Needs and views on eye health and women's empowerment and theory of change map: implication on the development of a women-targeted eyecare programme for older Zanzibari craftswomen.

OBJECTIVES: To assess needs and views regarding eye health and empowerment from craftswomen's perspectives to develop a theory of change (ToC) for a women-targeted eyecare programme. MATERIAL AND METHODS: Eighteen stakeholders participated in a 2-day consultation workshop in Zanzibar. The composition was (1) 15 women and 3 men; (2) Unguja (n=8), Pemba (n=6) and Tanzania mainland (n=4) and (3) craftswomen (n=14) and governmental stakeholders (n=4). Thematic analysis determined the craftswomen's needs and views regarding eye health and empowerment and subsequently inputs, activities, outputs, outcomes and impact to develop the programme's initial ToC. In refining the initial ToC, we used insights from a qualitative study suggesting that improved near vision is perceived by craftswomen as a potential source of empowerment across economic, psychological, social, political and educational dimensions. RESULTS: The eye conditions experienced by the craftswomen were eye irritation caused by foreign bodies, the need for near spectacles and other eye morbidities. They were advised by the cooperatives to visit eye health centres for treatment. The main barriers to accessing services were inaccessibility and unaffordability of eye services and a lack of eye health knowledge and practices. Nineteen subthemes on women empowerment (economic n=4, social n=4, psychological n=6, education n=2 and political n=3) were obtained. We created a ToC on how investing in improving craftswomen near vision could achieve empowerment. CONCLUSION: The participants provided insights into their needs and how they would like the eyecare programme to be implemented and how they see they could be empowered in the process.

Is an integrated model of school eye health delivery more cost-effective than a vertical model? An implementation research in Zanzibar.

OBJECTIVE: To review and compare the cost-effectiveness of the integrated model (IM) and vertical model (VM) of school eye health programme in Zanzibar. METHODS AND ANALYSIS: This 6-month implementation research was conducted in four districts in Zanzibar. Nine and ten schools were recruited into the IM and VM, respectively. In the VM, teachers conducted eye health screening and education only while these eye health components were added to the existing school feeding programme (IM). The number of children aged 6-13 years old screened and identified was collected monthly. A review of project account records was conducted with 19 key informants. The actual costs were calculated for each cost categories, and costs per child screened and cost per child identified were compared between the two models. RESULTS: Screening coverage was 96% and 90% in the IM and VM with 297 children (69.5%) from the IM and 130 children (30.5%) from VM failed eye health screening. The 6-month eye health screening cost for VM and IM was US$6 728 and US$7 355. The cost per child screened for IM and VM was US$1.23 and US$1.31, and the cost per child identified was US$24.76 and US$51.75, respectively. CONCLUSION: Both models achieved high coverage of eye health screening with the IM being a more cost-effective school eye health delivery screening compared with VM with great opportunities for cost savings.

Prevalence of refractive error, presbyopia and spectacle coverage in Kahama District, Tanzania: a rapid assessment of refractive error.

BACKGROUND: In Tanzania, the prevalence of refractive error and presbyopia have not been comprehensively assessed, limiting appropriate planning and implementation of delivery of vision care. This study sought to determine the prevalence of refractive error and presbyopia, spectacle coverage and the barriers to uptake of refractive services in people aged 15 years and older in the Kahama district of Tanzania. METHODS: A cross-sectional community-based survey was conducted using 54 randomly selected clusters. Respondents 15 years and older were interviewed and underwent standardised clinical eye examinations. Uncorrected refractive error (URE) was defined as presenting vision worse than 6/12 that could be corrected to better than 6/12 using a pinhole. Spectacle coverage was defined as the proportion of need that was met (those that improved from unaided vision with their own spectacle correction). RESULTS: A total of 3,230 subjects (99.75 per cent of 3,240 eligible) participated in the study with 57.2 per cent males and the median age of participants was 35 years (inter-quartile range, 24 to 49). The prevalence of visual impairment was 10.4 per cent (95% CI 9.4 to 11.4) and was lower in those who had completed their primary school education (odds ratio (OR) 0.54, 95% CI: 0.40 to 0.72) and highest in subjects 40 years and older (OR 3.17, 95% CI: 2.14 to 4.70) and farmers (OR 8.57 95% CI: 2.27 to 32.43). Refractive error prevalence was 7.5 per cent (95% CI: 6.65 to 8.54) and this was highest in participants over 40 years (OR 1.60, 95% CI: 1.14 to 2.25) and in students (OR 3.64, 95% CI: 1.35 to 9.86). Prevalence of presbyopia was 46.5 per cent (773/1,663, 95% CI: 44.34 to 48.75). Spectacle coverage for refractive error and presbyopia was 1.69% (95% CI: 0 to 3.29) and 0.42% (95% CI: 0 to 1.26), respectively. CONCLUSION: Uncorrected refractive error is a public health challenge in the Kahama district and sustainable service delivery and health promotion efforts are needed.