Prevalence of refractive error and visual impairment among school-age children of Hargesia, Somaliland, Somalia

Background: Childhood visual impairment is a global public health problem, especially in low and middle-income countries. Its most common causes are avoidable by early diagnosis and treatment. Aims: To assess prevalence of refractive error and visual impairment among school-aged children in Hargeisa, Somaliland, Somalia. Methods: This was a cross-sectional study of 1204 students (aged 6-15 years) in 8 randomly selected primary schools in Hargeisa from November 2017 to January 2018. We used the modified Refractive Error Study in Children to determine prevalence of refractive error and visual impairment, including the following investigations: distance visual acuity, assessed by Snellen Tumbling E-chart; refraction, assessed by retinoscope binocular vision assessment; and examination of anterior and posterior segments. Results: Prevalence of uncorrected, presenting and best-corrected visual impairment of 6/12 or worse was 13.6%, 7.6% and 0.75%, respectively. Only 16 of 91 (17.6%) children were using spectacles and the rest were unaware of the problem. Refractive error was the cause of visual impairment in 76.8% of participants, amblyopia in 22.0%, trachoma in 2.4%, and corneal opacity and cataract in 0.6%. Anterior segment abnormalities were found in 8.3%, mainly vernal keratoconjunctivitis, while posterior abnormalities were observed in 0.7%. Prevalence of myopia was 9.1%, hypermetropia 2.7% and astigmatism 3.9%. Prevalence of visual impairment because of Refractive Error was associated with increasing age, but there was no significant association with school grade or sex. Conclusion: Prevalence of visual impairment among school-aged children in Hargeisa was high, and the leading cause was uncorrected Refractive Error. There are barriers to care and it is critical that they are overcome.