Doctoral Degrees (Optometry)

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Barriers to eye health care among school going children in Swaziland: towards the development of a framework for access to child eye health care.
(2018) Sukati, Velibanti Nhlanhla.; Moodley, Vanessa Raquel.; Mashige, Khathutshelo Percy.
Background: Good vision and eye health plays an important role in the overall development and well-being of a child. Visual impairment in children has a significant impact on their social interaction, quality of life, and economic independence. Providing accessible and equitable eye health delivery for all children, particularly the disadvantaged, requires establishing a balance between their eye care demands and the services a country can afford to supply. Purpose: The study aimed to investigate the barriers to child eye health services in the public health system in Swaziland in order to recommend, through the development of an access framework, strategies to improve access and address their specific eye health needs. Methods: A mixed methods study design was used in the study which entailed a document review of neighbouring country’s eye health policies, quantitative surveys to establish parents, teachers and eye health professionals knowledge and practices about children eye health; clinical facility assessment questionnaire to determine the availability of eye care facilities and services for children and qualitative interviews with Health and Education officials to determine current levels and factors that impact on access for children. The analyses included descriptive analysis for the quantitative data, thematic analysis for qualitative data and content analysis for the documents. The qualitative (interviews) and quantitative data (questionnaires) were triangulated to develop the draft access framework, and the Delphi technique used for experts’ input and comments for the draft access framework. Results: South Africa has national eye health guidelines that advocate for better public eye health services guided by formulated objectives with set targets. Although strides towards providing eye health care in Mozambique are noticeable, the country still lacks concrete eye health guidelines. Three major themes emerged from both the Health and Education interviews, these being; level of access, structural barriers and knowledge barriers to child eye care services. The absence of an eye care referral system, an outdated National Health Policy, the lack of or skewed distribution of human eye care resource and clinics, and inadequate knowledge about eye health care for children were the most important issues contributing to poor access and provision of ophthalmic services. Poor access to basic education excludes many children, particularly those from rural areas, from benefiting from school health programmes, despite these being characterized by poor service delivery. The clinical facility assessments indicated that only a few children presented to the public sector eye care facilities that are available in the country and that the majority lacked working equipment and essential drugs for patient management. In addition, low vision and contacts lens fitting services were lacking while only two out of the five clinics conducted outreach programmes at schools. Many (60.1%) parents reported that they have never taken their children for an eye test and 31.7% felt that their children’s vision was fine. The presence of a health facility in a community influenced early child eye examination (p=0.001). The majority (90.1%) of teachers indicated that they were able to detect signs and symptoms of eye diseases, although, this was insignificantly associated with those who indicated being well informed about eye health (p=0.089). Children wearing spectacles was significantly associated with teachers who indicated being well informed about eye health (p<0.001) and those who were more likely to advise parents to take their children for eye testing (p=0.003). Nine (60%) eye health practitioners felt that they were less informed about eye health problems among children and six (40%) reported being well informed. Eight (53.3%) respondents indicated that there were no school and community eye care outreach programmes and seven (46.7%) reported that their clinics offered outreach programmes. This is the first access framework study for child eye care in Swaziland and provides an opportunity to be a benchmark for other developing countries facing similar challenges. The framework advocates for a holistic approach in order to eliminate the isolation of eye health services. It further adopts a consumer oriented approach, with a particular focus on the current and future eye health status of children. The framework will serve as a foundation for eye health policy formulation and programmes aimed at redressing, promoting and preventing visual impairment or blindness. Conclusion: A carefully planned public health system, supported by an effective eye health plan and public health agencies, is needed to promote access to eye health services by children in the public education system in Swaziland. There is also a need for parents to be informed about basic child eye health in order to seek appropriate care. Teachers need adequate training and understanding about child eye health, including visual disabilities, to remove barriers in the teaching system. Developing and implementing guidelines for promoting access to child eye health may be useful to improve eye health service delivery in the country. The Swaziland government need to adopt and translate the framework into practice according to its intent as the information contained will be useful to the Ministry of Health and Social Welfare, Ministry of Education and Training, eye health professionals and parents.
A clinical description of anterior segment variables measured using optical coherence tomography in a healthy South African young adult population: the development of normal reference intervals.
(2018) Rampersad, Nishanee.; Hansraj Singh, Rekha.
