Seeing Inequalities: Self-Reported Visual Difficulty and Eye Care Utilization Among Women in Malawi, a Secondary Analysis of the 2024 Demographic and Health Survey Data

Background: This study aimed to identify the factors associated with self-reported visual difficulty and uptake of spectacle/contact lens correction among women of reproductive age in Malawi. Methods: We conducted a cross-sectional secondary analysis of the 2024 Malawi Demographic and Health Survey data. Outcomes were self-reported visual difficulty and use of spectacles/contact lenses. Age, residence, region, education, and marital status were examined as associated variables. Categorical variables were summarized using frequencies and percentages. Chi-square tests, multinomial and binary logistic regression models were used to assess associations. Results: The analysis included 5634 women aged 15–49 years; 78.3% lived in rural areas, and 62.4% had primary education. Self-reported visual difficulty was significantly associated with region, age, residence, education, and marital status (all p ≤ 0.004). Reported use of spectacle/contact lenses was also associated with these factors. Increasing age was associated with higher odds of reporting “some difficulty” seeing (OR 1.07, 95% CI 1.06–1.09). Compared with women in the Southern region, those from the Northern (OR 2.1, 95% CI 1.5–2.9) and Central regions (OR 1.6, 95% CI 1.2–2.1) had higher odds of reporting visual difficulty, with stronger associations for “a lot of difficulty” in the Central region (OR 4.3, 95% CI 2.1–8.6). Urban residence was associated with higher odds whereas being married/living together, divorced/separated, or widowed was associated with lower odds. Conclusion: Self-reported visual difficulty and use of spectacles/contact lenses varied by demographic and socioeconomic characteristics. Targeted strategies to improve access to affordable eye care may reduce barriers to uptake of corrective services and reduce visual impairment among women in Malawi.