{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T18:12:19Z","timestamp":1780510339786,"version":"3.54.1"},"reference-count":75,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010090","name":"Women and Children\u2019s Health Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010090","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["EY014800"],"award-info":[{"award-number":["EY014800"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001818","name":"Research to Prevent Blindness","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001818","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Evidence on how social and school-level contexts shape pediatric vision screening outcomes is limited, particularly in sub-Saharan Africa. We examined the association between individual and contextual factors and vision screening outcomes in a pilot enhanced school-based vision screening program (ESVSP) in Kumasi, Ghana. We conducted a cross-sectional study using data from an ESVSP to detect suspected eye disorders in school-children aged 4\u201322 years. Outcomes were the presence of suspected eye disorders and referral adherence. Exposure variables were individual [(age, sex, socioeconomic status (SES)], and contextual [school type (public vs private)] factors. Logistic regression was used to estimate unadjusted (OR) and adjusted (aOR) odds ratios with 95% confidence intervals (CI). We analyzed data for 1,123 children screened and 299 referred. The average age was 10.2 (\u00b12.6) years. Overall, 34.0% (n\u2009=\u2009382) had suspected eye disorders, and 32.8% (n\u2009=\u200998) adhered to the referral. After adjusting for key variables, children attending public (32.2%) compared to private (67.8%) schools had 45% lower odds of suspected eye disorders (aOR= 0.55; 95% CI 0.37, 0.83). Children with low (13.3%) compared to high (28.6%) SES had 70% lower odds of referral adherence (aOR= 0.30; 95% CI 0.12, 0.80). In this pilot school-based program, school context and SES (an individual-level factor) were associated with suspected pediatric eye disorders and referral adherence, respectively. These findings highlight equity-relevant gaps in referral adherence and underscore the need for context-specific strategies to strengthen referral pathways in low-resource settings.<\/jats:p>","DOI":"10.1371\/journal.pgph.0006000","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T17:36:08Z","timestamp":1780508168000},"page":"e0006000","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Individual and school-level factors associated with suspected pediatric eye disorders and referral adherence in an enhanced school-based vision screening program in Ghana"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0341-0799","authenticated-orcid":true,"given":"Afua O.","family":"Asare","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla","family":"Ablordeppey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1093-0679","authenticated-orcid":true,"given":"Enoch","family":"Ansah-Asiedu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1977-8287","authenticated-orcid":true,"given":"Emmanuel T.","family":"Doku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6135-7111","authenticated-orcid":true,"given":"Gabriel K.","family":"Agbeshie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyram A.","family":"Gle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nana Akwasi Owusu","family":"Mensah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0021-9557","authenticated-orcid":true,"given":"Ruby E.","family":"Adikah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3319-7458","authenticated-orcid":true,"given":"Christiana Nyarko","family":"Yeboah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2621-4888","authenticated-orcid":true,"given":"Debora A.","family":"Baidoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine K.","family":"Darko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisha E.","family":"Arkhurst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa H.","family":"Watt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eldrick A.","family":"Acquah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hornametor","family":"Afake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7347-4159","authenticated-orcid":true,"given":"Sylvia","family":"Agyekum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwadwo Owusu","family":"Akuffo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"issue":"9","key":"pgph.0006000.ref001","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1097\/OPX.0b013e318264f1dc","article-title":"Impact