School-based Screening Program Research Articles

Prevalence of Hypertension and Diabetes in Children

In 2017, the American Academy of Pediatrics issued a new clinical practice guideline for defining hypertension in children as an update to the previous Fourth Report guidelines issued in 2004. Prevalence of confirmed pediatric hypertension in children has ranged from 2% to 4% based on previous guidelines yet it is unknown what the prevalence is under the new guideline. We estimated the prevalence of elevated blood pressure, stage 1, and stage 2 hypertension by the new American Academy of Pediatrics guideline in our school-based blood pressure screening program. New prevalence estimates were compared with Fourth Report prevalence estimates in the same population by sex, age, and height factors. In 22 224 students aged 10 to 17 years screened in school as part of the Houston Pediatric and Hypertension Program at the University of Texas McGovern Medical School, the prevalence of elevated blood pressure (previously called prehypertension) increased from 14.8% by Fourth Report to 16.3% by the new American Academy of Pediatrics guideline. This increase in elevated blood pressure resulted from differential classification changes in younger and older children. Prevalence of confirmed hypertension remains at 2% to 4% in this population, however shorter children <13 years old and taller, older children 13+ years old are systematically more likely to be diagnosed with hypertension by new guidelines..

FEASIBILITY OF SCHOOL-BASED SCREENING FOR HIGH BLOOD PRESSURE IN CHILDREN: THE HEALTHY HEARTS @ SCHOOL STUDY

Objective: High blood pressure (BP) in childhood is associated with end organ damage and cardiovascular events in mid-adulthood. Community-based BP screening may improve equitable access and awareness, but robust methodology is required. Accordingly, our aim was to assess the acceptability and feasibility of a two-stage school-based BP screening program incorporating targeted 24-hour ambulatory blood pressure monitoring (ABPM). Design and method: One-hundred-ninety-eight children (59% male, 7.6–12.7 years) in grades 3-6 were recruited from three primary schools in Melbourne, Australia. Following an education session for all children in these grades, BP was measured five times in students after parental consent, using the auscultatory method, alternating between arms and after five minutes of rest. Those with an average BP >85th percentile (AAP thresholds) or a risk factor for high BP had these measurements repeated two weeks later, along with ABPM. Families and students also completed an optional questionnaire post-program. Results: At the first assessment, 11 (5.6%) and 10 (5.0%) had elevated or hypertensive BP respectively (14.6% combined if using just the first measure). Fifty-nine (29.8%) were selected for the second assessment (including 10 with obesity, 15 born premature, four with a history of congenital heart disease, and nine with BP >85th percentile, but <90th percentile), of which 52 attended. ABPM indicated that 11 (5.6%) and five (2.5%) had white coat hypertension based on assessment one and two respectively, three (1.5%) had sustained hypertension (based on either assessment stage), and two (1%) had masked hypertension. Three additional participants each had either high BPs during school assessment but did not undertake, or had inconclusive, ABPMs. Overall, 11 (5.6%) were referred to a doctor for medical follow-up. The majority of students (67%) reported that ABPM was tolerable (‘bothersome’ score <8/10 for day and/or night). 96% of families approved of the program and 90% welcomed it as part of their child's schooling. Conclusions: These data indicate that a school-based BP screening program is acceptable and feasible, and that measuring BP on multiple occasions, and with targeted ABPM, is pivotal for minimising false positives and unnecessary referrals.

Abstract MP56: Screening for Familial Hypercholesterolemia: School Based Programs May Be Best Alternative

