Abstract / Summary
Abstract Background Refractive error coverage (REC) and effective refractive error coverage (eREC) are World Health Organization-recommended indicators that are usually reported separately. REC reflects access to refractive services, whereas eREC reflects access resulting in effective visual correction. Using Burundi’s first national estimates from the 2024 Rapid Assessment of Avoidable Blindness (RAAB7), we examined how joint interpretation of REC, eREC and their gap can distinguish potential access shortfalls from shortfalls in service effectiveness and inform policy within universal health coverage. Methods This secondary analysis used the published population-based RAAB7 dataset from all six regions. A target sample of 3,850 adults aged ≥ 50 years was selected from 77 clusters. Standard RAAB7 definitions were used to reproduce the parent REC and eREC estimates and calculate absolute and relative gaps; the contribution is their joint interpretation, not new estimation. Estimates were age- and sex-adjusted; post hoc sex comparisons used approximate two-sided Wald tests based on design-adjusted standard errors. Results Of 3,850 sampled adults, 3,781 (98.2%) were examined. Age- and sex-adjusted REC was 8.6% (95% CI 4.9–12.4) and eREC was 6.1% (95% CI 3.1–9.1). The absolute difference was 2.5% points and the relative gap was 29.2%, so eREC represented 70.8% of REC; the mechanisms could not be identified. Women had higher REC (11.9% vs. 4.9%; approximate p = 0.029) and eREC (8.8% vs. 3.0%; approximate p = 0.028), while their absolute unmet or under-met need was also greater (approximately 64,600 vs. 58,800). Uncorrected refractive error was the leading cause of early vision impairment (69.4%). Conclusions The novelty lies in a practical framework for joint interpretation, not new estimates. Low REC identifies an access shortfall, while lower eREC shows that access does not always yield effective correction. The 2024 estimates provide a national baseline for the World Health Assembly target of a 40-percentage-point increase in eREC by 2030. Policies to expand access should be paired with measures to evaluate and improve service effectiveness within universal health coverage. Trial registration Not applicable. This is an analysis of data from an observational, cross-sectional, population-based survey.