of pediatric vision impairment on daily life: results of focus groups","volume":"89","author":"DK Decarlo","year":"2012","journal-title":"Optom Vis Sci"},{"issue":"3","key":"pgph.0006000.ref002","doi-asserted-by":"crossref","first-page":"65","DOI":"10.15761\/PD.1000114","article-title":"Ametropia among school children-A cross-sectional study in a sub-urban municipality in Ghana","volume":"1","author":"M Abdul-Kabir","year":"2016","journal-title":"Pediatr Dimensions"},{"issue":"12","key":"pgph.0006000.ref003","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1097\/OPX.0000000000000099","article-title":"Refractive error and visual impairment in private school children in Ghana","volume":"90","author":"BD Kumah","year":"2013","journal-title":"Optom Vis Sci"},{"issue":"2","key":"pgph.0006000.ref004","first-page":"111","article-title":"Prevalence of ocular morbidities among basic school children in the Kwabre East District of Ghana","volume":"4","author":"DB Kumah","year":"2015","journal-title":"IJHAS"},{"issue":"2","key":"pgph.0006000.ref005","first-page":"16","article-title":"Visual impairment and ocular findings among deaf and hearing impaired school children in Central Region, Ghana","volume":"2","author":"G Ovenseri-Ogbomo","year":"2013","journal-title":"J Medical Biomedical Sci"},{"issue":"5","key":"pgph.0006000.ref006","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1111\/cxo.13041","article-title":"Inter-regional trends in causes of childhood blindness and low vision in Ghana","volume":"103","author":"A Ilechie","year":"2020","journal-title":"Clin Exp Optom"},{"key":"pgph.0006000.ref007","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1542\/peds.111.4.902","article-title":"Eye examination in infants, children, and young adults by pediatricians","volume":"111","author":"Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology","year":"2003","journal-title":"Pediatrics"},{"issue":"3","key":"pgph.0006000.ref008","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1177\/10598405060220030601","article-title":"Lack of follow-up exams after failed school vision screenings: an investigation of contributing factors","volume":"22","author":"LS Kimel","year":"2006","journal-title":"J school nursing: the official publication of the National Association of School Nurses"},{"key":"pgph.0006000.ref009","unstructured":"National Center for Children\u2019s Vision and Eye Health at Prevent Blindness. Importance of follow-up eye examination after receiving referral from a vision screening. 2020. [Available from: https:\/\/nationalcenter.preventblindness.org\/wp-content\/uploads\/sites\/22\/2020\/12\/3A-Importance-of-eye-examination.pdf"},{"issue":"3","key":"pgph.0006000.ref010","doi-asserted-by":"crossref","first-page":"136","DOI":"10.12968\/bjsn.2015.10.3.136","article-title":"Improving parental adherence to a failed vision screening referral in the United States","volume":"10","author":"K Neville","year":"2015","journal-title":"British Journal of School Nursing"},{"issue":"8","key":"pgph.0006000.ref011","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/j.1746-1561.1998.tb00592.x","article-title":"Barriers to seeking care following school vision screening in Rochester, Minnesota","volume":"68","author":"BP Yawn","year":"1998","journal-title":"J Sch Health"},{"issue":"1","key":"pgph.0006000.ref012","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s12886-025-04592-w","article-title":"Barriers and limitations of conventional oculovisual screening methods in children: a systematic review perspective","volume":"26","author":"\u2019Assfi Rahmat BS","year":"2026","journal-title":"BMC Ophthalmol"},{"issue":"5","key":"pgph.0006000.ref013","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1007\/s00431-020-03904-0","article-title":"Instrument-based screening for amblyopia risk factors in a primary care setting in children aged 18 to 30 months","volume":"180","author":"Muga M Vil\u00e0-de","year":"2021","journal-title":"Eur J Pediatr"},{"issue":"1","key":"pgph.0006000.ref014","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1177\/0264619614561690","article-title":"Epidemiology of ocular disorders and visual impairment among school pupils in the Cape Coast Metropolis, Ghana","volume":"33","author":"EK Abu","year":"2014","journal-title":"British Journal of Visual Impairment"},{"issue":"2","key":"pgph.0006000.ref015","first-page":"59","article-title":"Visual impairment among public school children in the Biadan and Kato circuits in the Berekum