Introduction: Familial Hypercholesterolemia (FH) is an autosomal dominant condition characterized by elevated cholesterol and premature development of cardiovascular (CV) disease affecting 1/200 - 1/500 individuals. Only 10% of the affected population in the United States have been identified and treated compared to 50-70% in Scandinavian countries identified through school-based or universal screening programs. Hypothesis Statement: School based programs are the best mechanism for FH screening. Methods: The Healthy Hearts and Minds Program (HHM) through UCHealth performs biometric screenings on 5th, 7th, and 10th grade students in Northern Colorado. HHM tested 10,991 5th grade students (9/2017 - 5/2022) and identified 424 students with total cholesterol levels ≥200 mg/dL (range 200-302). A buccal smear test (APOB, LDLR, PCSK9) was performed on 99 individuals with the highest total cholesterol levels to identify genetic status. A binomial logistic regression model was used for analysis. Results: Of the 99 students, six tested positive (50% male, 10.3 years, 22.8 BMI) for FH with five (40% male, 11.3 years, 17.3 BMI.) reporting a variant of indeterminate significance. A sigmoidal association between total cholesterol and predicted chance of FH was identified with the inflection point at ~270 mg/dL. Conclusions: Comprehensive school based programs are the most effective and equitable means of identifying this genetic based disease and should be supported in a collaborative manner with health care systems, industry and the community. With availability to all students, diversity, equity, and inclusion concerns are addressed and provide at risk populations with personalized health information. The results from this study suggest a school-based screening program can be effective at identifying students most at risk for FH. These results further define the relation between total cholesterol and predicted chance of FH for a school-aged population where 245 mg/dL indicates a 10.3% of testing positive for FH whereas 275 mg/dL has a 54.8% chance. Additionally, the multiplier effect documented through cascade FH testing enhances the benefit of the information to other family members, as the autosomal dominant pattern insures that 50% of members will be at risk. The individual benefit of identifying FH early is the treatability of this condition. Early use of lipid lowering agents can make the CV disease risk equal to the general population. If left untreated, CV disease occurs approximately 10 years earlier which results in increased mortality and disability, along with increased health care costs. Therefore, if elevated cholesterol is present in school children, genetic testing is warranted and treatment considered by age 8-10 years, especially if signs of abnormal vascular plaquing is identified.

Midterm Follow-Up of Familial Hypercholesterolemia from a Cross-Sectional School-Based Cholesterol Screening Program

Midterm Follow-Up of Familial Hypercholesterolemia from a Cross-Sectional School-Based Cholesterol Screening Program

Implementing a digital comprehensive myopia prevention and control strategy for children and adolescents in China: a cost-effectiveness analysis

Children and adolescents' myopia is a major public problem. Although the clinical effect of various interventions has been extensively studied, there is a lack of national-level and integral assessments to simultaneously quantify the economics and effectiveness of comprehensive myopia prevention and control programs. We aimed to compare the cost-effectiveness between traditional myopia prevention and control strategy, digital comprehensive myopia prevention and control strategy and school-based myopia screening program in China. A Markov model was used to compare the cost-utility and cost-effectiveness among school-based myopia screening, traditional myopia prevention and control strategy, and digital comprehensive myopia prevention and control strategy among 6 to 18-year-old rural and urban schoolchildren. Parameters were collected from published sources. The primary outcomes were quality-adjusted life-year, disability-adjusted life-year, incremental cost-utility ratio, and incremental cost-effectiveness ratio. Extensive sensitivity analyses were performed to test the robustness and sensitivity of base-case analysis. Compared with school-based myopia screening strategy, after implementing digital comprehensive myopia prevention and control strategy, the prevalence of myopia among 18-year-old students in rural and urban areas was reduced by 3.79% and 3.48%, respectively. The incremental cost-utility ratio per quality-adjusted life-year gained with the digital myopia management plan ($11,301 for rural setting, and $10,707 for urban setting) was less than 3 times the per capita gross domestic product in rural settings ($30,501) and less than 1 time the per capita gross domestic product in urban settings ($13,856). In cost-effectiveness analysis, the incremental cost-effectiveness ratio produced by digital comprehensive myopia management strategy ($37,446 and $41,814 per disability-adjusted life-year averted in rural and urban settings) slightly exceeded the cost-effectiveness threshold. When assuming perfect compliance, full coverage of outdoor activities and spectacles satisfied the cost-effectiveness threshold, and full coverage of outdoor activities produced the lowest cost ($321 for rural settings and $808 for urban settings). Health economic evidence confirmed the cost-effectiveness of promoting digital comprehensive myopia prevention and control strategies for schoolchildren at the national level. Sufficient evidence provides an economic and public health reference for further action by governments, policy-makers and other myopia-endemic countries. National Natural Science Foundation of China,NSFC(82171051),Beijing Natural Science Foundation(JQ20029),Capital Health Research and Development of Special(2020-2-1081),National Natural Science Foundation of China, NSFC(82071000),National Natural Science Foundation of China, NSFC (8197030562).

