Reach, effectiveness, adoption, implementation and maintenance of a school eye health program in Petauke district, Zambia

Purpose

This study evaluates the performance of a school eye health program conducted by Vision Action in the Petauke district, Zambia, using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance).

Design

Program evaluation study design.

Methods

The program targeted 50,000 learners and 780 teachers across 101 schools. Teachers conducted screenings, with referrals made to mobile eye clinics. Data on knowledge, attitudes, practices (KAP), and children's quality of life (QoL) were collected and analyzed using qualitative and quantitative indicators.

Results

A total of 53,353 children (106 % of the target) were screened, with rural students (65 %) and girls (55 %) being the largest beneficiaries. Teachers exhibited the greatest improvement in eye health knowledge and practices. Children's QoL scores significantly improved from a baseline mean of 48.9 (95 % CI: 45.9–51.9) to 70.2 (95 % CI: 64.9–75.5), representing a 51.6 % change (p < 0.001). However, spectacle compliance was low (17 %), and only 59 % of referred children attended the mobile clinic due to barriers like COVID-19 fears and harvest season timing.

Conclusion

The program successfully reached over 53,000 children, surpassing its target and improving eye health awareness and QoL. While it demonstrated strong effectiveness, challenges like low spectacle compliance and referral uptake persist. Addressing barriers such as parental fears and community activities is essential. The findings emphasize the importance of sustainable screening practices and integrating community engagement strategies to ensure long-term benefits in resource-limited settings.