municipality, Bono region, Ghana","volume":"10","author":"EM Akpakli","year":"2023","journal-title":"J Advocacy Res Educ"},{"issue":"1","key":"pgph.0006000.ref016","doi-asserted-by":"crossref","DOI":"10.4102\/aveh.v80i1.578","article-title":"Magnitude and causes of visual impairment amongst school children in the Bono Region of Ghana","volume":"80","author":"V Opoku-Yamoah","year":"2021","journal-title":"African Vision and Eye Health"},{"issue":"1","key":"pgph.0006000.ref017","doi-asserted-by":"crossref","DOI":"10.4102\/aveh.v76i1.377","article-title":"Visual status and prevalence of eye disorders among school-age children in southern Nigeria","volume":"76","author":"BN Ekpenyong","year":"2017","journal-title":"African Vision and Eye Health"},{"issue":"2","key":"pgph.0006000.ref018","doi-asserted-by":"crossref","first-page":"102","DOI":"10.21315\/mjms2022.29.2.10","article-title":"Association between Socioeconomic Status and Vision Screening Outcomes among Preschool Children in Klang Valley, Malaysia: A Cross-Sectional Study","volume":"29","author":"H Kamaruddin","year":"2022","journal-title":"Malays J Med Sci"},{"issue":"8","key":"pgph.0006000.ref019","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1136\/bjophthalmol-2015-307206","article-title":"Vision screening in children: a retrospective study of social and demographic factors with regards to visual outcomes","volume":"100","author":"U O\u2019Colmain","year":"2016","journal-title":"The British Journal of Ophthalmology"},{"issue":"4","key":"pgph.0006000.ref020","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(20)30488-5","article-title":"The Lancet Global Health Commission on Global Eye Health: vision beyond 2020","volume":"9","author":"MJ Burton","year":"2021","journal-title":"Lancet Glob Health"},{"issue":"11","key":"pgph.0006000.ref021","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0259309","article-title":"Parents\u2019 reasons for nonadherence to referral to follow-up eye care for schoolchildren who failed school-based vision screening in Cross River State, Nigeria-A descriptive qualitative study","volume":"16","author":"L Lohfeld","year":"2021","journal-title":"PLoS One"},{"issue":"10","key":"pgph.0006000.ref022","doi-asserted-by":"crossref","first-page":"2100","DOI":"10.1016\/j.ophtha.2013.02.035","article-title":"Risk factors for incident myopia in Australian schoolchildren: the Sydney adolescent vascular and eye study","volume":"120","author":"AN French","year":"2013","journal-title":"Ophthalmology"},{"issue":"4","key":"pgph.0006000.ref023","article-title":"Outdoor activity and myopia progression in 4-year follow-up of Chinese primary school children: The Beijing Children Eye Study","volume":"12","author":"Y Guo","year":"2017","journal-title":"PLoS One"},{"key":"pgph.0006000.ref024","volume-title":"Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease","author":"National Academies of Sciences, Engineering, and Medicine","year":"2024"},{"issue":"12","key":"pgph.0006000.ref025","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0189774","article-title":"Incidence and progression of myopia and associated factors in urban school children in Delhi: The North India Myopia Study (NIM Study)","volume":"12","author":"R Saxena","year":"2017","journal-title":"PLoS One"},{"key":"pgph.0006000.ref026","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.preteyeres.2017.09.004","article-title":"The epidemics of myopia: Aetiology and prevention","volume":"62","author":"IG Morgan","year":"2018","journal-title":"Prog Retin Eye Res"},{"issue":"5","key":"pgph.0006000.ref027","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1001\/jamaophthalmol.2025.0205","article-title":"Prevalence and Severity of Astigmatism in Children After COVID-19","volume":"143","author":"KW Kam","year":"2025","journal-title":"JAMA Ophthalmol"},{"issue":"6","key":"pgph.0006000.ref028","first-page":"919","article-title":"High Prevalence of Astigmatism in Children after School Suspension during the COVID-19 Pandemic Is Associated with Axial Elongation","volume":"9","author":"S-C Wong","year":"2022","journal-title":"Children (Basel)"},{"issue":"2","key":"pgph.0006000.ref029","article-title":"Prevalence and Pattern of Eye Disorders Among Primary Schoolchildren in Abakaliki, Nigeria: A Cross-Sectional Study","volume":"16","author":"DI Aniemeka","year":"2024","journal-title":"Cureus"},{"issue":"3","key":"pgph.0006000.ref030","doi-asserted-by":"crossref","first-page":"85","DOI":"10.4103\/njo.njo_47_21","article-title":"Prevalence of Visual Impairment