Adolescents' experiences and views of the national school-based thalassaemia screening programme in Malaysia: a qualitative study.

In 2016, a national school-based thalassemia screening programme was implemented in Malaysia. This study aimed to explore the experiences and views of adolescents from an urban school who had undergone the screening programme. We carried out in-depth interviews with 18 participants aged between 18 and 19 years old, with 12 of them identified as carriers during the school screening. Interviews were transcribed verbatim and analysed using thematic analysis. Three main themes emerged from this study: (1) issues encountered at various levels of the school screening programme: appropriate age for screening, thalassaemia education in school, parental consent and follow-up visit and post-test counselling; (2) experiencing emotional rollercoaster: worry, anxiety, shame, stigma; (3) choosing future partners after carrier status was known-prepared or unprepared? Various issues and screening-related challenges were encountered before, during and after the screening test. Recommendations include improving thalassaemia screening education for both school-going adolescents and parents, and better follow-up care and support for those identified as carriers. These will help stakeholders to be well informed and supportive of thalassaemia screening in schools.

Digital game addiction, social anxiety, and parental attitudes in adolescents: A cross-sectional study

Digital game addiction negatively affects the physical and psychosocial health of adolescents. The aim of this study was to determine digital game addiction, social anxiety, and parental attitudes among adolescents, and to identify the risk factors of these parameters. A cross-sectional design was used. The sample consisted of 1379 students aged 14–17 years. A Personal Information Form, the Digital Game Addiction Scale, the Social Anxiety Scale for Adolescents, and the Parental Attitude Scale were used for collecting data. The prevelance of digital game addiction was found as 12.9%. The risk of digital game addiction was 2.6 times higher in boys compared to girls. While digital game addiction was the highest in adolescents who perceived their parent's attitude as negligent, social anxiety was found to be the highest in adolescents who perceived their parent's attitude as authoritarian. Parental attitude affected digital game addiction and social anxiety among adolescents. Gender, duration of playing games, and parental control over playing game were factors that predicted digital game addiction. School based screening programs should be designed for early detection of addiction, prevention of risky behaviors, and management of social anxiety in adolescents.

Cannabis use in Tunisian high school adolescents: MedSPAD 2021

IntroductionCannabis use is wrongly deemed “safe” by teenagers worldwide, despite its increased tetrahydrocannabinoids content and its psychosocial and cognitive harmful effectts.ObjectivesWe aimed to estimate the prevalence of cannabis use, identify associated factors among Tunisian adolescents and assess the risk of problem cannabis use among users.MethodsThe 2021-Mediterranean School Survey Project on Alcohol and Other Drugs (MedSPAD) is a national survey, targeting Tunisian high school adolescents aged 16 to 18 years.Based on a self-administered questionnaire, adolescents were asked about their engagement in several risky behaviours including cannabis use. The 6-item Cannabis Abuse Screening Test (CAST) was intended for users to assess the risk of problem cannabis use.Binary logistic regression was performed to identify factors associated to cannabis use and Adjusted Odds Ratios (AORs) were presented with correspondent 95% confidence intervals (CI). Cspro and STATA software were used for data entry and analysis respectively.ResultsAmong 6201 participants (girls: 60.4%), lifetime prevalence of cannabis use was 7.9% ,95% CI [7.0, 8.9] significantly higher among boys (16.1 % Vs. 2.5 % in girls, p<10-4). Early onset (at 13 or younger) was reported by 8.6% of users.Multivariate analysis showed that cannabis use was more prevalent in Tunis district(p=0.04), and significantly associated to alcohol, tobacco and electronic-cigarettes use (AOR of 6.2, 4.2 and 2.6 respectively, p<10-3). Absenteeism for non-medical reasons and nights spent away from home were also independent factors significantly associated with cannabis use (p<10-3).The CAST indicated a high risk of cannabis-use-related problems in 67.2% of respondents (n=223).ConclusionsCannabis use is increasingly common in Tunisian adolescents. Moreover, the alarming risk of problem cannabis use warrant the urgent need for school-based interventions and screening programs to prevent and control cannabis use especially among vulnerable subgroups.Disclosure of InterestNone Declared

