Prevalence of Visual Impairments and Refractive Errors in School-aged Children in Mogadishu, Somalia

Abstract

Background: Childhood visual impairment is a significant global health issue, particularly in low-income countries (LICs). Most cases can be prevented through timely diagnosis and treatment. This study assessed the prevalence of visual impairment (VI) and refractive errors (RE) in school-aged children in Mogadishu, Somalia.

Methods: A cross-sectional study was conducted among children aged 6-15 years across five schools in Mogadishu from November 2024 to January 2025 using a modified Refractive Error Study in Children protocol. Visual acuity was assessed using the Snellen Tumbling E-chart. Children with uncorrected VA ≤ 6/12 underwent pinhole testing, non-cycloplegic retinoscopy, and refraction. Refractive errors were classified as myopia (≥ −0.5 D), hypermetropia (≥ +2.0 D), or astigmatism (≥ 0.75 D). Anterior and posterior segment examinations were performed. Data analysis was performed using SPSS version 26, with significance set at P < 0.05.

Results: Of the 1,540 selected children, 1,516 participated (response rate 98.4%). The mean age was 7.44 ± 1.58 years, with 57.3% females. Visual impairment in the better eye was found in 19.4% of children (95% CI: 17.4–21.4%), with 19.7% using spectacles. VI prevalence was higher in females (21.9%) than in males (16.0%) (P = 0.004), peaking at 49.2% in ages 10-11. Refractive errors caused 93.8% of VI cases, with a RE prevalence of 24.9% (myopia, 10.5%; astigmatism, 8.4%; hypermetropia, 6.1%). RE prevalence was higher in females (29.1%) than in males (19.2%) (P = 0.001) and increased with age. Posterior segment abnormalities were observed in 1.8% of patients.

Conclusions: VI prevalence among Mogadishu schoolchildren was high, mainly due to uncorrected REs. Low spectacle coverage indicates the need for school-based vision screening and affordable corrective lenses in this population. Multisectoral collaboration is needed to address preventable childhood VI in Somalia.