Is the Child-to-Child approach useful in improving uptake of eye care services in difficult-to-reach rural communities? Experience from Southwest Nigeria

Background: Blindness and severe visual impairment render affected individuals, families and communities economically, socially and physically disadvantaged. The number of adults ≥ 40 years with severe visual impairment and blindness in Nigeria is projected to increase from 1.02 million (2008) to 1.4 million (2020). Utilization of available eye care services improves quality of life, but uptake is generally unsatisfactory. Empowering individuals, including children, to identify, motivate and appropriately refer them improves utilization. Children, because of their peculiar roles in families and communities, could be important change agents. This study was designed to determine if primary school pupils aged 9-14 years can be satisfactorily trained, using the child-to- parent approach, to assess vision, refer and motivate people to attend screening eye camps. Methods: Ninety pupils aged 9-14 years attending two purposively-selected primary schools were selected by simple random sampling. Using the child-to-parent approach and Snellens 6/60 illiterate E-chart, participants had a 2-day knowledge and skill-based training followed by 2 days of community-based vision assessment and referral of those assessed. The adequacy and success of the training were assessed by comparing pre- and post-test scores. Results: Three hundred and thirty-six persons were referred and examined; of these, 142 (42.3%) persons were reviewed. Overall there was significant improvement in knowledge. The accuracy of assessments was 82.1% for Right Eyes (RE), 83.3% for Left Eyes (LE) and 72.1% for presbyopia. The sensitivities for the RE, LE and presbyopia were 84.8%, 86.1% and 76.3% respectively. Similarly, the specificities were 44.4% for RE, 50.0% for LE and 68.6% for presbyopia. The performances were not significantly influenced by age, sex and locality. Conclusion: Children aged 9-14 years in primary schools can be empowered, using the child-to-child approach, to assess vision and motivate members of their communities to utilize available eye care services.