Evaluation of a combined school-based vision screening and mobile clinic program

Effective vision screening programs for children require follow-up with eye care providers, but studies demonstrate poor follow-up rates after failed screenings. Programs have attempted to address this issue by providing free examinations and glasses after failed screenings. This study presents data from a mobile clinic program that provides instrument-based vision screening, eye examinations, and free glasses directly to children at school. Between 2018 and 2021, a nonprofit organization provided in-school instrument-based screening and noncycloplegic examinations and refractions in elementary, middle, and high schools. Deidentified screening and clinic data were reviewed retrospectively. Information about each school regarding total student enrollment, enrollment based on race, and number of economically disadvantaged students was obtained from the Virginia Department of Education. In the 2019-2020 school year, 14,006 students from 58 schools were screened, and 4,238 (30.3%) were referred. The percentage of economically disadvantaged students was positively correlated to referral rate (R2 = 0.406). Between 2019 and 2020, the mobile clinic examined 3,095 students from the same 58 schools. Of these, 72.9% were prescribed glasses, and 16.3% were referred for a more comprehensive eye examination and treatment. Students were also diagnosed with cataracts, nystagmus, amblyopia, and strabismus. A combined screening program and mobile clinic traveling directly to schools can provide a pipeline for delivering eye care to vulnerable populations.

Analysis of school-based asthma screenings and need for care coordination in underserved urban communities

BackgroundAsthma is one of the most common chronic childhood disease states in the United States and continues to become more prevalent. Data suggest the incidence, morbidity, and mortality of asthma are higher among minority children of lower socioeconomic status living in urban settings. There is a lack of data evaluating the impact of mass school-based asthma screenings and care coordination in underserved communities. ObjectiveThis study aimed to determine whether a school-based asthma screening program is effective in identifying children who are at risk of undiagnosed and uncontrolled asthma and whether there is a need for care coordination. MethodsThis study is a retrospective review describing the outcomes of the 2021 school-based asthma screening program. Asthma screening data from 6 participating school districts (prekindergarten to twelfth grade) in the greater Pittsburgh area were included in this review. An asthma screening questionnaire was distributed school-wide and included questions about demographics, previous asthma diagnosis, repeated episodes of asthma, and frequency of symptoms. Based on caregiver-reported answers, children who screened positive for previously diagnosed asthma, uncontrolled asthma, or undiagnosed asthma received care coordination for follow-up care. ResultsThis study included asthma screening results for 561 participants. Approximately 13% of participants (n = 73) displayed asthma symptoms but did not have a diagnosis of asthma. Of those 73 participants, 9.6% (n = 54) were at risk of uncontrolled asthma. The screening tool also identified 5.6% of participants (n = 32) who had a diagnosis of asthma and were at risk of uncontrolled asthma. ConclusionsThe school-based asthma screening program was effective in identifying children at risk of undiagnosed and uncontrolled asthma. Pharmacists are well positioned to implement asthma screening programs in schools and throughout the community.