Among Primary School Pupils in the Ga West Municipality, Ghana","volume":"30","author":"W Ceesay","year":"2022","journal-title":"Nigerian J Ophthalmol"},{"issue":"2","key":"pgph.0006000.ref031","doi-asserted-by":"crossref","first-page":"133","DOI":"10.4103\/0301-4738.45503","article-title":"Ocular morbidity prevalence among school children in Shimla, Himachal, North India","volume":"57","author":"M Gupta","year":"2009","journal-title":"Indian J Ophthalmol"},{"issue":"8","key":"pgph.0006000.ref032","first-page":"208","article-title":"Prevalence of ocular morbidity among primary school children in Calabar, Nigeria","volume":"10","author":"SN Okonkwo","year":"2020","journal-title":"IJHSR"},{"key":"pgph.0006000.ref033","doi-asserted-by":"crossref","first-page":"59","DOI":"10.2147\/OPTO.S10583","article-title":"Prevalence of refractive error among school children in the Cape Coast Municipality, Ghana","volume":"2","author":"G Ovenseri-Ogbomo","year":"2010","journal-title":"Clin Optom (Auckl)"},{"issue":"2","key":"pgph.0006000.ref034","doi-asserted-by":"crossref","DOI":"10.4102\/aveh.v69i2.129","article-title":"Refractive error in school children in Agona Swedru, Ghana","volume":"69","author":"GO Ovenseri-Ogbomo","year":"2010","journal-title":"African Vision and Eye Health"},{"issue":"184","key":"pgph.0006000.ref035","first-page":"182","article-title":"Ocular morbidity among children attending government and private schools of Kathmandu valley","volume":"51","author":"RK Shrestha","year":"2011","journal-title":"JNMA J Nepal Med Assoc"},{"key":"pgph.0006000.ref036","volume-title":"An international education from Cambridge","author":"Cambridge University Press Assessment","year":"2024"},{"key":"pgph.0006000.ref037","unstructured":"Ministry of Education. Education Strategic Plan 2018\u20132030. Accra, Ghana: Ministry of Education. 2018."},{"issue":"5","key":"pgph.0006000.ref038","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.jcjo.2017.02.002","article-title":"Community vision screening in preschoolers: initial experience using the Plusoptix S12C automated photoscreening camera","volume":"52","author":"AO Asare","year":"2017","journal-title":"Can J Ophthalmol"},{"issue":"1","key":"pgph.0006000.ref039","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1097\/APO.0000000000000488","article-title":"Lessons Learned From School-Based Delivery of Vision Care in Baltimore, Maryland","volume":"11","author":"ME Collins","year":"2022","journal-title":"Asia Pac J Ophthalmol (Phila)"},{"issue":"1","key":"pgph.0006000.ref040","article-title":"Procedures for the Evaluation of the Visual System by Pediatricians","volume":"137","author":"PRACTICE CO, MEDICINE, A, OPHTHALMOLOGY","year":"2016","journal-title":"Pediatrics"},{"issue":"1","key":"pgph.0006000.ref041","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.jaapos.2005.08.007","article-title":"Lions Clubs International Foundation Core Four Photoscreening: Results from 17 Programs and 400,000 Preschool Children","volume":"10","author":"SP Donahue","year":"2006","journal-title":"J AAPOS"},{"issue":"4","key":"pgph.0006000.ref042","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1080\/09286586.2021.1962918","article-title":"Community based vision screening in preschool children; performance of the Spot Vision Screener and optotype testing","volume":"29","author":"V Kapoor","year":"2022","journal-title":"Ophthalmic Epidemiol"},{"issue":"3","key":"pgph.0006000.ref043","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.jaapos.2018.01.012","article-title":"Oregon Elks Children\u2019s Eye Clinic vision screening results for astigmatism","volume":"22","author":"J Vaughan","year":"2018","journal-title":"J AAPOS"},{"issue":"1","key":"pgph.0006000.ref044","article-title":"Procedures for the Evaluation of the Visual System by Pediatricians","volume":"137","author":"Donahue SP, Baker CN, Committee on Practice and Ambulatory Medicine, American Academy of Pediatrics, Section on Ophthalmology, American Academy of Pediatrics, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus","year":"2016","journal-title":"Pediatrics"},{"issue":"10","key":"pgph.0006000.ref045","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1097\/OPX.0000000000002290","article-title":"Recommended practices for vision screening in pre-school-age children: A 2025 update","volume":"102","author":"Y Pang","year":"2025","journal-title":"Optom Vis Sci"},{"issue":"1","key":"pgph.0006000.ref046","doi-asserted-by":"crossref","DOI":"10.1016\/j.jaapos.2021.09.009","article-title":"AAPOS uniform guidelines