Visual Difficulties and Uptake of Optical Correction Among Malawians: Insights from the 2024 Demographic and Health Survey

BACKGROUND: Uncorrected visual impairment, primarily due to refractive errors, is a persistent public health concern in low- and middle-income countries. In Malawi, national data on the prevalence of visual difficulty and uptake of optical correction remain scarce, hindering targeted health interventions. This study examines the prevalence of self-reported visual difficulties, the uptake of refractive correction, and the sociodemographic determinants of optical correction in Malawi using 2024 national survey data. METHODS: We conducted a secondary analysis of data from the 2024 Malawi Demographic and Health Survey (MDHS), a nationally representative, cross-sectional survey encompassing 23,095 participants across urban and rural regions. Self-reported visual difficulties and optical correction (spectacle/contact lens use) were assessed alongside key sociodemographic factors. Associations were examined using chi-square tests and multinomial logistic regression. RESULTS: < 0.001). The prevalence of visual difficulty increased markedly with age, from 2.3% in the youngest group to 15.5% in those over 74 years. Women, individuals with lower education, widowed participants, and residents of the Northern region experienced higher rates of visual difficulty. Spectacle or contact lens use was low overall (6.4%), with uptake increasing with age, education, and urban residence but remaining below 20% even among the most educated. Most individuals reporting visual difficulty were not using optical correction, including 70% of those with "some difficulty" and 67% of those with "a lot of difficulty" indicating substantial unmet need. Multivariable analysis identified advancing age, higher education, urban residence, and Northern region as key independent predictors of both visual difficulty and refractive correction uptake. CONCLUSIONS: The unmet need for refractive correction in Malawi is substantial, disproportionately affecting older, less educated, rural, and widowed individuals. Expanding access to affordable and equitable refractive services is essential to reducing avoidable visual impairment and addressing social and geographic health disparities.