Background: The Ministry of Health (MoH) in Botswana has developed the National Plan for Eye Care 2015-2019 to improve eye health. Peek Botswana, MoH, Ministry of Education and Botswana Optometrists Association implemented smartphone-based Peek Vision School Screening in one subdistrict to provide evidence for the development of a national school screening programme.
Objective :To evaluate the challenges and opportunities of implementing a school vision screening programme utilising Peek Vision smartphone technology to inform planning and implementation of a national school vision screening programme.
Method: 49 schools in the Goodhope Sub-district of Botswana underwent school vision screening using smartphone vision screening, SMS notification and tracking level of take up of services: refraction, spectacles, referral. Triage (including refraction where indicated) was delivered in two comparative arms: directly after screening (26 schools), and at a hub school (23 schools). Selected teachers and nurses were trained to use the system.
Results: 12 876 children were screened (6-22 years). 16% screened positive. There was a 96% triage attendance rate (95.2% attendance for same day triage, 97.4% for ‘hub’ site triage. Relative to total cohort: 1985 refractions (15.4%), 796 spectacles (6.2%), 94 treated with medications (0.7%), 63 referred for investigation (0.5% of screenings). True positive rate of screening 43%. Where elite screeners were identified and used the true positive rate rose to 64%.
Conclusion: The true positive screening rate, although acceptable (>40%), varied greatly between schools but paired screeners had better true positive rates which can be incorporated into future programmes. Cost savings and efficiencies of running triage in hub schools did not result in a lower attendance. Combining the learnings from this pilot will increase the effectiveness of school vision screening programmes in Botswana resulting in efficiencies, cost savings and contribute to planning for a national scale up.