Visual Impairment and Refractive Error Among Deaf and Hard of Hearing Learners in Ghana

Abstract

Introduction

This study aims to assess the prevalence of visual impairment and refractive error among learners who are deaf or hard of hearing in schools for Deaf students in Ghana.

Methods

A descriptive cross-sectional study design was used to assess the distance visual acuity with the logMAR “E” chart, and ocular health was assessed with an ophthalmoscope and handheld slit lamp with a 90 D lens.

Results

A total of 1,914 learners were examined in six schools for Deaf students in Ghana. Their ages ranged from 5 to 43 years (M = 15.18 ± 4.53 years). There were more males (55.5%) than females (44.5%) in the study. Among the learners, 91.1% were deaf, followed by mild hard of hearing (4.0%) and profound hard of hearing (1.8%), among others. Also, 94.8% of the learners had typical vision, followed by moderate visual impairment (2.5%), mild visual impairment (1.4%), and blindness (1.3%) before the provision of spectacles. There was no association between visual impairment (i.e., blindness and visual impairment) and sex among the learners (p < .05). The leading causes of visual impairments were refractive error and cataracts, while the leading cause of ocular morbidity was allergic conjunctivitis. The prevalence of visual impairment was reduced by almost 2-fold after the provision of spectacles.

Discussion

The prevalence of deafblindness was low among the learners, with uncorrected refractive errors as the leading cause of mild and moderate visual impairment. If these learners had not been identified through this study, they would have continued to struggle to access the curriculum visually.

Implications for Practitioners

There is a need to assess hearing and visual functions among learners with disabilities in developing countries like Ghana.

Keywords

visual impairment dual sensory loss School for the Deaf deaf/hard of hearing Ghana

There is a potential prevalence of visual impairment (i.e., blindness and visual impairment) among learners with different disabilities. Multiple impairments interfere with learners’ academic pursuits (Woodhouse et al., 2013). It may be challenging for educators to ascertain the specific cause of poor academic performance when a learner has multiple disabilities such as deafness or hard of hearing and visual impairment (deafblind), which is referred to as dual-sensory impairment; hearing and cognitive (intellectual) impairment; and cognitive and visual impairment (Woodhouse et al., 2013). Learners with special needs are more likely to have visual impairments ranging from 2.2% to 34.6% more often than their colleagues in mainstream schools due to their developmental difficulties (Cockerill, 2002; Das et al., 2010; Ghasia et al., 2008; Hollingsworth et al., 2013; Kwarteng, Mashige, Kyei, et al., 2022; Leekam et al., 2006; Nielsen et al., 2007a, 2007b; Sobrado et al., 1999; Woodhouse et al., 2013).

Individuals who are deaf or hard of hearing with visual impairments (i.e., those who are deafblind) are not often completely deaf or completely blind but have residual hearing or seeing abilities (Brabyn et al., 2007). Deafblindness affects an individual's independence (Haanes et al., 2015; Hajek et al., 2015), quality of life (Eisele et al., 2015; Michikawa et al., 2009), social involvement (Polku et al., 2015), and mental health (Zhang et al., 2013). Deafness or hard of hearing can be categorized into congenital and acquired, as well as sensorineural, conductive, or mixed depending on the cause of the impairment (Amedofu, Brobby, et al., 1999; Amedofu, Opoku-Buabeng, et al., 2003).

Ophthalmic disorders among children with deafness or hard of hearing have been reported to be high (15%–75%) across the globe (Gogate et al., 2009). A high prevalence rate of visual impairment has been recorded among learners with deafness or hard of hearing globally (Hollingsworth et al., 2013; Khanna et al., 2019; Ovenseri-Ogbomo et al., 2013; Woodhouse et al., 2013). The high prevalence has led to the understanding that deafness or hard of hearing is associated with ophthalmic disorders among children globally (Hanioğlu-Kargi et al., 2003; Hollingsworth et al., 2013; Majekodunmi et al., 2018; Omolase et al., 2012; Osaiyuwu & Ebeigbe, 2010). The most common cause of visual impairment in children has been reported as uncorrected refractive error, which ranges from 7.2% to 73.26% (Khanna et al., 2019; Kumar Sah et al., 2021; Kwarteng, Mashige, Kyei, et al., 2022; Ovenseri-Ogbomo et al., 2013; Woodhouse et al., 2013).

