WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Safa Hassan Abd AL-Hussain*, Anwer Hameed Rashid, Sakina Abd AL-Hai

ABSTRACT

Introduction: Visual impairment in children is a significant public health challenge, particularly in low- and middle-income countries where early detection programs are often underdeveloped. Method: This study aimed to assess the prevalence and causes of visual impairment among primary school children in Karbala, evaluate the effectiveness of existing school vision screening program, and identify barriers to spectacle use and referral adherence. Results: A cross-sectional analytic study was conducted in Karbala Governorate between the 23rd of March and end of April 2025. Prevalence of visual impairment was obtained from Primary Health Care sectors records. For the assessment of parental awareness and obstacles to vision correction, questionnaires were administered to parents of children with reduced vision. A total of 477 children aged 6–12 years were included. Results: The prevalence of visual impairment higher in urban (3.7%) than rural (1.23%) children. Refractive errors were the main causes, mainly myopia (33.5%) and astigmatism (28.1%). Spectacle use was significantly higher in urban areas (59.9% vs. 38.9%; p<0.001). Higher Parental education, income, and urban residence were strongly associated with wearing glasses. Wearing glasses were also associated with improvement in academic and psychosocial wellbeing (p<0.001). Urban and male gender was associated with higher screen time (P< 0.019 and 0.038 respectively). Despite 99.5% coverage of school-based screening, referral adherence was limited with only 44.7% completing the referral pathway. Awareness remained low 36.1% of parents recognized the school vision test as structured program, and less than half received reports or educational materials. Still Major barriers to spectacle uptake included child refusal (45.7%) and high cost (33.5%). Conclusion: Visual impairment among primary school children in Karbala is relatively low (3.7% in urban and 1.23% in rural), but refractive errors remain the leading cause. School-based screening programs are effective with coverage of 99.5%, yet their impact is weakened by poor referral adherence (44.7%), financial barriers, and limited parental awareness. Strengthening referral systems, subsidizing spectacles, and enhancing communication with families are essential for improving program outcomes. Importantly, consistent use of corrective spectacles also contributes to better academic achievement and psychosocial wellbeing.

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