Individual and school-level factors associated with suspected pediatric eye disorders and referral adherence in an enhanced school-based vision screening program in Ghana

Evidence on how social and school-level contexts shape pediatric vision screening outcomes is limited, particularly in sub-Saharan Africa. We examined the association between individual and contextual factors and vision screening outcomes in a pilot enhanced school-based vision screening program (ESVSP) in Kumasi, Ghana. We conducted a cross-sectional study using data from an ESVSP to detect suspected eye disorders in school-children aged 4–22 years. Outcomes were the presence of suspected eye disorders and referral adherence. Exposure variables were individual [(age, sex, socioeconomic status (SES)], and contextual [school type (public vs private)] factors. Logistic regression was used to estimate unadjusted (OR) and adjusted (aOR) odds ratios with 95% confidence intervals (CI). We analyzed data for 1,123 children screened and 299 referred. The average age was 10.2 (±2.6) years. Overall, 34.0% (n = 382) had suspected eye disorders, and 32.8% (n = 98) adhered to the referral. After adjusting for key variables, children attending public (32.2%) compared to private (67.8%) schools had 45% lower odds of suspected eye disorders (aOR= 0.55; 95% CI 0.37, 0.83). Children with low (13.3%) compared to high (28.6%) SES had 70% lower odds of referral adherence (aOR= 0.30; 95% CI 0.12, 0.80). In this pilot school-based program, school context and SES (an individual-level factor) were associated with suspected pediatric eye disorders and referral adherence, respectively. These findings highlight equity-relevant gaps in referral adherence and underscore the need for context-specific strategies to strengthen referral pathways in low-resource settings.