Page 157 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

Implementing paediatric vision screening in urban and rural areas in Cluj county, Romania
advised to screen children at the rural kindergartens as an alternative. Additionally, they were encouraged to visit kindergartens in neighbouring communes to screen children, if no screening would take place there otherwise. Eventually five nurses screened children in more than one commune.
The average number of children screened by one person in the city of Cluj-Napoca was 100, in the small cities 80 and in the rural areas 41. This meant that nurses in cities could build up their screening expertise more quickly, as compared to nurses in rural areas. A schematic overview of all the assessed implementation outcomes, in relation to the various measurement methods, is presented in table 2.
On-site observations
Screenings of fourteen children at seven locations were observed by one of the authors (MN) during the first weeks of implementation. All screenings were performed in a separate room, where a three metre distance to the VA chart was marked on the floor, usually with tape. In all screenings the Tumbling E was used and all screenings were performed by nurses, either at a doctor’s office or a kindergarten. Six children were four years old, eight children were five years old. Almost all steps were carried out in accordance with the screening protocol. Explaining the test took 1:20 minutes (SD = 48 seconds), on average. In twelve cases, the test was explained before the measurement started. In the other two cases the test was explained while the child was already wearing the spectacle frames with unilateral cover, but before showing the chart. In thirteen out of fourteen screenings the child indicated the position of the optotype by pointing its direction. In one case the child explained the direction with words. The average total time for screening, including explanation, was 8:20 minutes (SD = 2 minutes). Seven out of fourteen children were referred, in four cases because of a VA difference between the eyes or low VA in one eye and in three cases because of low VA in both eyes.
On-site interviews
In January 2019, 34 family doctors, nurses and kindergarten staff were interviewed. The urban kindergarten nurses indicated that screening was not difficult because they saw the children on a daily basis, meaning there were no difficulties in scheduling screening. Also, the urban kindergartens are attended by many children, so many children could be screened in a short time. According to both urban and rural screeners, most parents consented. Only a few refused, reportedly out of fear screening might hurt their child, because the child had already been diagnosed with an eye condition, or without providing a reason.
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