Background: Assessment of anterior segment variables is important to screen, diagnose and monitor ocular anomalies. Previous studies, which have focused exclusively on Caucasian and Asian sub-populations with limited attention to South African sub-populations, suggest that anterior segment variable (corneal and anterior chamber angle) measurements vary with demographic and/or ocular factors. This study investigated anterior segment variables, measured using optical coherence tomography, in a healthy South African young adult population and develop a clinical biometric guideline with normal reference intervals. Methods: A quantitative cross-sectional research design was used. Multistage random sampling was used to select 700 participants from a university population. Anterior segment variables were measured using the Fourier-domain iVue100 Optical Coherence Tomographer. The Oculus Keratograph, Goldmann applanation tonometer and Nidek US-500 ultrasonographer were used to measure corneal topography, intraocular pressure (IOP) and axial biometry respectively. Data were analysed by descriptive and inferential statistics. The reference intervals were computed using the non-parametric method recommended by the Clinical and Laboratory Standards Institute. Results: The mean age of the sample, which consisted of 350 males and 350 females, was 20.4 ± 1.8 years. The anterior segment variable measurements of the right and left eyes showed high levels of interocular symmetry with intraclass correlation coefficients greater than 0.933 and marginal mean interocular differences. Accordingly, data from only the right eyes were analysed because of the high levels of interocular symmetry. The mean central corneal thickness (CCT) was 501.91 ± 33.74 μm and significantly thinner than the mean corneal thickness in each quadrant of the paracentral and peripheral cornea (p < 0.001). The mean minimum corneal thickness was 495.73 ± 33.89 μm and 1.23% thinner than the mean CCT measurement (p < 0.001). The thinnest point on the cornea was central for 94% of participants (n = 659). The anterior chamber angle (ACA) width variables, which included the angle-opening distance taken at 500 μm (AOD500) and trabecular-iris angle (TIA), were ~553 μm and ~37° respectively. The majority of participants showed ACA width variable measurements associated with open non-occludable ACAs. The temporal ACA had slightly higher variable measurements than the nasal ACA. The corneal thickness measurements in the different zones were normally distributed (p ≥ 0.095) whereas the ACA width variable measurements were asymmetrically distributed (p < 0.001). Black participants had significantly thinner mean corneal thickness measurements than Indian participants (range between 29.10 μm between 36.38 μm) for all zones (p < 0.001). For both the nasal and temporal ACAs, Black participants had 10 μm to 22 μm lower median AOD500 measurements (p ≥ 0.031) and slightly higher (less than 1°) median TIA measurements (p ≥ 0.068). The mean corneal thickness in males were 0.35 μm to 3.93 μm thicker compared with females (p ≥ 0.137). Female participants had higher median ACA width variable measurements than male participants for both the nasal and temporal ACAs (p ≥ 0.029). Emmetropes and hyperopes had the lowest corneal thickness and ACA width variable measurements respectively. The anterior segment variables were inversely correlated with spherical equivalent refraction (p ≤ 0.003) although the correlation coefficients were relatively weak (range between 0.111 and 0.222). The CCT was the most important anterior segment variable, with a cut-off value of 527 μm, to influence IOP in the unpruned and pruned regression tree models. The other important variables included the average peripheral corneal thickness, axial anterior chamber depth and average paracentral corneal thickness. The clinical biometric guideline presents the normal reference intervals as well as the associated 95% confidence intervals for the corneal thickness and ACA width variables in a healthy South African young adult population. The normal reference interval for the CCT measurement ranged from 434 μm to 566 μm. In the present study, the mean, range and normal reference interval for the CCT measurement differed when compared with the measurements reported in other studies involving healthy African samples living within the African continent. Conclusion: This study demonstrated that anterior segment variable measurements in a South African young adult population differ when compared with studies involving Caucasian, Asian and other African sub-populations globally. Consequently, the clinical biometric guideline with normal reference intervals therein should be used by eye care personnel when examining South African individuals. Moreover, the possible influences of demographic and/or ocular factors should be considered when evaluating anterior segment variable measurements.
Development of an algorithmic approach for the early detection and management of keratoconus.
(2023) Masiwa, Lynett Erita.; Moodley, Vanessa Raquel.