Postural habits and lifestyle factors associated with adolescent idiopathic scoliosis (AIS) in China: results from a big case–control study

BackgroundAdolescent idiopathic scoliosis (AIS) is the most prevalent type of scoliosis affecting children between the ages of 10–16 years. However, risk factors for AIS, particularly the modifiable ones, are still largely unknown. This study aims to investigate the associations of lifestyle and social environment factors with AIS in Chinese schoolchildren.MethodsThis is a matched case–control study based on survey data collected from school-based scoliosis screening program. We used conditional logistic regression models to describe the relative risk of AIS incidence for each variable in the analyses. To examine the independent effect of each factor on developing AIS, a multivariate conditional logistic regression was conducted and odds ratios (ORs) were adjusted for age and other significant variables.ResultsOverall, 2538 participants from 49 schools were included in this study, comprising 1269 AIS cases and 1269 controls. Mean age of the study population was 13.4 years ± 1.06 (range 10–18). One thousand five hundred and fifty (61.1%) of the study subjects were girls. After adjusting for other significant factors, inappropriate desk heights, either too low (OR = 1.40, 95% CI 1.04–1.90) or too high (OR = 1.61, 95% CI 1.09–2.38), standing with anterior pelvic tilt (OR = 2.73, 95% CI 1.41–5.28), and sleeping on the right side (OR = 1.38, 95% CI 1.00–1.91), remained associated with elevated AIS risks. In contrast, sitting normally and classroom sitting positions change regularly were associated with lower odds of AIS. The adjusted ORs were 0.69 (95% CI 0.50–0.96) for sitting normally, and 0.72 (95% CI 0.53–0.98) for sitting positions change.ConclusionsThis is the first study to address the associations between desk heights and AIS and showed inappropriate desk heights were related to increased AIS risks. To protect school children from developing AIS, stakeholders are advised to consider introducing height-adjustable desks in the class, changing students’ sitting positions in the classroom on a regular basis, and implementing educational programs to help students maintain correct sitting postures.

A national school-based screening program for mental health problems among children aged 6 to 12 years in Iran: scale development and psychometric evaluation

ABSTRACT Schools are an ideal setting in which to measure and promote mental health difficulties. The aim of present study was to develop the Nemad Electronic Mental-Health Assessment Devices for Children (NEMAD-C) aged 6 to 12 years in Iran. A sample of parents and teachers (N = 10,163) were recruited to complete the parent and teacher reports. Totally, explorative and confirmatory factor analyses showed that the eight-factor model provides a better fit for both parental report and teacher report versions. Results revealed a screening tool consisting of eight dimensions: child abuse risk, self-harm, anxiety, depression, disruptive behavior disorders, attention deficit/hyperactivity disorders, academic achievement deficit, and self-regulation. Findings showed that the internal consistency coefficients of the subscales were high, and convergent validity was evidenced by significant correlations with theoretically related constructs. Therefore, the NEMAD-C has adequate reliability and validity and could be used for multi-dimensional assessment of mental health problems in Iran.

Vision Screening in Children: The New South Wales Statewide Eyesight Preschooler Screening Program.

The aim was to investigate universality of access, screening rate, and outcomes from the New South Wales (NSW) Statewide Eyesight Preschooler Screening (StEPS) over the period of 2009 to 2016. Cross-sectional, observational study. The StEPS program provides vision screening to 4-year-old children residing in NSW and is administered within Local Health Districts (LHDs). Visual acuity (VA) was examined by trained lay and nurse screeners using HOTV logMAR. Children who had VA <6/9-2 were referred to local practitioners while those with VA <6/18 were referred to public hospital pediatric ophthalmic outpatient clinics where available. Activity data were collected by NSW Health and screening rates determined from population projections of 4-year-olds per LHD based on adjusted 2014 Census data. To determine factors impacting screening and referral rates, a random effects panel analysis was undertaken. A total of 719,686 (96.4%) NSW 4-year-old children were offered StEPS vision screening between 2009 and 2016, 84% accepted and 564,825 children (75.6%) were screened. The screening rate increased from 67.3% in 2009 to 74.5% in 2016, with an 80% target reached for 3 consecutive years from 2013 to 2015. Of those screened, 19.2% were referred to an eye health professional or advised to have a vision retest in 12 months. This referral rate remained steady over the period studied, with little variation between metropolitan, and rural and regional LHDs. StEPS is an ideal service model for preschool vision screening providing coverage that is comparable to school-based screening programs and at an age likely to facilitate optimal treatment outcomes.

