Prevalence of visual impairment and associated risk factors: a cross-sectional community-based study among children and adolescents in Ghana

Objective: Contrary to hospital-based estimates of visual impairment, which are influenced by care-seeking behavior and clinical referral patterns, community-based studies provide a more accurate reflection of the true population burden. There is limited evidence on childhood visual impairment in Ghana; this study therefore reports the prevalence and determinants of visual impairment in a community-based sample from the Ashanti Region of Ghana. Methods: A total of 622 participants, all aged 0-20 years, 332 of whom were females, underwent comprehensive ocular examinations, including age-appropriate visual acuity assessment, refraction, anterior segment and fundus evaluations. Visual impairment was defined as visual acuity worse than 0.3 logMAR (6/12 Snellen) in the better-seeing eye. Univariate and multivariable logistic regression analyses were used to assess factors associated with visual impairment (p ≤ 0.05). Results: Of the 622 participants recruited, 571 were included in the analysis after 51 were excluded due to incomplete visual assessment. These participants ranged from 3 months to 20 years (mean ± SD: 8.88 ± 4.11 years), comprising 53.6% females. The prevalence of presenting distance visual impairment was 6.1% (95% CI: 4.3-8.4), while near visual impairment was 10.9% (95% CI: 8.3-13.9). In the multivariable analysis, age (AOR = 0.68, 95% CI: 0.57-0.82, p < 0.001) and ethnicity (AOR = 0.10, 95% CI: 0.03-0.37, p < 0.001) were significantly associated with lower odds of distance visual impairment. Conclusion: Childhood visual impairment remains relatively high in this community-based population in Ghana. Age and ethnicity were significant determinants of distance visual impairment, highlighting important demographic influences on visual health among children and adolescents. These findings underscore the need for strengthened early detection and improved access to pediatric eye care services to reduce avoidable vision loss. Longitudinal studies are warranted to further clarify risk patterns and inform targeted intervention strategies.