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Impact of School-Based Vision Assessment on Colour Vision Deficiency Detection among School Children in Nigeria

Abstract

Colour vision deficiency is an important visual health concern among school children and may affect their ability to distinguish certain colours accurately in educational, social, and everyday environments. Undetected colour vision deficiency may create difficulties in subjects and activities that depend on colour identification, including science experiments, maps, charts, diagrams, laboratory activities, art, and certain practical tasks. Because many children may adapt to their colour perception differences without recognizing them as a visual condition, colour vision deficiency may remain undetected until it becomes evident through school activities or other situations. Early identification through school-based vision assessment can help teachers, parents, and healthcare providers understand a child's visual needs and make appropriate educational adjustments where necessary. School-based vision assessment provides an accessible opportunity to evaluate children's visual health within the school environment through visual acuity assessment, colour vision testing, basic eye examination, and referral for further evaluation where indicated. However, inadequate school eye-health programmes, limited availability of trained eye-care personnel, insufficient screening materials, low awareness among parents and teachers, and weak referral and follow-up systems may limit the effectiveness of school-based vision assessment in Nigeria. Against this background, this study investigates the impact of school-based vision assessment on colour vision deficiency detection among school children in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and the Health Systems Framework. The Health Belief Model explains how parents', teachers', and children's perceptions of susceptibility to visual problems, perceived severity, perceived benefits of vision assessment, perceived barriers, and cues to action may influence participation in school-based vision assessment. The Social Ecological Model emphasizes the influence of individual, family, school, community, and environmental factors on children's visual health, educational experiences, healthcare-seeking behaviour, and access to preventive services. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, and accessibility as essential components of effective school-based vision assessment and referral programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how school-based vision assessment may influence colour vision deficiency detection among school children in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise school children enrolled in selected public and private primary and secondary schools across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, schools, classes, and eligible children. School-based vision assessment will be measured using indicators such as availability of school vision assessment programmes, assessment coverage, frequency of vision assessments, visual acuity testing, colour vision testing, basic ocular assessment, availability of trained eye-care personnel, appropriate vision-testing materials, teacher and parent eye-health education, and referral arrangements. Colour vision deficiency detection will be assessed using indicators such as abnormal colour vision test results, identification of difficulty distinguishing specific colours, newly detected colour vision deficiency, severity or type of colour perception abnormality, referrals for comprehensive eye assessment, professional confirmation where appropriate, and educational or visual support recommendations. Data will be collected using structured questionnaires, school vision assessment registers, colour vision testing forms, eye-care referral records, school health records, and relevant education and health programme documents. Descriptive statistics will be used to summarize children's characteristics, assessment coverage, visual findings, and patterns of colour vision deficiency detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the impact of school-based vision assessment on colour vision deficiency detection. Where appropriate, colour vision deficiency detection rates before and after implementation of school-based vision assessment activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that school-based vision assessment has a significant positive impact on colour vision deficiency detection among school children in Nigeria. Children who participate in school-based vision assessment are expected to have a higher likelihood of having previously undetected colour vision deficiency identified than children without access to routine school vision assessment. Systematic colour vision testing may facilitate early identification of children who have difficulty distinguishing certain colours and provide opportunities for appropriate eye-care evaluation and educational support. Early detection may help teachers adapt instructional materials, reduce unnecessary academic difficulties, and improve children's awareness of their visual needs. Conducting assessment within schools may also reduce geographical, financial, and time-related barriers to accessing eye-care services and reach children who may not routinely receive comprehensive visual assessment. School-based eye-health education may further improve awareness among children, parents, and teachers regarding colour vision deficiency and the importance of appropriate visual assessment. Conversely, inadequate assessment coverage, limited availability of trained eye-care personnel, insufficient testing materials, low parental participation, and weak referral and follow-up systems may reduce the effectiveness of school-based vision assessment. The study therefore expects accessible and well-organized school-based vision assessment to contribute significantly to improved detection and appropriate management of colour vision deficiency among school children in Nigeria. The study is expected to contribute to the literature on school-based vision assessment, colour vision deficiency detection, childhood eye health, visual health, school health services, educational support, preventive eye care, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Federal Ministry of Education, National Primary Health Care Development Agency, state ministries of health and education, primary and secondary schools, optometrists, ophthalmologists, eye-care professionals, school health coordinators, teachers, parents, development partners, and policymakers regarding strategies for improving children's visual health. The study will also provide evidence-based recommendations for expanding school-based vision assessment programmes, incorporating routine colour vision testing into appropriate school eye-health services, increasing availability of trained eye-care personnel and suitable testing materials, strengthening teacher and parent awareness, improving referral and follow-up systems, providing appropriate educational support for children with colour vision deficiency, and integrating comprehensive vision assessment into school health programmes across Nigeria.

Keywords: School-based vision assessment, colour vision deficiency detection, school children, colour blindness, childhood eye health, vision screening, school health services, visual health, educational support, preventive eye care, Nigeria, public health.