Will my child see me again? Addressing children’s vision impairment through surgeries, optical correction, and low vision services in Northern Malawi

BACKGROUND: Blindness and low vision in children remain significant public health concerns, particularly in low- and middle-income countries. These conditions are often underdiagnosed and undertreated due to limited access to specialized services, spectacles, and assistive devices, posing critical challenges to health equity. The Childhood Blindness and Low Vision Programme (CBLVP) in Northern Malawi, Africa aimed to address these gaps through capacity building, advocacy, improved access to regular eye health and low vision assessments, and the provision of spectacles and low vision devices. This article reports on the activities and outcomes of the CBLVP, implemented between 2022 and 2024. METHODS: Activities included establishing clinical services at a government referral eye hospital, conducting outreach screenings and assessments, and building capacity through training and mentorship. Advocacy efforts engaged stakeholders-including government officers, parents, teachers, and disability organizations, to promote awareness, increase service uptake, and provide basic skills for supporting children's use of vision at school and home. Programme monitoring drew on routine service records and feedback from stakeholders and beneficiaries, capturing key achievements and identifying challenges to inform future service improvement. RESULTS: A total of 2,054 children were served; among these, 370 (18%) received glasses, 70 (3.4%) received low vision services, and 96 (4.7%) underwent cataract surgery. Spectacles and low vision devices were reported to improve children's visual status, enabling better educational and vocational performance. Awareness campaigns, including radio and social events, increased visibility and service uptake, particularly among persons with albinism. Stakeholders highlighted that the absence of a regular screening and admission policy led to some children with low vision being misclassified and placed in Braille-based programs, despite being capable of learning through print. CONCLUSION: The programme demonstrated that children's vision services can be comprehensively integrated through school screening and hospital-based services. To improve service delivery, future initiatives should emphasize early identification and ensure that all children with suspected visual impairment are screened before placement in mainstream or special education settings.