Page 164 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

CHAPTER 8
among medical professionals as well as among the general population and too many administrative tasks (more details can be found in Additional file 8).
Screening coverage
In 2018, 7,876 children were screened or 1.23x the average birth rate (two birth years being eligible). In the city of Cluj-Napoca 4,928 children were screened, in the small cities 1,848 and in the rural areas 1,100. This means that in Cluj-Napoca 1.62x the average birth rate was screened, in the small cities 1.64x and in the rural areas 0.49x. Children were screened in 24 out of 75 communes, that together comprised 54% of the rural population. Even so, in the 24 communes where children were screened, only 0.84x the birth rate was screened. An overview of how many children were screened is presented in figure 3.
It should be noted that children were not always screened in the locations where they were residents, as it is not uncommon for rural children to attend a kindergarten in a city. An investigation brought to light that 589 children from rural areas were screened in cities: 436 in Cluj-Napoca and 153 in small cities. If the figures are adjusted to take this into account, in Cluj-Napoca 1.48x the birth rate was screened, in the small cities 1.50x and in the rural areas 0.76x.
Referral to family doctor and ophthalmologist
The overall referral rate was 14%. It was highest in Cluj-Napoca, 15% as compared to 11% in the small cities and 10% in the rural areas. There were large differences between screeners, with referral rates varying from 0% to 44%. One exceptional screener had a referral rate of 76%. This was explained by the fact this screener screened children from a minority group, many of whom, according to the screener, did not pass because they did not understand the test. Referral decreased as screeners gained experience, from 20% in January to 12% in March. The number of children scheduled for a repeat screen was only 2%. Out of 97 screeners, 28 had a referral rate above 15% and 32 had a referral rate below 5%. Of these, fifteen did not refer a single child, even though they screened 45 children on average. Three of these screened more than 92 children. Not referring a single child out of more than 92 screened is highly implausible: assuming a low referral rate of 3.2%, the chance of a nurse not referring any children is less than 5% as soon as the number of examined children exceeds 92, according to the formula (HP Prime) BINOMIAL_CDF (93, 0.032, 0) = 0.0486, which is slightly less than alpha = 0.05. One other nurse, who screened 86 children, recorded exactly the same visual acuity for all these children.
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