Vision status is usually ignored in learners who are Deaf or hard of hearing, and the emphasis is placed on the physical challenges and learning difficulties among these students (Woodhouse et al., 2013). Although there is a reported study by (Ovenseri-Ogbomo et al., 2013) on visual impairments among learners who are Deaf or hard of hearing in the central region of Ghana, there are no published data on visual impairments among these learners from other parts of the country. Additionally, the aforementioned study is nearly a decade old, which raises concerns about its relevance in accurately reflecting the current prevalence of visual impairments within this specific group.

Methods

This study was conducted using a descriptive cross-sectional study design in a school setting of six randomly selected schools for Deaf students in Ghana from March 2022 to October 2022. The six schools were randomly selected from the 11 public schools for Deaf students across the country using stratified random sampling. The schools were categorized into two; the northern sector (four schools) and the southern sector (seven schools) per the national geographic classification. In the northern sector, three schools were randomly selected from four. The schools selected were the Ashanti, Gbeogo, and Savelugu schools for Deaf students. In the southern sector, schools’ proximity of less than 80 km was used to classify the schools in the radius as one. Four schools were classified as one using this criterion to make the southern schools four. Among the four sites, three schools were randomly chosen to be the sites for this study. The schools selected were Sekondi, Cape Coast, and State Schools for the Deaf. The study employed census in selecting the subjects, since the study needed all the learners present at the time of the study. In Ghana, the Deaf or hard of hearing learners are required to submit assessment reports that include audiogram, medical report, and the Ghana Education Service placement form before they are enrolled in specialized programs (Fobi et al., 2020). Some of the schools for learners with disabilities have vocational systems that provide learners with the requisite entrepreneurship skills for the job market or self-employment and the schools are mostly residential (boarding facilities) with few learners as day students (Kwarteng et al., 2021).

Inclusion and Exclusion Criteria

The study included all learners at the schools for Deaf students whose parents or guardians agreed to it or gave their permission. Also, adult learners under the vocational systems were included in the study. The study excluded learners who were absent or refused to participate at the time of the study.

Data Collection Procedure

The classification of deafness or hard of hearing was determined using the medical data of the learners, with the support of teachers who gave their time to assist in the process. A team of registered optometrists conducted the visual function assessment. The Tumbling “E” distance logMAR Chart (Precision Vision, Illinois, USA) was utilized in order to conduct the visual acuity testing at a distance of 4 meters. A handheld slit-lamp biomicroscope (Canton Optics, Shanghai, China) was utilized in order to do an examination of the anterior segment of the eye on each subject. A direct ophthalmoscope and a slit-lamp biomicroscope equipped with a 90 D lens (Canton Optics, Shanghai, China) were used for the evaluation of the posterior segment of the eye as described in the report by Kwarteng, Mashige, Dogbe, et al. (2022)

Data Analysis

The Statistical Package and Service Solutions (SPSS), Version 24 was utilized in order to do an analysis on the data that were collected. A descriptive study was carried out, including the ranges of visual acuity, measures of central tendency for age, and frequencies for both genders. Additionally, the prevalence and causes of visual impairment were investigated.

Ethical Considerations

The Biomedical Research Ethics Committee of the University of KwaZulu-Natal, South Africa (BREC/00003247/2021) and the Ghana Health Service Ethical Review Committee (GHS-ERC: 006/04/21) gave approvals for the study. The study adhered to the tenets of the Declaration of Helsinki. Informed assent and consent were obtained from each learner aged 17 years and below and their parents or guardians, respectively, after the nature of the study was explained. Informed consent was obtained from learners aged 18 years and above. Participation in the study was voluntary, and participants were free to quit at any point. Confidentiality was maintained throughout the study by giving each student a unique identification.

