O.O. Ayorinde1, G.V.S. Murthy2 and O.O. Akinyemi3

  1. Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
  2. International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London
  3. Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan, Nigeria


Objective: 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 three-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.


Dr. O.O. Akinyemi
Dept. of Health Policy and Management,
College of Medicine,
University of Ibadan,
Ibadan, Nigeria;
Tel: +2348035020136


The global estimates for visual impairment and blindness in all ages, are currently 285 million and 39 million respectively;1 yet, 75-80% of blindness is preventable.1 About 80% of all visually impaired persons and 70% of all blind individuals are fifty years and above. Moreover, with the global economic growth, increased health awareness and life expectancy, populations are ageing and non-communicable diseases are attaining greater significance in eye care. Intensified efforts will therefore be needed to eliminate avoidable blindness and visual impairment.2

Despite the challenges of poor vision and the proven benefits of service utilization, a substantial number of affected individuals do not access available services even when provided as outreaches with partial or full sponsorship.3 The observed poor uptake of eye care service could be ‘provider’ or ‘consumer’ related. A lot of social marketing is thus currently being done by providers to ensure provision of good quality service to consumers and better uptake by users.3, 4

The novel strategy of empowering children to share in the responsibility for improving their health and that of their communities using the child-to-child or child to- parent approach has been successfully implemented in other health areas and may have a place in eye care.5 Over 95 countries including India, Zambia, Botswana, Uganda, Jamaica and Madagascar have conducted child-to-child projects which targeted various health and development issues peculiar to their communities and these were successful; success was measured by various levels of desired change. However of the many projects, the few that have been evaluated did not discuss their outcomes in relation to age, sex, or community settings of children involved.6,7 Additionally, available evidence are in support of using this approach to promote eye health and prevent blindness in developing economies.8, 9

In Nigeria children are an integral part of households and communities. From an early age, they assume responsibilities of caring for younger siblings and physically/mentally challenged relatives, watching over wares, and occasionally street hawking. Strong social ties and respect are known to exist between families living in communities. Children aged 5-14 years are 24.4% of the Nigerian population; there are 14,917,987 and 666,719 primary school pupils nationwide and in Oyo-State respectively.10 If they are involved in improving eye health, by the time they mature into adults, their health (including eye) awareness and practice will be better than those of their parents;11 they will have a better orientation to education and self-esteem.12 Furthermore, the prevalence of blindness among individuals >40years in the Southwest geopolitical zone is 2.8% (Presenting Visual Acuity). 13 This translates into 150,930 individuals, being the lowest among the six geopolitical zones in the country.13 However, the zone has the highest number of health (and eye) care workers in the country.14

Although information on use of child-to-child approach in Nigeria is scarce, it has been recommended for eye health and child care by some local publications. 15, 16 Thus, this study was conducted to determine if primary school pupils aged 9–14 years could be satisfactorily involved in identifying and motivating visually impaired members of their communities to utilize available eye care services in rural Oyo State, Southwest Nigeria.