for instrument-based pediatric vision screen validation 2021","volume":"26","author":"RW Arnold","year":"2022","journal-title":"J AAPOS"},{"issue":"3","key":"pgph.0006000.ref047","doi-asserted-by":"crossref","first-page":"0310","DOI":"10.15275\/rusomj.2013.0310","article-title":"Prevalence of glaucoma in an eye clinic in Ghana","volume":"2","author":"KB Otabil","year":"2013","journal-title":"RusOMJ"},{"issue":"1","key":"pgph.0006000.ref048","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0245486","article-title":"Epidemiology and clinical presentation of glaucoma in a referral facility in Ghana: Any lessons for public health intervention?","volume":"16","author":"S Kyei","year":"2021","journal-title":"PLoS One"},{"issue":"1","key":"pgph.0006000.ref049","doi-asserted-by":"crossref","DOI":"10.1016\/j.ophtha.2017.09.032","article-title":"Pediatric Eye Evaluations Preferred Practice Pattern\u00ae: I. Vision Screening in the Primary Care and Community Setting; II. Comprehensive Ophthalmic Examination","volume":"125","author":"DK Wallace","year":"2018","journal-title":"Ophthalmology"},{"key":"pgph.0006000.ref050","volume-title":"International Standard Classification of Occupations: ISCO-08","author":"International Labour Office","year":"2012"},{"key":"pgph.0006000.ref051","unstructured":"Warwick Institute for Employment Research. Cascot: Computer Assisted Structured Coding Tool. Coventry, UK. 2024."},{"issue":"1","key":"pgph.0006000.ref052","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0049-089X(92)90017-B","article-title":"A standard international socio-economic index of occupational status","volume":"21","author":"HBG Ganzeboom","year":"1992","journal-title":"Soc Sci Res"},{"issue":"6","key":"pgph.0006000.ref053","doi-asserted-by":"crossref","first-page":"2856","DOI":"10.1167\/iovs.11-9091","article-title":"Time outdoors and physical activity as predictors of incident myopia in childhood: a prospective cohort study","volume":"53","author":"JA Guggenheim","year":"2012","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"11","key":"pgph.0006000.ref054","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1001\/jama.2015.10803","article-title":"Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial","volume":"314","author":"M He","year":"2015","journal-title":"JAMA"},{"key":"pgph.0006000.ref055","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s12886-015-0052-9","article-title":"Effect of outdoor activity on myopia onset and progression in school-aged children in northeast China: the Sujiatun Eye Care Study","volume":"15","author":"J-X Jin","year":"2015","journal-title":"BMC Ophthalmol"},{"issue":"5","key":"pgph.0006000.ref056","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1016\/j.ophtha.2012.11.009","article-title":"Outdoor activity during class recess reduces myopia onset and progression in school children","volume":"120","author":"P-C Wu","year":"2013","journal-title":"Ophthalmology"},{"issue":"6","key":"pgph.0006000.ref057","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1111\/aos.13403","article-title":"Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review","volume":"95","author":"S Xiong","year":"2017","journal-title":"Acta Ophthalmol"},{"issue":"6","key":"pgph.0006000.ref058","doi-asserted-by":"crossref","first-page":"342","DOI":"10.7150\/ijms.7.342","article-title":"Refractive status and prevalence of refractive errors in suburban school-age children","volume":"7","author":"L-H Pi","year":"2010","journal-title":"Int J Med Sci"},{"key":"pgph.0006000.ref059","doi-asserted-by":"crossref","first-page":"101232","DOI":"10.1016\/j.stueduc.2022.101232","article-title":"Private supplementary tutoring expenditures and children\u2019s learning outcomes: gender and locational evidence from Ghana","volume":"76","author":"D Ansong","year":"2023","journal-title":"Stud Educ Eval"},{"issue":"3","key":"pgph.0006000.ref060","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1111\/opo.12945","article-title":"Time spent outdoors as an intervention for myopia prevention and control in children: an overview of systematic reviews","volume":"42","author":"R Dhakal","year":"2022","journal-title":"Ophthalmic Physiol Opt"},{"issue":"10","key":"pgph.0006000.ref061","article-title":"The Association between Near Work Activities and Myopia in Children-A Systematic Review and Meta-Analysis","volume":"10","author":"H-M Huang","year":"2015","journal-title":"PLoS One"},{"key":"pgph.0006000.ref062","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.childyouth.2018.07.026","article-title":"Child