Empirical evidence, supported by anecdotal evidence suggests that some Keratoconic pre-pubescent children present for their first clinical examinations with advanced signs of KC and visual impairment that cannotr be corrected with readily accessible optical aids. This is evidenced by higher prevalences of KC reported in some African communities. This negatively impacts on the lives of these children and hinders the practitioner’s capacity to successfully manage the patient and provide good functional vision, often resulting in visual impairment. The study set out to verify this observation and to offer a potential solution to the problem that is the late presentation of young subjects with KC residing in Harare. Method: A questionnaire, Visual acuity check, retinoscopy and anterior segment assessment were used to award subjects attending primary school in urban Harare aged 6-12years a keratoconus risk score as per scoring sheet developed. A comprehensive exam including refraction, slit lamp exam and keratometry were then performed on the high-risk subjects for the diagnosis of clinical KC. Topography, contrast sensitivity measurement and pachymetry map analysis were then performed for the diagnosis of pre-clinical KC. Results: 1159 subjects were recruited, 57% were female, 99% of African ethnicity and Christian background. Prevalence of clinical KC was found to be 630: 100 000 and pre-clinical KC was found to be 1360:100 000. Anterior surface abnormalities were present in 30% of the subjects considered to be high risk for the development of KC. The age range of the subjects diagnosed with clinical KC was 8-12years. VKC, reduced VA, itchy eyes and eye rubbing were the most frequently encountered symptoms. Conclusion: The odds of having KC are increased if the child is aged between 8 and 12 years and of African ethnicity, regardless of gender. Increased probability of developing KC was found in the presence of VKC, reduced VA, itchy eyes and frequent eye rubbing.. The early detection and management algorithm developed will allow for the timely diagnosis of KC and in turn offer improved prognosis as the earlier management of the condition will be possible with all treatment options still viable.
Development of an assessment instrument to measure disability related distress in primary school learners with vision impairment due to uncorrected refractive error in rural areas of KwaZulu-Natal Province, South Africa.
(2017) Chan, Ving Fai.; Naidoo, Kovin Shunmugam.; Singer, Susanne Katharina.
With the increasing global emphasis on improving eye health in children, numerous efforts are being implemented to meet the eye care needs of the children. There is no instrument which can be used to measure the impact of the Disability Related Distress (DRD) on children with vision impairment (VI) due to uncorrected refractive error (URE). Aim The aim of the study was to develop an assessment instrument to measure DRD in Grade 1 to Grade 5 learners with VI due to URE in a rural and semi-rural setting. Methods This mixed-method study was conducted in 4 primary schools in Pinetown, KwaZulu Natal, Durban in 3 phases. Phase 1 involved twelve focus group discussions using semi-structured interviews to identify themes that formed the DRD items in the Instrument. A topic was qualified as an item if at least two participants made substantive comments on the topic in a single focus group and the topic was discussed by at least one child in two different groups. In Phase 2, we consulted ten experts to construct an instrument for pre-testing by considering relevance, relative importance, upsetting issues and wording of the items. Issues that had a mean score < 2 for relevance or importance were excluded. In Phase 3, we pre-tested the instrument to identify missing or redundant issues. An item was included in the final instrument if the mean score of relevance was > 1.5; prevalence ratio >30% or prevalence of scores 3 or 4 >50%; range of rate of occurrence was > 2 points; no significant concerns expressed by Primary Subjects, Secondary Subjects and Tertiary Subjects, and compliance of less than 5% of the responses to the item in the debriefing session suggested that the issues were not related to VI due to URE. Results In Phase 1, thirteen children with normal vision and 63 children with VI due to URE consented to participate in the focus group discussions. Eleven themes were generated from the focus group discussions and included as items in the draft provisional list. In Phase 2, one item was excluded and the experts pointed out the need to give explanations to the children. The items included were from the domains of Loss of Self Confidence (n=3), Loss of self-worth (n=3), Loss of interconnection/ interaction with community (n=2), Suspicion, humiliation and fight (n=1) and Discrimination (n=2). In Phase 3, pre-testing was conducted on 120 children (Normal vision, NV: Mild vision impairment, MVI: Severe vision impairment, SVI: 60:30:30). The rate of occurrence of the items showed an increasing trend, from NV to MVI and SVI. The average time needed for completing the questionnaire showed an increasing trend, from NV to MVI and SVI. All eleven items in the provisional list fulfilled the retention parameters. Conclusion The developed instrument is valid, appropriate and culturally sensitive to the rural population. Its administration is resource-friendly and efficient with straightforward analysis and interpretation of data. This makes it easy to communicate the finding to a wide range of stakeholders and decision makers.
Ocular health of cocoa farmers in Ghana : an assessment and intervention study.
Boadi-Kusi, Samuel Bert.; Hansraj, Rekha.; Mashige, Khathutshelo Percy.
