Prevalence of visual impairment and refractive errors among secondary school children in Central and Western Cameroon

Refractive errors and visual impairment are among the leading causes of vision problems in school-aged children and can adversely affect educational performance and quality of life. However, there is limited evidence on the burden and distribution of these conditions among school children in Cameroon, particularly from large-scale school eye health programmes. This study estimated the prevalence and pattern of refractive errors and visual impairment among secondary school children in the Centre and West regions of Cameroon and examined the associated sociodemographic factors. A cross-sectional survey was undertaken in 124 public and private schools between January 2022 and March 2024. Trained teachers conducted distance visual acuity (VA) (Snellen 5 m). Children with VA ≤ 5/10; (6/12) in either eye were refracted by ophthalmic personnel using non-cycloplegic autorefraction followed by subjective refraction. Standard spherical-equivalent criteria defined refractive errors. Multivariable logistic regression was used to determine the predictors of myopia and visual impairment. A total of 87,327 students were screened (mean age 13.2 years (SD 1.7 years); 54.8% girls). Overall, 2.24% ( n = 1,954) had refractive error in the better eye, & 3.16% in the worse eye. Myopia was the predominant refractive error (2.15%). Astigmatism (<–0.5 D) was present in 4.1% of children. Anisometropia occurred in 0.67%. Visual impairment (presenting VA ≤ 5/10) was detected in 4.9% of children in the better eye before any possible correction. Children in private schools (6.46% impaired), semi-urban areas (5.72%), and urban areas (4.67%) carried the highest burden. In multivariate analysis, the risks of myopia were- being girls (Adjusted odds ratio (aOR) 1.46) & private-school students (aOR 1.45). Both the groups had a high risk for visual impairment (aOR 1.77 & 1.6, respectively). Refractive errors and visual impairment are important yet unevenly distributed burdens among schoolchildren in Cameroon. The study highlights a clear need for structured, and scalable school eye-health programmes, at least target-based screening.