This review will map available evidence for SSA on RE and VI, as well as their impact on the QoL of school-age children. This systematic scoping review will follow five steps outlined in a framework proposed by Arksey and O’Malley.(17) The steps are as follows (1) Identify the research question, (2) Identify relevant studies, (3) Study selection, (4) Charting the data, and (5) Collating, summarizing and reporting the results.
- Identifying the research question
The research question has been identified as: “What is the prevalence and distribution of RE and VI in school-age children in SSA?
Sub-Question: What impact do these have on QoL?
Eligibility criteria
Studies to be included:
- Studies reporting on RE
- Studies reporting on VI
- Studies showing evidence on the impact of RE on QoL
- Studies showing evidence on the impact of VI on QoL
- Those with participants from ages 5 to 20 years of age
- Subjects being children of school age
- Studies conducted on the SSA countries
- Peer-reviewed black literature
- Peer-reviewed grey literature
- Studies published in the period 1998 to 2020
Exclusion criteria:
All studies not published in English, all qualitative studies and all studies that are not primary studies, will be excluded.
The Population Concept Context (PCC) framework will be employed in this study (Table 1).
TABLE 1: Population Concept Context framework
PCC
|
Detailed
|
Population
|
school-going children/ learners/pupil
|
Concept
|
Refractive error OR visual impairment AND quality of life
|
Context
|
Sub-Sahara Africa
|
Identifying relevant studies
All peer-reviewed literature and any grey literature accessible online will be included in this systematic review. This review will focus on four main areas of interest, which are RE, VI, QoL and school-going children, however not all authors refer to them in these aforementioned terms, therefore we will then use Medical subject heading (MeSH) terms as follows ‘‘Refractive error OR Visual impairment OR Ametropia AND Quality of Life AND School going children OR Learner OR Scholar OR Pupil’’. To identify relevant studies, an electronic search will be conducted in various databases using the keyword search
(((‘‘Refractive error OR Visual impairment OR Ametropia AND Quality of life AND school going children OR learner OR scholar OR pupils AND sub-Saharan Africa’’)))
This study search will be conducted using the following databases:
- Google Scholar
- Science direct
- PubMed
- EBSCOhost: CINAHL, Academic search complete, Health-Consumer and Health-Nursing.
The articles found will be exported to a Mendeley library especially created for this study. Thereafter, duplicates will be removed. Table 2 indicates the results of a pilot search. Figure 1 show the screenshot of pilot study done using Science Direct search engine as an example.
TABLE 2: Results of pilot search
Keywords searched
|
Date of search
|
Search engine used
|
Number of retrieved publications
|
(((“Refractive error OR Visual impairment OR Ametropia AND Quality of life AND school going children OR learner OR scholar OR pupils AND Sub-Saharan Africa’’)))
|
24 November 2020
|
Google scholar
|
667
|
Science direct
|
31561
|
PubMed
|
21
|
EBSCOhost
|
441 570
|
Suitable studies that are aligned with the inclusion criteria will be exported to a Mendeley library specifically created for this study done by The Principal investigator (PI), after which all duplicates will be removed. This will be followed by abstract screening (AS), conducted independently by two reviewers, using a tool developed and piloted for this study (Table 3). Full article screening (FAS) will follow, also conducted independently by two independent reviewers using a tool as (Table 4).
TABLE 3: Abstract Screening tool
1. Author and date:
2. Title:
3. Does this article bear evidence on refractive error/ visual impairment? Yes/No/ Can’t tell
4. Does this article bear evidence on school age children/learners (aged 5-20)? Yes/No/ Can’t tell
5. Was the study done in Sub-Saharan Africa? Yes/NO/Can’t tell
6. Screener – Initials:
|
TABLE 4: Full Article screening tool
1. Author and date:
2. Title:
3. Does this article bear evidence on refractive error/ visual impairment? Yes/No
4. Does this article bear evidence on school age children/learners (aged 5-20)? Yes/No
- Was the study done in Sub-Saharan Africa? Yes/No
6. Screener – Initials:
|
All discrepancies will be resolved by the two screeners meeting to reconcile and agree on those studies they initially differed upon. The University of KwaZulu-Natal (UKZN) library will be the primary source for retrieving articles should the authors not respond to such requests. The process of article selection will be reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA), as per Figure 2. Following finalizing of articles, the PI will conduct data extraction on all included articles.
Quality assurance of the study
The quality index of all included studies will be determined using the Mixed Method Appraisal Tool (MMAT). This study will employ the 2018 MMAT tool in conjunction with the 2011 version of MMAT tool. The 2018 tool does not provide actual score yet advises that qualitative analysis be provided rather. However, since this does not have absolute values, the scoring section from the 2011 tool will be adopted with five criteria from 2018 tool to grade the studies. The scoring ranges from 100% being a good area of study and 20% being low quality. Two independent reviewers will grade the quality of each study’s aim, design, methodology and statistical analysis
An electronic data collection tool to chart evidence that seeks to answer the research question, as shown in Table 5 will be utilized. This tool will extract the necessary information based on prevalence of RE and or VI, distribution of RE and or VI and any impact of RE and or VI on the quality of life. This electronic screening tool will be updated as the need arises during the course of the study.
TABLE 5:Data Electronic collection tool
1. Author & Date
|
2. Article title
|
3. Country of study
|
4. Region of study
|
5. Total sample size
|
6. Age
|
7. No of male participants
|
8. No of female participants
|
9. No. of participants with V/A of 6/9 and worse in the Re
|
10. No. of participants with V/A of 6/9 and worse in the Le
|
11. No. of participants with V/A of 6/12 to 6/18 in one or both eye
|
12. No. of participants with V/A worse than 6/18 to 6/60 in one or both eyes
|
13. No. of participants with V/A worse than 6/60 to 3.60 in one or both eyes
|
14. No. of participants with V/A worse than 3/60 or Visual field loss of 10 degrees or less (Blindness)
|
15. No. of participants with Visual field loss of 20 degrees to >10 degrees
|
16. Causes of VI
|
17. No. of participants with RE
|
18. No. of participants with Myopia
|
19. No. of participants with Hyperopia
|
20. No. of participants with Astigmatism
|
21. No. of male participants with of RE
|
22. No. of female participants with RE
|
23. No. of male participants with myopia
|
24. No. of female participants with myopia
|
25. No. of male participants with hyperopia
|
26. No. of female participants with hyperopia
|
27. No. of male participants with astigmatism
|
28. No. of female participants with astigmatism
|
29. Any evidence on the quality of life (QoL)?
|
30. How was the QoL?
|
No. = number, V/A = visual acuity, RE = refractive error, Re = right eye, VI = visual impairment, QoL = quality of life
- Collating, summarizing and reporting the results
The findings of this systematic scoping review will be captured onto Microsoft Excel and analysed with the help of a statistician. They will thereafter be published in peer-review journals.