Background: Cocoa farmers are known to face a lot of ocular health hazards such as chemicals, ultraviolet radiations, farm equipment, plants, dust and allergens among others in the field of work. This study sought to examine and understand the factors that affect the ocular health of cocoa farmers in Ghana in order to improve their knowledge and awareness on ocular health and safety practices through a training intervention. Methods: The study employed two quantitative approaches: a cross-sectional survey and a quasi- experimental pre-post-test study design. The cross-sectional study involved administration of a questionnaire and conducting a comprehensive eye examination among participants, while the pre-post-test study used a structured questionnaire to gather baseline knowledge and post training knowledge on ocular health and safety practices among the participants to establish a change. A multistage random sampling approach was used to select participants from four cocoa growing districts of Ghana. Results: Five hundred and fifty-six, out of the 576, who were recruited for the first phase of the study, met the inclusion criteria, giving an eligibility rate of 96.5%. The participants consisted of 359 (64.6%) males and 197 (35.4%) females with a mean age of 54.9 years (± 11.2). Educational attainment among the participants was low, with 142 (25.5%) having had no formal education. Participants spent an average of 33.3 (±13.4) hours per week on the farm, with males spending more time 35.3 (±13.9) than females 29.6 (± 11.8) (p<0.001) and also spent more hours on the farm than females (p<0.001). Participants reported poor distance and near vision, itching/redness, pain and tearing as major complaints. Anterior eye conditions recorded included pterygium 23.7% (CI: 20.3-27.5), allergic conjunctivitis 9.7% (CI: 7.4 - 12.5) and corneal scar/opacity 6.1% (CI: 4.3 - 8.4). Other conditions included cataract 25.5% (CI: 22.0-29.3), glaucoma 15.8 (CI: 12.9 - 19.1) and macular disorders 4.9% (CI: 3.2 - 7.0). Posterior segment conditions and uncorrected refractive errors (67.6%) were the major causes of moderate and severe visual impairment (MSVI) (16.7%) and legal blindness (4.9%) among the population studied. Presbyopia was present in 83.1% (CI: 79.7 - 86.1) of the participants. The rate of ocular injuries was 143/12 854.5 worker years or 11.3/1 000 worker years (95% CI: 9.4 - 31.0), which led to a lost work time injuries of 137 injuries/ 12 854.5 worker years or 37.3/1000 worker years (95% CI: 34.1- 40.8) and were predominantly in males. Blunt injuries from plants/branches and chemical injuries were mostly reported. Only 34 (6.1%) reported using ocular protection. Barriers to use of ocular protection included non availability of the equipment, lack of funds and ignorance or lack of training. More than half of the participants (52.4%) had never seen an eye care practitioner, while 25% reported seeking eye care within the last one year preceding the study. Those who were registered with the National Health Insurance Scheme were more likely to attend a hospital/clinic for eye care services (OR = 3.93, 1.40 - 11.06, p = 0.009). Barriers to utilization of eye facilities included lack of funds, long distance to facility and long waiting time at eye facilities. Two hundred participants enrolled for the quasi-experimented pre-post-tested study, and had varied opinions on ocular health and safety practices on the farm. They demonstrated a good knowledge on the ocular hazards they face at work, although most were unaware of the effect of some of the hazards on the eye. Farmers also had a poor knowledge on ocular protection but a fair knowledge on first aid for ocular emergencies. Participants improved their knowledge scores (overall 40 points) on ocular health and safety practices from a pre- median score of 172 (IQR: 164 - 177.5) to 212 (IQR: 206 - 219.5) following the pre- and postevaluation of the training intervention. Conclusions: Eye disorders are prevalent among cocoa farmers in Ghana. Farmers are engaged in improper ocular health and safety practices on the farm. They also make insufficient use of appropriate protective eye devices and health services. The study demonstrated that, with an ocular health intervention, cocoa farmers can improve on their knowledge and awareness level on ocular health and safety practices which may be of benefit to the farmer, employers and the national economy.
Profiling the visual characteristics of school children in Abia State, Nigeria, towards the development of a vision screening protocol.
(2019) Atowa, Uchenna Chigozirim.; Wajuihian, Samuel Otabor.; Hansraj Singh, Rekha.
