Prevalence and Patterns of Refractive Error among School children in Rural and Urban Khulna, Bangladesh: A Cross-sectional Study

Background: Uncorrected refractive error is an important and readily treatable cause of visual impairment in school-age children. Evidence comparing rural and urban schoolchildren in Khulna, Bangladesh, is limited. Objective: To estimate the prevalence and describe the pattern of refractive error among schoolchildren in rural and urban settings of Khulna. Methods: This school-based cross-sectional study included 350 children aged 6–17 years, with 175 recruited from urban schools and 175 from rural schools. Distance visual acuity was measured with a Snellen chart, followed by pinhole testing and cycloplegic refraction using cyclopentolate 1%. Myopia was defined as spherical equivalent ≤−0.50 dioptre (D), hyperopia as ≥+0.5, and astigmatism as cylinder power ≥0.75 D. Prevalence estimates are presented with 95% confidence intervals (CIs). Group differences were evaluated using Pearson’s chi-square test; p<0 .05 was considered statistically significant. Results: Refractive error was identified in 29 of 350 children (8.3%; 95% CI, 5.8%–11.6%). Prevalence was 10.9% (19/175) in urban children and 5.7% (10/175) in rural children (p=0.081). Prevalence increased substantially with age: 2.7% at 6–9 years, 4.4% at 10–13 years, and 23.3% at 14–17 years (p<0 .001). Prevalence was 10.2% in boys and 6.1% in girls (p=0.163). Among affected children, myopia accounted for 65.5% (19/29), hyperopia for 27.6% (8/29), and astigmatism for 6.9% (2/29). Conclusion: Approximately one in 12 participating schoolchildren had refractive error. Myopia predominated, and refractive error was strongly concentrated in older students. Although the urban estimate was nearly twice the rural estimate, the study lacked sufficient precision to establish a statistically significant residence difference. Periodic school-based vision screening with referral and spectacle provision should include both rural and urban schools and should particularly ensure coverage of older students. J.Natl.Inst.Ophthalmol.2025;8(1): 47-50