Abstract
BACKGROUND AND AIMS: Childhood visual impairment remains a major public health concern in low-and-middle income settings, including Ghana, where timely intervention can prevent avoidable vision loss. Although Ghana's National Health Insurance Scheme (NHIS) aims to reduce financial barriers, pediatric eye health-seeking behavior among caregivers is poorly understood. This study assessed determinants of pediatric eye care-seeking behavior across multiple districts in Ghana. METHODS: A community-based cross-sectional study was conducted among 622 children aged ≤ 20 years and their caregivers in selected Ghanaian districts. Structured questionnaires collected data on socio-demographic characteristics, NHIS coverage, prior eye examinations, and eye care-seeking practices. Multivariable logistic regression was used to identify factors associated with seeking eye care (p < 0.05). RESULTS: Among caregivers who reported that their child had experienced an eye problem (60.3%, 375/622), fewer than half (41.2%, 154/374) sought professional eye care, most commonly at general health facilities rather than specialized eye clinics. In multivariable analysis, children residing in peri-urban (AOR = 5.50, 95% CI: 1.33-23.47; p = 0.02) and urban districts (AOR = 6.91, 95% CI: 2.13-22.38; p = 0.001) had significantly higher odds of seeking eye care compared with those in rural areas. Prior eye examination history also influenced care-seeking: children examined within the past 2 years had lower odds of seeking additional eye care (AOR = 0.01, 95% CI: 0.00-0.04; p < 0.001), whereas those whose last examination occurred ≥ 2 years previously had higher odds of seeking care (AOR = 3.73, 95% CI: 1.18-11.82; p = 0.025), relative to children who had never undergone an eye examination. Socio-demographic factors, including education, income, and insurance status, showed no significant associations. CONCLUSION: Overall, the study identified limited utilization of pediatric eye care services that is influenced by settlement type and previous engagement, rather than socioeconomic status. Strengthening community-based outreach and embedding pediatric eye care into primary healthcare can enhance early intervention and reduce avoidable childhood visual impairment.