Results

Demographics

A total of 1,914 pupils were examined during the study period, with no learner opting not to partake in the study. The Savelugu School for the Deaf had the lowest number of learners (10.4%), whereas the Ashanti School for the Deaf had the most pupils (30.0%). Their average age was 15.18 ± 4.53 years, with a range of 5–43 years. Males made up 55.5% of the study's participants, compared to females (44.5%). The majority of the students (91.1%) were deaf, with 4.0% having mild hard of hearing and 1.8% having profound hard of hearing (Table 1). The mean number of years of enrollment at the institutions (the number of years a learner has spent at the school) was 6.54 ± 3.20 years, with 16 years as the highest stay at an institution.

Table 1.
Demographic Characteristics of the Learners According to Sex.

Variables Sub-groups Sex of the learners Total (%) p

Male Female

School Jamasi 316_a 259_a 575 (30.0) .047*

Cape Coast 220_a 157_a 377 (19.7)

Savelugu 119_a 81_a 200 (10.4)

Sekondi 134_a 107_a 241 (12.6)

Gbeogo 141_a 99_a 240 (12.5)

Tema 133_a 148_b 281 (14.7)

Level of education Kindergarten 115_a 100_a 215 (11.2) .215

Primary 571_a 472_a 1043 (54.5)

Junior high school 345_a 244_a 589 (30.8)

Vocational/technical 32_a 35_a 67 (3.5)

Type of enrollment Boarding 1005_a 825_b 1830 (95.6) .011*

Day 58_a 26_b 84 (4.4)

Degree of deafness and hard of hearing None 3_a 15_b 18 (0.9) .003*

Mild 45_a 32_a 77 (4.0)

Moderate 14_a 3_b 17 (0.9)

Moderately severe 5_a 6_a 11 (0.6)

Severe 9_a 5_a 14 (0.7)

Profound 14_a 20_a 34 (1.8)

Deaf 973_a 770_a 1743 (91.1)

Previous eye examination Yes 413 312 725 (37.9) .500

No 627 516 1143 (59.7)

Cannot tell 23 23 46 (2.4)

Years of stay in the institution 1–5 421 358 779 (40.7) .444

6–10 513 386 899 (47.0)

11–16 129 107 236 (12.3)

Total 1063 (55.5) 851 (44.5) 1914 (100.0)

Note. Each subscript letter denotes a subset of the sex of participant categories whose column proportions do not differ significantly from each other at the .05 level.

Significant p-value < 0.05. Statistically significant association, where p-value < 0.05.

Classification of deafness and hard of hearing (Olusanya et al., 2019): None, −10 to 19.9 dB; Mild, 20–34.9 dB; Moderate, 35–49.9 dB; Moderately severe, 50–64.9 dB; Severe, 65–79.9 dB; Profound, 80–94.9 dB; Deaf 95 dB or greater.

Distribution of Visual Impairment in the Better Seeing Eye According to Sex

There was no association between the distribution of visual impairment before correction and sex, χ²(3) = 6.354, p > .05, and after correction and sex, χ²(3) = 3.466, p > .05. The prevalence of visual impairment was reduced by almost 2-fold after correction (see Table 2). Among the 1,914 learners, 69 (3.6%) had uncorrected refractive error that was corrected with spectacles. Fifty-two (2.7%) of the learners had vision needs that required accommodations and supports.

Table 2.
Distribution of Visual Impairment Before and After Correction According to Sex.

Visual impairment Sex of the learners Total p

Male Female

Before correction Typical (0.0–0.3 logMAR) 1020 795 1815 (94.8) .096

Mild (>0.3–0.5 logMAR) 12 15 27 (1.4)

Moderate (>0.5–1.0 logMAR) 21 26 47 (2.5)

Blindness (>1.3–4 logMAR) 10 15 25 (1.3)

After correction Typical (0.0–0.3 logMAR) 1040 822 1862 (97.3) .325

Mild (>0.3–0.5 logMAR) 3 2 5 (0.3)

Moderate (>0.5–1.0 logMAR) 10 12 22 (1.1)

Blindness (>1.3–4 logMAR) 10 15 25 (1.3)

Total 1063 (55.5) 851 (44.5) 1914 (100.0)

Note. Significant p-value < 0.05.

