A team of researchers with the UNC Institute for Global Health and Infectious Diseases has quantified the link between vision impairment and academic performance in a new study of primary school students in Tanzania. Led by Joy Noel Baumgartner, PhD, MSSW, professor of social work, with Emily Gower, PhD, associate professor of ocular epidemiology, and medical student Michael Maizel as first author, the study examined vision within a broader health and wellness framework. The approach, published in Vulnerable Child Youth Studies, could provide a model for global wellness.
Designing the Study
Collaborating with Muhimbili University of Health and Allied Sciences in Dar es Salaam, Tanzania, and Duke Global Health Institute, the research team designed the vision study to be implemented via school-clinic partnerships which included health education and screenings for nutrition, mental health and more. Vijana Tambua Afya, translated to “Youth Health Check,” is a Tanzanian health initiative providing prevention-oriented health check-ups for adolescents, particularly those in their final year of primary school. Researchers wanted to estimate the prevalence of distance vision impairment among Tanzanian adolescents; examine the relationship between vision status and academic performance; and identify the facilitators and barriers to school-based vision screenings and access to eye care.
The study included 509 students (ages 11-17) from both rural and urban districts, an age group rarely studied, with trained teachers and nurses performing the vision screenings.
“Most vision health studies focus on younger children or adults,” explained Gower. “But this study specifically targeted a group often overlooked in health policy and programming, especially in low- and middle-income countries.”
The investigators combined quantitative data (prevalence, exam scores, follow-up rates) with qualitative insights (interviews and focus groups with teachers, nurses, and parents) to understand outcomes and barriers to treatment.
The Results
Over 11% of students screened were found to have reduced or impaired vision in at least one eye, with 6.9% of students having mildly reduced vision, and 4.3% having impaired vision in their worse eye. Meanwhile, students with vision problems were more likely to score lower on the national Primary School Leaving Examination (PSLE), with nearly 72% receiving a grade C or below, compared to 60% of students with normal vision. This measurement showed a clear association between reduced vision and lower academic achievement—a connection not often quantified in similar studies.
“Vision health is not just a medical issue—it’s a critical factor in educational success and future opportunities for Tanzanian youth,” explained Baumgartner, corresponding study author.
“My Tanzanian colleagues, including co-PI Dr. Sylvia Kaaya at MUHAS, are sharing this data with key stakeholders to highlight that a multi-sectoral response for improved eye care across the lifespan is warranted.”
The study tracked the entire pathway, from screening to referral and follow-up care, revealing that less than 10% of referred students received necessary treatment. It also identified specific financial, logistical, and educationalbarriers, and highlighted gaps in the referral system.
Vision Health Impacts Education Systems Everywhere – Policy and Practice
The clear association between vision impairment and lower academic achievement in Tanzania strengthens the global case for prioritizing vision health, where similar links have been observed but may not be systematically addressed.
In North Carolina, disparities in access to vision care persist, especially in rural communities. Approximately 25,614 preschoolers and 349,518 school-age children in North Carolina have visual problems, according to data from Prevent Blindness North Carolina. An estimated 3% of children under 18 in the U.S. have blindness or vision impairment, defined as having trouble seeing even with glasses or contact lenses, while 60% of students identified as “problem learners” have undetected vision problems making early detection and intervention critical for improving educational outcomes.