Protocol for an automated, pragmatic, embedded, adaptive randomised controlled trial: behavioural economics-informed mobile phone-based reminder messages to improve clinic attendance in a Botswanan school-based vision screening programme

BackgroundClinic non-attendance rates are high across the African continent. Emerging evidence suggests that phone-based reminder messages could make a small but important contribution to reducing non-attendance. We will use behavioural economics principles to develop an SMS and voice reminder message to improve attendance rates in a school-based eye screening programme in Botswana.MethodsWe will test a new theory-informed SMS and voice reminder message in a national school-based eye screening programme in Botswana. The control will be the standard SMS message used to remind parents/guardians to bring their child for ophthalmic assessment. All messages will be sent twice. The primary outcome is attendance for ophthalmic assessment. We will use an automated adaptive approach, starting with a 1:1 allocation ratio.DiscussionAs far as we are aware, only one other study has used behavioural economics to inform the development of reminder messages to be deployed in an African healthcare setting. Our study will use an adaptive trial design, embedded in a national screening programme. Our approach can be used to trial other forms of reminder message in the future.Trial registrationISRCTN https://doi.org/10.1186/ISRCTN96528723. Registered on 5 January 2022.

Evaluation of a combined school-based vision screening and mobile clinic program

Uncorrected refractive error can lead to lowered academic performance. Many children depend on state-mandated school vision screening programs. Effective screening programs require follow-up with eye care providers, but studies demonstrate poor follow-up rates after failed screenings. Programs have attempted to mediate this issue by providing free examinations and glasses after failed screenings. This study presents data from a mobile clinic program that provides instrument-based vision screening, eye examinations, and free glasses directly to children at school.

Okul Temelli Ergen Sağlığı Tarama Programı Sonuçları

Amaç: Bu çalışmada, halk sağlığı hemşireliği uygulamaları kapsamında yürütülen okul temelli ergen sağlığı tarama programı sonuçlarının paylaşılması amaçlanmıştır. Yöntem: Kesitsel tipteki araştırma, 2019-20 eğitim-öğretim yılında Tekirdağ İl Milli Eğitim Müdürlüğü’ne bağlı üç ayrı okulda yürütülmüştür. Araştırma verileri 1913 öğrenciden toplanmıştır. Okullarda hipertansiyon, boy, kilo, görme keskinliği, işitme, diş çürüğü, skolyoz, baş biti ve dijital oyun bağımlılığı taraması yapılmıştır. Veriler SPSS 21 paket programı kullanılarak sayı, yüzde, ortalama ve standart sapma kullanılarak analiz edilmiştir. Bulgular: Öğrencilerin yaş ortalaması 14,60±2,21’dir, %52,7’si erkektir. Tarama sonucunda sırasıyla öğrencilerin %51,75’inde diş çürüğü, %23,9’nda fazla kilo/obezite, %20,49’de dijital oyun bağımlılığı, %18,98’de skolyoz, %14,85’inde sağ göz, %13,23’inde sol göz, %7,42’inde her iki göz görme keskinliğinde azalma, %10,82’de hipertansiyon, % 9,5’de düşük kilolu olma riski tespit edilmiştir. Sonuç: Okul sağlığı hizmetleri kapsamında çocukların sağlık risklerini belirlemek, bu riskleri önlemeye çabalamak ya da erken dönemde tanı ve tedavisi için yönlendirme yapmak aşamalarında, okul sağlığı hemşirelerinin önemli sorumluluklar ve roller üstlenebileceği gösterilmiştir. Okul sağlığı hemşireliği uygulamalarının yaygınlık kazanması çocuk sağlığının geliştirilmesi, sağlık hizmetlerinin yükünün azaltılması, sağlıklı ve üretken nüfusun artması ve ülke ekonomisinin gelişmesine fayda sağlayacaktır.

