Caretakers' stated willingness to pay for children's spectacles in cross river state, Nigeria and its implication for a cross-subsidisation scheme: a cross-sectional study.

BACKGROUND: Understanding caretakers' willingness to pay (WTP) for their children's spectacles is essential to improving the sustainability of refractive error services and spectacle provision. Therefore, we investigated the willingness of caretakers to pay for their children's spectacles in a multi-centre study to develop a spectacle cross-subsidisation scheme in the Cross River State (CRS), Nigeria. METHODS: We administered the questionnaire to all caretakers whose children were referred from school vision screenings to four eye centres for full refraction assessment and dispensing of corrective spectacles from 9 August to 31 October 2019. We collected information on socio-demography, children's refractive error types, and spectacle prescription and then asked the caretakers about their WTP for the spectacles using a structured questionnaire and bidding format (in the local currency, Naira, ₦). RESULTS: A total of 137 respondents (response rate = 100%) from four centres were interviewed: with greater proportion of women (n = 92, 67.1%), aged between 41 and 50 years (n = 59, 43.1%), government employees (n = 64, 46.7%) and had acquired college or university education (n = 77, 56.2%). Of the 137 spectacles dispensed to their children, 74 (54.0%) had myopia or myopic astigmatism (equal to or greater than 0.50D). The mean stated WTP for the sample population was ₦3,560 (US$ 8.9) (SD ± ₦1,913.4). Men (p = 0.039), those with higher education (p < 0.001), higher monthly incomes (p = 0.042), and government employees (p = 0.001) were more willing to pay ₦3,600 (US$9.0) or more. CONCLUSION: Combining our previous findings from marketing analysis, these findings provided a basis to plan for a children's spectacles cross-subsidisation scheme in CRS. Further research will be needed to determine the acceptability of the scheme and the actual WTP.

Demographic characteristics and ocular needs of children attending child eye clinics in Cross River State, Nigeria: a retrospective analysis of clinical records.

OBJECTIVES: To describe the demographic characteristics and ocular needs of children attending four child eye clinics in Cross River State, Nigeria, to inform the development of a sustainable spectacle cross-subsidisation scheme. DESIGN: Retrospective analysis of clinic records. SETTING: Four child eye clinics in Calabar, Ogoja, Ikom and Ugep, Cross River State, Nigeria, from 1 May 2017 to 30 June 2019. PARTICIPANTS: Children who failed the vision screening in schools and visited assigned child eye clinics, and self-referred children from the community. MAIN OUTCOME MEASURES: Children's age, sex, residence, diagnosis, disease management, presenting and corrected visual acuity, history of spectacle wear and magnitude of refractive errors in spherical equivalent in the worse eye. RESULTS: Of all the 3799 records reviewed, data were available for 3774 children (mean age 10.6±4.35 years; 61.6% girls; 69.1% from urban settings); 30.8% (n=1162) of them had vision impairment. Of those children, 71.2% (n=827) were diagnosed with refractive error. For management, 48.6% (n=1833) were prescribed spectacles and 40.5% (n=1527) were prescribed ocular medications. Children prescribed spectacles were significantly more likely to be girls (68.0%, p<0.001), and older than 13 years of age (53.6%, p<0.001). The most common range of spherical equivalent (in the worse eye) was <-0.50 DS to +1.75 DS (51.6%, n=945), followed by >-0.25 DS to -3.00DS (39.7%, n=727). Non-refractive eye conditions such as cataract (33.3%) and corneal disorders (14.1%) contributed to almost half of the total blindness. CONCLUSION: The findings show that spectacles provisions and ocular medications are the primary and secondary needs for children who attended child eye clinics seeking eye care services. Further research is needed to understand parents' willingness to pay for spectacles to set strategic multitier pricing for a sustainable cross-subsidisation scheme.

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.

BACKGROUND: Uncorrected 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. METHODS: Ten 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. RESULTS: Forty-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). CONCLUSION: Participants 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.

Factors affecting guardians' decision making on clinic-based purchase of children's spectacles in Nigeria.

BACKGROUND: This study aims to understand the key factors influencing guardians' decisions when purchasing spectacles for their children in semi-urban and urban areas of Cross River State, Nigeria, where a spectacle cross-subsidisation scheme will be implemented. METHODS: This cross-sectional study was conducted among all consecutive guardians visiting the Calabar (urban), Ugep, Ikom and Ogoja (semi-urban) public eye clinics in Cross River State, southern Nigeria, from August 1 to October 31 2019, and whose children had significant refractive errors (myopia ≤-0.50D, hyperopia ≥1.50D, astigmatism >0.75D) and received spectacles. Guardians were interviewed using a questionnaire which included i) close-ended questions on reasons guardians choose to purchase spectacles for their children in eye clinics, ii) guardians' perceptions of the quality and design of children's current spectacle, iii) factors most heavily influencing their choice of spectacles for children, and iv) open-ended questions to seek guardians' suggestions on how to improve the current spectacle range. RESULTS: All 137 eligible guardians (67.2% women [n = 92]) who visited the selected eye clinics participated in the study (response rate = 100%), with 109 (79.6%) from semi-urban and 28 (20.4%) attending urban clinics. Guardians from both urban and semi-urban clinics prioritised frame design, quality, and material as the main factors affecting their decision when purchasing spectacles for their children. Female guardians and those with higher incomes were both 1.5 times more likely to emphasise frame quality when describing selection criteria for purchasing spectacles for their children than male guardians (p = 0.01) or guardians earning less (p = 0.03). CONCLUSION: Design, material, and frame quality are key factors influencing guardians when purchasing spectacles for their children in these setting and female guardians or those with higher income prioritise frame quality. This study could guide the planning and implementation of a novel cross-subsidisation scheme in Cross River State.