Distribution of Deafness or Hard of Hearing According to Visual Impairment

One thousand eight hundred and ninety-six students were deaf or hard of hearing, and there was a 4.3% rate of vision impairment among those students (95% CI: [3.39–5.31]). Twenty-six (1.4%) of the deaf or hard of hearing students had mild visual impairment, 40 (2.1%) had moderate visual impairment, and 15 (0.8%) were blind (see Table 3). In addition, those with typical hearing had the highest prevalence of blindness (40%). The learners with typical hearing were found in only one school (Ashanti School for the Deaf), since the school provided support in braille and tactile language for these learners due to their blindness.

Table 3.
Distribution of Deafness and Hard of Hearing According to Presenting Visual Impairment.

Degree of deafness and hard of hearing Presenting visual impairment Total (%)

Typical Mild Moderate Blindness

None 0 1 7 10 18 (0.9)

Mild 76 1 0 0 77 (4.0)

Moderate 17 0 0 0 17 (0.9)

Moderately severe 6 3 2 0 11 (0.6)

Severe 13 0 0 1 14 (0.7)

Profound 25 5 3 1 34 (1.8)

Deaf 1678 17 35 13 1743 (91.1)

Total 1815 (94.8) 27 (1.4) 47 (2.5) 25 (1.3) 1914 (100.0)

Note.* Typical = (0.0–0.3 logMAR), Mild (>0.3–0.5 logMAR), Moderate (>0.5–1.0 logMAR), Blindness (>1.3–4 logMAR).

Classification of deaf/hard of hearing (Olusanya et al., 2019): None, −10–19.9 dB; Mild, 20–34.9 dB; Moderate, 35–49.9 dB; Moderately severe, 50–64.9 dB; Severe, 65–79.9 dB; Profound, 80–94.9 dB; Deaf 95 dB or greater.

Causes of Visual Impairment and Ocular Morbidity Among Learners

Among the 99 learners with visual impairments, the causes were refractive error (47.5%), cataract (14.1%), corneal opacity (13.1%), glaucoma (10.1%), nystagmus (9.1%), and retinopathy (6.1%). The distribution of refractive error was myopia 62 (89.9%) and hyperopia, 7 (10.1%); based on the definitions of spherical equivalent, myopia ≤−0.50DS and hyperopia ≥+2.00 DS. Myopia ranged from −0.50 DS to −2.00 DS, while hyperopia ranged from +2.00Ds to +10.00DS. According to ocular morbidity frequency, allergic conjunctivitis (7.4%) was the leading cause followed by glaucoma (4.1%) and refractive error (3.6.%), as shown in Table 4. Among the ocular morbidities, conditions such as allergic conjunctivitis, refractive error, dry eyes, glaucoma suspects, and some forms of cataracts are treatable (manageable). These findings show that 137 learners had eye conditions that would affect their academic life.

Table 4.
Distribution of Ocular Morbidity According to Sex.

Ocular morbidity Sex of the learners Total

Male Female

Normal 883_a 670_b 1553 (81.1)

Allergic conjunctivitis 72_a 69_a 141 (7.4)

Glaucoma and glaucoma suspects 40_a 38_a 78 (4.1)

Refractive error 32_a 37_a 69 (3.6)

Cataract 11_a 11_a 22 (1.1)

Corneal opacity 11_a 7_a 18 (0.8)

Dry eyes 7_a 7_a 14 (0.7)

Nystagmus 5_a 7_a 12 (0.6)

Retinitis pigmentosa 2_a 5_a 7 (0.4)

Total 1063 (55.5) 851 (44.5) 1914 (100.0)

Note. Each subscript letter denotes a subset of the sex of participant categories whose column proportions do not differ significantly from each other at the .05 level.

Distribution of Visual Impairment According to the Location of the School

There were more Deaf and hard of hearing learners in the northern sector schools compared to those in the south. Also, there was a significant association between visual impairments and the location of the schools. More learners with visual impairments were enrolled in southern schools than in the north, χ²= 32.486, df = 3, p < .001 (Table 5). This finding shows that there was no bias across the study sites.