Vision is an important factor for realization of the full learning potential and intellectual performance of a child. While the ability to perform optimally at school depends significantly on the visual status of the individual, the prevalence of common vision conditions in children in Abia State and Nigeria remains largely unknown. The focus of the limited school-based crosssectional studies on paediatric vision conditions have been mainly to quantify significant refractive errors (RE), whereas the prevalence of strabismus, amblyopia, accommodative anomalies and vergence disorders, most of which have been linked to reduced academic-related performance has not been established. It is imperative that the paucity of data on the prevalence of paediatric vision conditions in Abia State is addressed as this will ensure that common visual anomalies are identified early and treated before functional performance of children is affected. An invaluable approach will be through a coordinated and standardized paediatric vision screening delivery system. However, no standard vision screening guidelines was found for school children in Abia State and Nigeria. The purpose of this study is to characterise the visual anomalies in school children in Abia State and to develop a common and comprehensive paediatric vision screening model based on an evaluation of the current paediatric vision screening programs of individual optometrists. This was a population based observational, descriptive study, using cross-sectional design to provide quantitative data. The study consisted of two parts. In part one, a total of 550 school children between 10 and 16 years were recruited from 9 schools (public and private) through a systematic random sampling method starting from the three geographic districts to the classrooms. Data were collected by means of a symptom questionnaire and a series of vision assessment instruments including visual acuity (VA), plus lens test, stereopsis, ocular motility, color vision test, non-cycloplegic autorefraction, accommodation, binocular vision and ocular health. Thirteen children were excluded from further participation due to not satisfying the inclusion criteria. A total of 537 (97.6%) children were examined with a mean age of 13.0 ± 2.0 years and median age of 13 years. Participants were divided into two age groups namely group 1 (10 – 12 years) and group 2 (13 – 16 years). The distribution of participants according to age group, gender and school level showed that 41.9% were from age group 1, 52.5% were female and 43.6% were from primary school. The prevalence of vision conditions such as visual impairment, RE, strabismus, colour vision deficiency, cornea opacity, retinal disorder, accommodative and vergence anomalies in school children in Abia State were determined. The prevalence of presenting, uncorrected and best corrected VA of ≤ 6/12 or worse in the better eye was 3.5%, 4.1% and 0.8%, respectively. Refractive error (78.9%) was the major cause of presenting visual impairment. Other causes include amblyopia (10.5%), corneal opacity (5.3%) and retinal disorders (5.3%). The prevalence of RE was 10.6%. Among the different REs, low categories of myopia, hyperopia, and astigmatism were the most frequent with corresponding values of 88.9%, 86.4% and 82.4% respectively. None of the children had a high degree hyperopia, myopia or astigmatism. Significant differences between age groups were found in hyperopia and myopia, with the prevalence of hyperopia (p = 0.03) decreasing with age while myopia (p = 0.01) increased with age, and as expected with school level (p = 0.04). There was no significant association between gender and RE. Similarly, no significant difference was found between age group or school level and astigmatism. The prevalence of strabismus, corneal opacity, and retinal disorder was 0.2 % each. A small percentage (0.9%) of children had red-green colour vision deficiency. Four participants (additional to the baseline data of 13) who have amblyopia were further excluded from the analysis of accommodative and vergence anomalies. For accommodative anomalies the estimates were 3.9% for accommodative insufficiency, 2.8% for accommodative excess and 10.1% for accommodative infacility. There were no association based on age, gender, school level with specific types of accommodative anomalies. For vergence anomalies, the estimates for low suspect, high suspect and definite convergence insufficiencies were 9.6%, 5.8% and 4.1%, respectively. Other prevalence estimates include convergence excess (2.9%), fusional vergence dysfunction (2.6%), basic exophoria (1.7%), basic esophoria (2.8%), divergence insufficiency (0.8%) and divergence excess (0.6%). The prevalence of high suspect (p < 0.01) and definite (p < 0.01) convergence insufficiency were significantly higher in older children than younger children and as expected therefore with secondary school children than primary school children (p = 0.01). There was no statistically significant association between gender and various vergence anomalies. In part two of this study, all registered optometrists currently practising in Abia State for at least one year prior to the survey were eligible to participate. A self-administered questionnaire was distributed to the optometrists by hand or email. The questionnaire covered areas such as the optometrist’s participation in paediatric vision screening, location of the screenings, the age of children being screened, tests performed and referral criteria, as well as children seen by the optometrists in their practice who were referred from a screening program. Out of a total of 83 registered optometrists that were contacted for the survey, 64 (77.1%) responded. The majority (87.5%) of the respondents were working in the two cosmopolitan cities of Aba and Umuahia and 