School-based screening for childhood anxiety problems and intervention delivery: a codesign approach

ObjectivesA very small proportion of children with anxiety problems receive evidence-based treatment. Barriers to access include difficulties with problem identification, concerns about stigma and a lack of clarity about how...

Impact of Weight Status Reporting on Childhood Body Mass Index.

Background: Many states have adopted school-based BMI screening or surveillance programs in an effort to address high rates of childhood obesity, some of which involve provision of confidential BMI reports to parents. While there is evidence that parents are attuned to information in the reports, there is less evidence showing that the reports are effective in preventing excess childhood weight gain. Methods: Data from Arkansas, the state with the nation's first and longest running and BMI screening program, were used to measure the impact of BMI reports. This was done through a regression discontinuity design that compared future BMI z-scores among children falling within a narrow band around the obese and overweight thresholds. We derived the effects of BMI reports by comparing students who received different types of reports around the relevant threshold. Results: While we are unable to detect any differences in BMI z-scores between the children who received the overweight report and the children who received the healthy weight report, we detected some differences between children who received the obese report and children who received the overweight report. These findings hold across subsamples by age, minority status, and school meal status. Conclusions: Based on these data, overweight or obese reports to do not meaningfully impact future BMI z-scores. This may be due, in part, to the format of parental reports, which may dampen the surprise element of an overweight or obese report.

Saving time saves lives! A time focused evaluation of a single-view echocardiographic screening protocol for subclinical rheumatic heart disease

BackgroundRheumatic heart disease affects 33 million people in low and middle income countries and is the leading cause of cardiovascular death among children and young adults. Evidence increasingly supports that simplified screening protocols can identify at risk children with good accuracy. One of the more proximal and pragmatic hurdles that has not been completely explored is the time required for executing the screening exam. MethodsWe conducted an observational study comparing three different echocardiographic strategies in four separate school-based screening programs in Kenya and Cameroon. ResultsIn a sample of 911 children, we found that a single-view screening strategy can be obtained in an average time of 1.2 min/child, the two-view in an average of 2.1 min/child, and multi-view in an average of 5 min/child. ConclusionsOur study demonstrates that there are significant differences in the time required to execute different screening protocols and is an essential consideration in the feasibility of large scale populations based rheumatic heart disease screening programs.

Parents' reasons for nonadherence to referral to follow-up eye care for schoolchildren who failed school-based vision screening in Cross River State, Nigeria-A descriptive qualitative study.

BackgroundUncorrected refractive error (URE) is a major cause of vision impairment in children worldwide. Cases are often detected through a school-based vision screening program and then treated in a follow-up appointment. This requires parents or guardians (‘parents’) to adhere to referrals for the eye exam and care plan. We aim to understand the reasons for parents’ referral non-adherence in Cross River State, Nigeria, using qualitative methods.MethodsTen focus groups were held with parents who had not adhered to the referral for a follow-up eye examination. Participants were recruited with help from staff in schools hosting the vision screening programme. Interviews were conducted using a semi-structured interview guide, audio taped and transcribed verbatim. After identifying relevant quotes, the researchers labelled each one with a descriptive code/subcode label. Then they clustered the data into categories and overarching themes.ResultsForty-four parents participated in 10 focus group discussions with 28 women and 16 men. Three themes and participated in the focus group discussions with 28 women (63%). Twelve themes were generated. The three megathemes were Modifiable Factors (with 4 themes), Contextual Factors (with 6 themes), and Recommendations (with 2 themes).ConclusionParticipants identified modifiable barriers that make it difficult for parents to adhere to a referral for a follow-up eye exam. These include not believing their child has a vision problem or the screening test, and issues with the referral letter. They also described important contextual factors such as poverty, logistical problems, parental attitudes towards their children and beliefs about appropriate care. Many of these issues could be addressed by following their recommendation to educate the public on the importance of child eye care and correct parents’ misconceptions. These themes will be used by the Nigerian government to enhance and scale up its child eye health programme.