Table 5.
Distribution of Visual Impairment According to the Location of the School.

Visual impairment before correction Sector Total (%) p

Northern Southern

Typical 990_a 825_b 1815 (94.8) .001

Mild 7_a 20_b 27 (1.4)

Moderate 11_a 36_b 47 (2.5)

Blindness 7_a 18_b 25 (1.3)

Total 1015 (53.0) 899 (47.0) 1914 (100.0)

Note. Each subscript letter denotes a subset of the sector categories whose column proportions do not differ significantly from each other at the .05 level.

Significant p-value < 0.05.

Typical = (0.0–0.3 logMAR), Mild (>0.3–0.5 logMAR), Moderate (>0.5–1.0 logMAR), Blindness (>1.3–4 logMAR).

Distribution of Visual Impairment According to Previous Eye Examination

Among the learners, 1,114 (58.2%) with typical vision had no previous eye examination. All the learners with blindness 25 (1.3%) had previous eye examinations. There was a significant association between visual impairments and learners with previous eye examinations, χ²= 61.284, df = 6, p < .001 (see Table 6).

Table 6.
Distribution of Visual Impairment According to Previous Eye Examination.

Previous eye examination Visual impairment before correction Total (%) p

Typical Mild Moderate Blindness

Yes 655 15 30 25 725 (37.9) .001

No 1114 12 17 0 1143 (59.7)

Cannot tell 46 0 0 0 46 (2.4)

Total 1815 (94.8) 27 (1.4) 47 (2.5) 25 (1.3) 1914 (100)

Note. Typical = (0.0–0.3 logMAR), Mild (>0.3–0.5 logMAR), Moderate (>0.5–1.0 logMAR), Blindness (>1.3–4 logMAR).

Significant p-value < 0.05.

Discussion

This school-based descriptive cross-sectional study determined that the distribution of visual impairments among learners attending schools for Deaf students in Ghana and an extended version of a conference proceeding (Kwarteng, Mashige, Dogbe, et al., 2022) The prevalence of visual impairments among the learners was 5.2%, with moderate and mild visual impairment being the leading category. These visual impairments were mostly caused by uncorrected refractive error, and they were easily corrected with spectacles. This discovery could be attributed to the largely unavailable periodic eye screening in schools as evidenced in a previous study in Ghana (Akuffo et al., 2020). Also, low utilization of eye care among the learners might have contributed to the uncorrected refractive errors (see Table 1). The prevalence of visual impairment in this study was lower than an earlier report of 6.0% on this study (Kwarteng, Mashige, Dogbe, et al., 2022). and the only similar study conducted in Ghana (Ovenseri-Ogbomo et al., 2013) in a single study setting with a prevalence of 7.3%. The reduced prevalence can be attributed to a larger sample size and multiple study settings compared to the previous report which was conducted in only two schools (Kwarteng, Mashige, Dogbe, et al., 2022). The findings in this study indicate a better representation of visual impairment among learners who are Deaf or hard of hearing in Ghana.

Also, the improvement in public awareness and the increase in eye care services in Ghana can be connected to the decline in the prevalence (Morny et al., 2019). Regular eye screening activities and eye health promotion for these learners and their guardians will be very beneficial. Compared to other similar studies in Sub-Saharan Africa, the prevalence in this study was higher than similar studies (Abah et al., 2011; Onakpoya & Omotoye, 2010), but lower than those reported by Majekodunmi et al. (2018) and Abikoye et al. (2020). It is worth noting that the variation was recorded in the same country, Nigeria. Also, the lower prevalence was recorded in studies conducted over a decade ago, while the high prevalence was discovered in recent studies. It is unclear why recent studies in Nigeria would record high visual impairment amidst the increase in the eye care workforce (Nathaniel et al., 2022). A recent study in Nigeria has reported inadequate resources in terms of primary eye care (Aghaji et al., 2021). Also, a probable reason would be the current lack of primary eye care policy in Nigeria, which has resulted in significant gaps in the delivery of eye care services, inadequate equipment, and data administration (Aghaji et al., 2021).