71.9% were working in private eye care facilities. Analysis of optometrists’ participation in paediatric vision screening showed that only 28 optometrists had participated in one or more vision screening that included children in the last one year before this study and only 10 have provided vision screening services more than four times. Visual acuity and ocular health assessment procedures were the major components of the screening battery of the optometrists. While a child with any disease abnormality was referred for evaluation, the referral criteria for a full examination were inconsistent. The follow-up of those referred for complete examination, could not be established due to lack of uniform guidelines and improper documentation. The present study has systematically characterised the prevalence of vision conditions in children in Abia State and efforts that have been made at their early detection through vision screening. The findings indicate that while the prevalence of visual impairment in school children in Abia State is low, uncorrected RE is the major cause of reduced vision in those with visual impairment. Given that children within the age group of 10 to 16 years are in stages of rapid growth and intensive education which can complicate RE progression, the high proportion of uncorrected RE in the study sample is a major concern as undetected and untreated RE may progress to sight threatening complications or permanent vision loss. On the contrary, a significant proportion of the study participants were affected by visual anomalies which do not necessarily affect VA but can negatively impact on school performance. Such visual anomalies include accommodative and vergence anomalies as well as low magnitude of hyperopia and astigmatism. Considering the public health implication, vision screening should be an immediate intervention. However, data on vision screen survey demonstrated that the existing paediatric screening programs in Abia State are irregular, unequal, unstandardized and limited in range with focus mainly on the detection of REs that are detrimental to VA. The implication is that many children with common paediatric eye conditions including those that have been linked to reduced academic achievements are not routinely screened. Overall, it appears that the current screening programs are not meeting the visual needs of the paediatric population suggesting the need for a new strategy that will increase the coverage and effectiveness of paediatric vision screening in Abia State. It is therefore expected that the public-private partnership strategy as proposed in this study will provide greater access to vision screening services across the state as well as help in the early detection of vision anomalies before functional performance of children is affected.
Reducing vision impairment in children through health system assessment and strengthening approach in Papua New Guinea.
(2018) Wabulembo, Geoffrey.; Naidoo, Kovin Shunmugam.
ABSTRACT A strong and efficient integrated health system is able to contribute to the reduction of vision impairment among children by ensuring preventive measures are implemented and timely access to care is done in case of morbidity. Children in Papua New Guinea presenting late for congenital cataract surgery, incurring avoidable eye injuries, living with uncorrected refractive error and some presenting with advanced retinoblastoma were of concern to the researcher. The overall aim of the study was to assess how the current health system in Papua New Guinea is addressing child eye health using Port Moresby General Hospital and Goroka hospital as case studies. It is envisaged that a health strengthening approach benefits children’s eye health in the community. Methods Both quantitative and qualitative methods were employed. Retrospective medical records review of children seen at the eye clinic in Port Moresby and Goroka Hospitals from January 2015 to December 2017 was conducted. In the qualitative method service providers and caregivers were interviewed to obtain their perspectives regarding performance of the health system. Results At Port Moresby General Hospital trauma, conjunctivitis and corneal ulcers accounted for 21.6%, 18.9% and 9% respectively of all the diagnoses among children. Trauma was in the ratio of 1:1 (p= 0.264) male to female. And 7.3% (n=51) of the children were blind (according to the WHO definition). Among the blind children optic nerve disorders accounted for 20.5 %( n=14) followed by both un-operated cataracts and uncorrected refractive error each at 13.2% (n=9). Retinoblastoma presented at mean age 5.869 (SD4.5) and 6.02(SD 2.4) years for girls and boys respectively. The main causes of ocular morbidity observed at Goroka Hospital were corneal ulcers (24.9%), uveitis (9.3%) and foreign bodies (9.2%). Service provider interviews revealed lack of policy on child eye health, shortage of health personnel and limited community eye health services. But among care givers lack of eye health information in the community, concerns about long waiting time at the hospitals and inadequate explanation about conditions affecting the children featured prominently. Conclusion Findings show a higher percentage of blind children compared to similar hospital based studies elsewhere. To achieve universal eye health coverage, raising awareness about child eye health needs among leaders in health is urgent. Successes registered in the past in Papua New Guinea in other child health efforts like immunisation suggest that a consistent and focused health system strengthening approach with greater integration may contribute to reduction of vision impairment among children. A proposed child eye health strategy based on the findings from this study is included in this thesis.

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