labour in Ghana: Implications for children\u2019s education and health","volume":"93","author":"ES Hamenoo","year":"2018","journal-title":"Children and Youth Services Review"},{"issue":"2","key":"pgph.0006000.ref063","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1080\/08164622.2022.2107891","article-title":"Adherence to referrals from preschool vision screening and identification of barriers for non-adherence in Israel","volume":"106","author":"A Gordon-Shaag","year":"2023","journal-title":"Clin Exp Optom"},{"issue":"10","key":"pgph.0006000.ref064","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.4103\/ijo.IJO_1603_19","article-title":"Identifying barriers to referrals in preschool-age ocular screening in Southern India","volume":"68","author":"M Ravindran","year":"2020","journal-title":"Indian J Ophthalmol"},{"issue":"12","key":"pgph.0006000.ref065","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0208164","article-title":"Recommendation for ophthalmic care in German preschool health examination and its adherence: Results of the prospective cohort study ikidS","volume":"13","author":"AK Schuster","year":"2018","journal-title":"PLoS One"},{"issue":"4","key":"pgph.0006000.ref066","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.4314\/ahs.v21i4.47","article-title":"A systemic review of barriers to accessing paediatric eye care services in African countries","volume":"21","author":"SH Alrasheed","year":"2021","journal-title":"Afr Health Sci"},{"issue":"8","key":"pgph.0006000.ref067","article-title":"Smartphone-based screening for visual impairment in Kenyan school children: a cluster randomised controlled trial","volume":"6","author":"HK Rono","year":"2018","journal-title":"Lancet Glob Health"},{"issue":"1","key":"pgph.0006000.ref068","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1097\/OPX.0000000000000431","article-title":"Barriers to use of refractive services in Mozambique","volume":"92","author":"S Thompson","year":"2015","journal-title":"Optom Vis Sci"},{"issue":"2","key":"pgph.0006000.ref069","doi-asserted-by":"crossref","DOI":"10.1093\/heapro\/daad002","article-title":"Access to school-based eye health programs in Central Region, Malawi: a qualitative case study","volume":"38","author":"A Yashadhana","year":"2023","journal-title":"Health Promot Int"},{"issue":"1","key":"pgph.0006000.ref070","doi-asserted-by":"crossref","DOI":"10.4102\/aveh.v75i1.355","article-title":"Prevalence of visual impairment and refractive error in school-aged children in South Darfur State of Sudan","volume":"75","author":"SH Alrasheed","year":"2016","journal-title":"African Vision and Eye Health"},{"key":"pgph.0006000.ref071","unstructured":"UNICEF Ghana Country Office. Rapid Assessment on Child Protection Related Attitude, Beliefs and Practices in Ghana. Accra, Ghana: UNICEF. 2018."},{"issue":"3","key":"pgph.0006000.ref072","doi-asserted-by":"crossref","first-page":"21582440251381232","DOI":"10.1177\/21582440251381232","article-title":"Last to sleep, first to sweep: Exploring the lived experiences of child househelps in Ghana","volume":"15","author":"S Kyei-Gyamfi","year":"2025","journal-title":"Sage Open"},{"issue":"7","key":"pgph.0006000.ref073","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/j.ophtha.2022.02.027","article-title":"Noncycloplegic Compared with Cycloplegic Refraction in a Chicago School-Aged Population","volume":"129","author":"X Guo","year":"2022","journal-title":"Ophthalmology"},{"issue":"9","key":"pgph.0006000.ref074","article-title":"Comparison of Cycloplegic and Non-Cycloplegic Refraction in School-Aged Children: A Cross-Sectional, Observational Study","volume":"17","author":"T Kar","year":"2025","journal-title":"Cureus"},{"issue":"1","key":"pgph.0006000.ref075","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.aopr.2025.11.004","article-title":"Instrument-based, non-cycloplegic versus cycloplegic refraction in pediatric and young adult populations (\u226425 years): A systematic review and meta-analysis","volume":"6","author":"A Roque","year":"2025","journal-title":"Adv Ophthalmol Pract Res"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006000","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T17:36:22Z","timestamp":1780508182000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006000"}},"subtitle":[],"editor":[{"given":"Julia","family":"Robinson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":75,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0006000","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,3]]}}}