There were more males in this current study, a sex distribution that is similar to previous studies among learners who are Deaf or hard of hearing in Sub-Saharan Africa (Kwarteng, Mashige, Kyei, et al., 2022). This observation is also common among children with other disabilities in Ghana (Kwarteng et al., 2021). Reports suggest that parents of learners with disabilities in Africa prefer to educate their sons rather than their daughters due to cultural beliefs (Majekodunmi et al., 2018). Among the schools in this study, all except one had more male learners than females. The school that recorded more females than males is located in a cosmopolitan setting compared to the rest of the schools we examined. However, the proportion of sex distribution in that school was comparable to others, and there was no significant difference between the two sexes (p < .05).

There was a wide age range among the learners, which agrees with research in similar settings in Africa (Kwarteng, Mashige, Kyei, et al., 2022). Learners may enroll late in school, after the disability has been identified, and they may have a history of poor academic performance (Kwarteng et al., 2021). This situation may explain the wide age range and adult learners in the vocational systems in these schools. Academic challenges are common among learners with disabilities, especially those with multiple disabilities, who tend to spend more years in school; hence the finding that 16 years was the maximum number of years the learners we studied spent in these institutions. The number of years of enrollment in the institutions, as shown in Table 1, confirm that the learners registered in the school late. Another component that plays a role in this wide age range is inadequate resources for these learners in inclusive education and the lack of special schools in every region or province in the country (Opoku, 2022; Opoku et al., 2022). Furthermore, the neglect of these learners with disabilities by their parents or guardians after they are enrolled in these specialized boarding schools also contributes to their poor performance and long stay on campus (Ruhagaze et al., 2013; Tumwesigye et al., 2009).

The leading causes of visual impairment among the learners were refractive error and cataracts. Globally, uncorrected refractive error and cataracts remain the leading causes of visual impairment (Burton et al., 2021; Steinmetz et al., 2021). The provision of spectacles and cataract surgery uptake among these learners will be beneficial in reducing the magnitude of their visual impairments. The leading type of refractive error was myopia, a finding that is similar to some studies conducted in Africa (Omolase et al., 2012; Onakpoya & Omotoye, 2010; Osaiyuwu & Ebeigbe, 2010). In contrast, other studies in Africa found astigmatism and hyperopia as the leading type of refractive error (Majekodunmi et al., 2018; Ovenseri-Ogbomo et al., 2013). Also, compared to global reports on learners with who are Deaf or hard of hearing, hyperopia has been the leading type of refractive error (Hollingsworth et al., 2013). A possible explanation for this variation is the definitions used in these studies. Due to the nature of this study and the provision of ready-to-clip spectacles for these learners, our study employed the spherical equivalent definitions compared to the other studies that used astigmatism and hyperopia as spherical power equal to or greater than +0.50D.

In Ghana, there is significant regional disparity in resources, and the northern sector is far worse off than the southern sector, especially in terms of access to health care (Akrofi et al., 2018). The regional differences are assumed to cause a high prevalence of visual impairment in the north compared to the south. However, the findings of this study suggest that learners in the south were in the minority, but had a higher prevalence of visual impairments (see Table 5). A probable reason for this finding are the skewed resources in terms of education in the southern part of Ghana (Akrofi et al., 2018).

According to the definition of deafblindness (dual-sensory loss) provided by the National Center for Deaf-Blindness, which states that deafblindness can exist when there is only mild vision loss and hard of hearing (National Center for Deaf-Blindness, 2022), 4.2% of the students were placed in this category. This is a significantly lower percentage than the 7% discovered among a population sample of 273 students in Nigeria (Aghaji et al., 2017). The differences in prevalence statistics across these studies could be attributable to a number of factors, including the sample size, the categories of schools that were involved in the studies, and the proportion of the prevalence that was contributed by the schools. The study by (Aghaji et al., 2017) included participants from schools for Deaf students as well as schools for blind students, but this current study only included participants from schools for Deaf students. According to (Aghaji et al., 2017), a school for blind students was accountable for 15 out of the total number of 19 students who had dual-sensory loss. Additional research that focuses on evaluating deafness and hard of hearing among students attending institutions for the blind in Sub-Saharan Africa would provide novel information to the existing body of knowledge pertaining to deafblindness. In addition, 13 of the participants in this study had both total deafness and blindness. Despite the low-incidence rate, when enrolled at schools for students who are Deaf, deafblind students have to use the same educational resources as their peers who do not also have visual impairments. It is imperative to conduct an educational needs assessment and cater to the requirements of this specific cohort of students in order to properly teach them.

