印度北部为患有屈光不正的城市学童提供补贴眼镜后的眼镜覆盖率
Spectacle Coverage among Urban Schoolchildren with Refractive Error Provided Subsidized Spectacles in North India.
作者信息
Gupta Vivek, Saxena Rohit, Vashist Praveen, Bhardwaj Amit, Pandey Ravindra Mohan, Tandon Radhika, Menon Vimla
机构信息
Department of Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
出版信息
Optom Vis Sci. 2019 Apr;96(4):301-308. doi: 10.1097/OPX.0000000000001356.
SIGNIFICANCE
Provision of subsidized spectacles to schoolchildren with refractive error in Delhi was associated with increased spectacle coverage.
PURPOSE
Studies involving free spectacle distribution and self-purchase of spectacles often report poor compliance. We assessed 1-year spectacle coverage among schoolchildren with refractive error who were provided subsidized spectacles.
METHODS
This was a study of a prospective cohort of 10,114 students from 20 randomly selected schools of Delhi. Children were presumed to have refractive error when unaided visual acuity was worse than or equal to 6/12 in either eye and a best-corrected visual acuity better than or equal to 6/9.5 in both eyes (n = 1503). Children with unmet need of spectacles (presenting with a visual acuity worse than 6/9.5 in the worse eye) were provided subsidized spectacles (n = 1191). Coverage was established by direct observation at baseline and after 1 year through unannounced visits.
RESULTS
Mean age of cohort was 12.0 ± 2.0 years, and 566 (37.7%) were girls. Baseline spectacle coverage was 29.3% (95% confidence interval [CI], 27.1 to 31.7%), which improved to 65.9% (95% CI, 56.0 to 61.6%) among all children (n = 1470) and 58.8% (95% CI, 56.0 to 61.6%) among children with unmet need (n = 1163) at 1 year. Uptake of the subsidized spectacles was 98.6%. On multivariate regression, the odds of spectacle use were greatest when unaided vision was poor: 55.5% when visual acuity was better than or equal to 6/9.5, 74.8% when visual acuity was 6/19 to 6/60 (adjusted odds ratio, 2.5; 95% CI, 1.7 to 3.5), and 91.5% when visual acuity was worse than 6/60 (adjusted odds ratio, 3.1; 95% CI, 1.0 to 9.5). Sex (boys, 66.3%; girls, 65.3%) and socioeconomic status (lower, 58.6%; middle, 61.8%; upper middle, 70.7%) were not associated with coverage. Increasing maternal education and baseline spectacle use were associated with coverage. However, 38.0% were wearing spectacles prescribed by the project, and 61.9% of the spectacles being used at 1 year were purchased in the open market.
CONCLUSIONS
Spectacle coverage after 1 year increased through a subsidized spectacle scheme, particularly for children with poor uncorrected vision.
意义
在德里为患有屈光不正的学童提供补贴眼镜与眼镜佩戴率的提高相关。
目的
涉及免费眼镜分发和自行购买眼镜的研究经常报告依从性较差。我们评估了获得补贴眼镜的患有屈光不正的学童的1年眼镜佩戴率。
方法
这是一项对来自德里20所随机选择学校的10114名学生的前瞻性队列研究。当任何一只眼睛的裸眼视力低于或等于6/12且双眼最佳矫正视力优于或等于6/9.5时，儿童被假定患有屈光不正（n = 1503）。眼镜需求未得到满足的儿童（较差眼的视力低于6/9.5）获得了补贴眼镜（n = 1191）。通过在基线时以及1年后进行的不预先通知的访视直接观察来确定佩戴率。
结果
队列的平均年龄为12.0±2.0岁，566名（37.7%）为女孩。基线眼镜佩戴率为29.3%（95%置信区间[CI]，27.1%至31.7%），在所有儿童（n = 1470）中1年后提高到65.9%（95%CI，56.0%至61.6%），在眼镜需求未得到满足的儿童（n = 1163）中为58.8%（95%CI，56.0%至61.6%）。补贴眼镜的使用率为98.6%。在多变量回归分析中，当裸眼视力较差时使用眼镜的几率最高：视力优于或等于6/9.5时为55.5%，视力为6/19至6/60时为74.8%（调整后的优势比，2.5；95%CI，1.7至3.5），视力低于6/60时为91.5%（调整后的优势比，3.1；95%CI，1.0至9.5）。性别（男孩，66.3%；女孩，65.3%）和社会经济地位（低，58.6%；中，61.8%；中上，70.7%）与佩戴率无关。母亲教育程度的提高和基线眼镜使用情况与佩戴率相关。然而，38.0%的人佩戴的是项目规定的眼镜，1年后使用的眼镜中有61.9%是在公开市场购买的。
结论
通过补贴眼镜计划，1年后眼镜佩戴率有所提高，特别是对于未矫正视力较差的儿童。
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