (49%) was observed among the poorer children who attend public schools. Attending public school was the only predictor of compliance to spectacle wear (odds ratio, 3.096; 95% CI, 1.228 to 7.805; P = .02).

CONCLUSIONS Despite accurate self-refraction by most children, only a small proportion was compliant with actual wear of the spectacles. Loss and breakage were the major reasons for noncompliance. The poorer children who attend public schools, who stand to benefit most from the technology, were the ones more likely to be compliant with wear.

1Department of Optometry, University of Cape Coast, Cape Coast, Ghana

2School of Optometry, Hong Kong Polytechnic University, Hong Kong, China

3Discipline of Optometry, The University of Kwazulu Natal, Westville Campus, KwaZulu-Natal, South Africa *

Submitted: June 12, 2018

Accepted: February 28, 2019

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have a financial or other conflict of interest to disclose in any product mentioned in the article.

Author Contributions and Acknowledgments: Conceptualization: AAI, SA, SB-K, EE; Data Curation: AAI, SA, SB-K, EE, EN; Formal Analysis: AAI, EE, EN; Investigation: AAI, SA, SB-K, EE, EN; Methodology: AAI, SA, SB-K, EE, EN; Project Administration: SB-K, EE; Resources: AAI, EE, EN; Supervision: AAI; Validation: AAI; Writing – Original Draft: AAI, SA, SB-K, EE; Writing – Review & Editing: AAI, SA, SB-K, EE.

The authors thank the optometry students, school teachers, and ophthalmic nurses who participated in the survey and gratefully acknowledge the immense support of the Immaculate Eye Foundation, a local nongovernmental organization in Ghana, for providing the adjustable spectacles used in this study.

Online date: May 17, 2019

© 2019 American Academy of Optometry