Limitations

There is a need to acknowledge the limitations in this current study. Firstly, the study did not include an audiologist or otorhinolaryngologist to confirm the degree of deafness or hard of hearing among the learners. However, the study made use of admission medical records and information available from the schools. Secondly, the study could not determine the actual response rate of participants due to the absence of the actual number of students admitted at a particular time. Furthermore, the absence of coexisting developmental conditions prevented us from drawing a conclusion on the effects of comorbidities on the age of learners at presentation or duration of stay in these schools.

Conclusion

The prevalence of deafblindness was low among the learners, with uncorrected refractive error as the leading cause of mild and moderate visual impairment. If these learners had not been identified through this study, they would have continued to struggle to access the curriculum visually. There should be a mandatory visual assessment for learners as part of the school admission process. The results can be used to develop individualized plans for learners with visual impairments.

Implications for Practitioners

There is a need to assess hearing and visual functions among learners with disabilities in developing countries like Ghana.

Variables	Sub-groups	Sex of the learners	Total (%)	p
School	Jamasi	316_a	259_a	575 (30.0)	.047*
Cape Coast	220_a	157_a	377 (19.7)
Savelugu	119_a	81_a	200 (10.4)
Sekondi	134_a	107_a	241 (12.6)
Gbeogo	141_a	99_a	240 (12.5)
Tema	133_a	148_b	281 (14.7)
Level of education	Kindergarten	115_a	100_a	215 (11.2)	.215
Primary	571_a	472_a	1043 (54.5)
Junior high school	345_a	244_a	589 (30.8)
Vocational/technical	32_a	35_a	67 (3.5)
Type of enrollment	Boarding	1005_a	825_b	1830 (95.6)	.011*
Day	58_a	26_b	84 (4.4)
Degree of deafness and hard of hearing	None	3_a	15_b	18 (0.9)	.003*
Mild	45_a	32_a	77 (4.0)
Moderate	14_a	3_b	17 (0.9)
Moderately severe	5_a	6_a	11 (0.6)
Severe	9_a	5_a	14 (0.7)
Profound	14_a	20_a	34 (1.8)
Deaf	973_a	770_a	1743 (91.1)
Previous eye examination	Yes	413	312	725 (37.9)	.500
No	627	516	1143 (59.7)
Cannot tell	23	23	46 (2.4)
Years of stay in the institution	1–5	421	358	779 (40.7)	.444
6–10	513	386	899 (47.0)
11–16	129	107	236 (12.3)
Total	1063 (55.5)	851 (44.5)	1914 (100.0)

Visual impairment	Sex of the learners	Total	p
Before correction	Typical (0.0–0.3 logMAR)	1020	795	1815 (94.8)	.096
Mild (>0.3–0.5 logMAR)	12	15	27 (1.4)
Moderate (>0.5–1.0 logMAR)	21	26	47 (2.5)
Blindness (>1.3–4 logMAR)	10	15	25 (1.3)
After correction	Typical (0.0–0.3 logMAR)	1040	822	1862 (97.3)	.325
Mild (>0.3–0.5 logMAR)	3	2	5 (0.3)
Moderate (>0.5–1.0 logMAR)	10	12	22 (1.1)
Blindness (>1.3–4 logMAR)	10	15	25 (1.3)
Total	1063 (55.5)	851 (44.5)	1914 (100.0)

