Discussion
This study aimed to compare the performance of integrated and vertical delivery of school eye health. We found that the IM achieved a higher coverage of eye health screening (IM=96%, VM=90%), voluntary follow-up rate (IM=63.6%, VM=46%) and spectacle-wearing rate (IM=71%, VM=13.3%) than VM. Furthermore, all the teachers in the IM completed their activities in 2 months and had higher validity (IM=76%, VM=58%) in eye health screening. These positive findings result from effective coordination between the implementing partners, motivated teachers willing to conduct eye health intervention and quick implementation of eye health screenings after the training in the IM.Our study findings addressed the concern that an integrated approach might decrease performance due to diverted attention given to multiple health interventions.There are a few challenges that remain. First, the timing of programme implementation is of critical importance. We recommend that screening be completed by February to avoid disruption from collecting data in the rainy, harvesting and Ramadhan seasons. Furthermore, the screening validity in IM is higher than findings from VietnamIt was observed that the number of children who voluntarily went for follow-up management was average in both models, though slightly higher in the IM. The financial barrier was the main issue—a common barrier to service uptake in most low-income and middle-income countries.The spectacle wear was low in both models compared with previous studies, which reported higher spectacle compliance among schoolchildren in Oman (71.6%),None of the schools continued their activities after the funds ended. This shortcoming highlighted the need to advocate for integrating eye health into school health programmes, as recommended by the local stakeholders. This would result in greater sustainability. Furthermore, our previous studyLimitations of the study should also be acknowledged. The fact that the school eye health programme was integrated into schools where a school health and nutrition programme exists might have introduced several confounders. For example, the children and teachers in the IM might be more knowledgeable about health issues and hence performed better than the VM. Second, our study employed an implementation science methodology on a pilot programme. A large-scale cluster randomised trial with a longer-term follow-up could be conducted to determine the performance and sustainability of the programme. Third, issues on maintaining teachers’ motivation and more effective education strategies will need to be studied further. Currently, a study on arts-based eye health education strategy to improve child eye health service uptake is underway in Zanzibar.