Degree of deafness and hard of hearing	Presenting visual impairment	Total (%)
None	0	1	7	10	18 (0.9)
Mild	76	1	0	0	77 (4.0)
Moderate	17	0	0	0	17 (0.9)
Moderately severe	6	3	2	0	11 (0.6)
Severe	13	0	0	1	14 (0.7)
Profound	25	5	3	1	34 (1.8)
Deaf	1678	17	35	13	1743 (91.1)
Total	1815 (94.8)	27 (1.4)	47 (2.5)	25 (1.3)	1914 (100.0)

Ocular morbidity	Sex of the learners	Total
Normal	883_a	670_b	1553 (81.1)
Allergic conjunctivitis	72_a	69_a	141 (7.4)
Glaucoma and glaucoma suspects	40_a	38_a	78 (4.1)
Refractive error	32_a	37_a	69 (3.6)
Cataract	11_a	11_a	22 (1.1)
Corneal opacity	11_a	7_a	18 (0.8)
Dry eyes	7_a	7_a	14 (0.7)
Nystagmus	5_a	7_a	12 (0.6)
Retinitis pigmentosa	2_a	5_a	7 (0.4)
Total	1063 (55.5)	851 (44.5)	1914 (100.0)

Visual impairment before correction	Sector	Total (%)	p
Typical	990_a	825_b	1815 (94.8)	.001
Mild	7_a	20_b	27 (1.4)
Moderate	11_a	36_b	47 (2.5)
Blindness	7_a	18_b	25 (1.3)
Total	1015 (53.0)	899 (47.0)	1914 (100.0)

Previous eye examination	Visual impairment before correction	Total (%)	p
Yes	655	15	30	25	725 (37.9)	.001
No	1114	12	17	0	1143 (59.7)
Cannot tell	46	0	0	0	46 (2.4)
Total	1815 (94.8)	27 (1.4)	47 (2.5)	25 (1.3)	1914 (100)

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the College of Health Science PhD Scholarship, University of KwaZulu-Natal, South Africa, The African Researchers' Initiative (ARI) research grant, Deafblind International (DbI), Switzerland, VisionSpring Inc., Africa.

ORCID iDs

Michael Agyemang Kwarteng

Samuel Kyei

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Variables	Sub-groups	Sex of the learners		Total (%)	p
Variables	Sub-groups	Male	Female	Total (%)	p
School	Jamasi	316_a	259_a	575 (30.0)	.047*
	Cape Coast	220_a	157_a	377 (19.7)
	Savelugu	119_a	81_a	200 (10.4)
	Sekondi	134_a	107_a	241 (12.6)
	Gbeogo	141_a	99_a	240 (12.5)
	Tema	133_a	148_b	281 (14.7)
Level of education	Kindergarten	115_a	100_a	215 (11.2)	.215
	Primary	571_a	472_a	1043 (54.5)
	Junior high school	345_a	244_a	589 (30.8)
	Vocational/technical	32_a	35_a	67 (3.5)
Type of enrollment	Boarding	1005_a	825_b	1830 (95.6)	.011*
Type of enrollment	Day	58_a	26_b	84 (4.4)	.011*
Degree of deafness and hard of hearing	None	3_a	15_b	18 (0.9)	.003*
	Mild	45_a	32_a	77 (4.0)
	Moderate	14_a	3_b	17 (0.9)
	Moderately severe	5_a	6_a	11 (0.6)
	Severe	9_a	5_a	14 (0.7)
	Profound	14_a	20_a	34 (1.8)
	Deaf	973_a	770_a	1743 (91.1)
Previous eye examination	Yes	413	312	725 (37.9)	.500
	No	627	516	1143 (59.7)
	Cannot tell	23	23	46 (2.4)
Years of stay in the institution	1–5	421	358	779 (40.7)	.444
	6–10	513	386	899 (47.0)
	11–16	129	107	236 (12.3)
Total		1063 (55.5)	851 (44.5)	1914 (100.0)

Visual impairment before correction	Sector		Total (%)	p
Visual impairment before correction	Northern	Southern	Total (%)	p
Typical	990_a	825_b	1815 (94.8)	.001
Mild	7_a	20_b	27 (1.4)
Moderate	11_a	36_b	47 (2.5)
Blindness	7_a	18_b	25 (1.3)
Total	1015 (53.0)	899 (47.0)	1914 (100.0)