World Health Organization · 1st edition, 2025 · 96 pages
Practical WHO guidance for establishing combined sensory screening programmes in school-age children (5–18 years) at community level.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2025
- Audience
- Programme planners, screening coordinators, school nurses, primary healthcare workers, teachers, community health workers
- Evidence
- Expert consensus; references WHO guidelines and validated screening methods
- Reviewed
- 17 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO handbook provides practical, step-by-step guidance for implementing combined vision and hearing screening programmes for school-age children (5–18 years). Uncorrected refractive errors are the leading cause of vision impairment in this age group, while many children with hearing loss remain unidentified. Early detection and intervention are critical to prevent long-term impacts on language development, educational attainment, and future employment opportunities.
The handbook outlines evidence-based screening methods: distance visual acuity testing at 3 metres using HOTV charts (ages 5–8) or tumbling E charts (over 8 years), with a pass threshold of 6/12; external eye examination with a torch; pure-tone audiometry screening at 20 dBHL for frequencies 1000, 2000, and 4000 Hz (or hearWHO app for ages 9+); and otoscopic ear examination. Screening can be conducted by trained non-specialist personnel including teachers, nurses, or community health workers after completing WHO training modules.
The handbook emphasizes that screening must be accompanied by established referral pathways, follow-up systems to track compliance, health promotion activities, and monitoring frameworks. A joint vision–hearing approach is more cost-effective than separate programmes and particularly suited to resource-limited settings. The document includes templates for consent forms, screening forms, notification letters, and health promotion materials.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Distance vision screening: pass criterion is correctly identifying ≥3 out of 4–5 letters on the 6/12 line at 3 metres; use HOTV chart for ages 5–8, tumbling E chart for over 8 years
- Hearing screening: pure-tone audiometry at 20 dBHL for 1000, 2000, and 4000 Hz; child must respond ≥2 out of 3 times per frequency in each ear; alternative hearWHO app (score ≥50) for ages 9+
- Ambient noise during hearing screening must not exceed 40 dBHL; use sound level meter to verify screening environment
- Refer for vision if: unable to see 6/12 line, abnormal external eye (discharge, redness, corneal opacity, misalignment), diabetes, or eye pain
- Refer for hearing if: fail pure-tone screen, ear discharge, tympanic membrane perforation/bulging/not visible, malformed pinna, or impacted cerumen blocking view
- Urgent referral required for: inability to see 6/60 line in either eye, acute ear pain, mastoid swelling/redness, foul-smelling ear discharge, or red bulging eardrum
- Screening should be repeated every 1–2 years as refractive errors and hearing conditions develop progressively; all children screened in first year at school
- Written consent from parent/caregiver required before screening; child assent also obtained; results provided to families with clear referral instructions and follow-up within one month
Example screening indicators for monitoring and evaluation
Table extracted from the guideline
| Indicator name | Definition | Disaggregation |
|---|---|---|
| Total number of children screened | Total number of children who were screened as part of the sensory screening programme | Gender; Age 5–10 years / >10 years |
| Percentage of children screened | Number of children screened / total number of children of that age group in the target population × 100 | Gender |
| Percentage of children with Refer result for vision and eye problems | Number of children with Refer result following vision and eye screening / Total number of children screened × 100 | Gender |
| Percentage of children diagnosed with vision impairment or blindness by eye care personnel | Number of children diagnosed with vision impairment or blindness (of any severity) by eye care personnel × 100 / Total number of children screened | Gender; Severity of loss |
| Percentage of children with a Refer result for hearing | Number of children with Refer result following hearing screening / Total number of children screened × 100 | Gender |
| Percentage of children diagnosed with hearing loss | Number of children diagnosed with hearing loss (of any severity) upon audiometry carried out by trained health care personnel / Total number of children screened × 100 | Gender; Age 5–10 years / >10 years; Type of hearing loss (mild/moderate/moderately severe/severe/profound) |
| Percentage of referral losses: after the 1-month follow-up | Total number of children who have not complied with the vision/eye health and/or hearing/ear health referral (after the 1-month follow-up) × 100 / Total number of children referred | Gender; Type of referral: Vision/eye health/hearing/ear disease |
Source: World Health Organization, Vision and hearing screening for school-age children: implementation handbook. Reproduced in summary form.
From the guideline
Verbatim
“Early identification, diagnosis and interventions for sensory (vision and hearing) impairments in children, are critical to avoid the long-term impact on their language, learning, cognition, educational attainment and social development.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Editor-in-Chief of the Georgian Medical Journal and former consultant to WHO on health systems, I recognize that Georgia's universal healthcare programme provides a policy foundation for school screening, but implementation will require coordination between the Ministries of Health and Education that has historically been challenging. The handbook's emphasis on 20 dBHL as the screening threshold for mild hearing loss is appropriate for settings where audiometry and hearing aid services exist; Georgian programmes should prioritize urban schools near audiology centres initially, then expand as capacity grows. The recommendation for combined vision–hearing screening is particularly relevant for Georgia given constrained health workforce—training existing school nurses or deploying mobile screening teams would be more feasible than separate programmes. The monitoring framework (page 37–39) is essential: without tracking referral completion rates, screening becomes a futile exercise; Georgian pilots should establish SMS reminder systems to parents and school-level follow-up officers, learning from successful models in Armenia's school health programme.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 17 Oct 2026
Applicability
Georgia and the South Caucasus
Georgia and neighbouring South Caucasus countries would benefit substantially from school-based sensory screening given rising myopia prevalence globally and limited newborn hearing screening coverage in the region. Implementation would require establishing referral networks linking schools to existing ophthalmology and ENT services, training primary healthcare workers or teachers using the WHO online modules, and integrating screening into routine school health checks as recommended in WHO school health service guidelines. National programmes should assess baseline capacity in paediatric optometry, refraction services, and audiology; map affordable spectacle provision and hearing aid fitting services; and pilot screening in urban schools before rural scale-up, ensuring cultural adaptation of consent processes and health promotion materials to local languages and literacy levels.
Questions this guideline answers
Quick answers
Who can conduct the vision and hearing screening?
Any personnel trained in the WHO screening methods can conduct screening, including school teachers, community health workers, nurses, clinical officers, or specialist eye/ear personnel. Training includes online WHO modules plus face-to-face practice of clinical skills. A minimum of two personnel are needed: one screener and one supervisor for waiting children.
What is the pass threshold for vision screening?
To pass, the child must correctly identify 3 or more letters out of 4–5 on the bottom line (6/12 line) of the vision chart at 3 metres distance, tested separately in each eye. For ages 5–8 use HOTV chart with pointing card; for over 8 years use tumbling E chart or WHOeyes mobile app.
When should a child be referred urgently for eye care?
Urgent referral (within one month) is required if the child cannot see the top line (6/60 line) with either eye, has any eye injury, reports pain/severe itchiness, has discharge or pus on eyelids, red colour on the white of the eye, haziness of the coloured part of the eye, or misaligned eyes.
What equipment is essential for hearing screening in schools?
Essential equipment includes: audiometer (conventional or automated digital screener) with noise-attenuating headphones calibrated annually; otoscope with at least two speculum sizes; sound level meter or validated mobile app to verify ambient noise ≤40 dBHL; and for ages 9+ the hearWHO mobile app can substitute for audiometry. A quiet room at least 3.5 metres long is also needed for vision screening.
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- Issuer
- World Health Organization
- Type
- Handbook
- Edition
- 1st edition, 2025
- Status
- Current
- Published
- 2025-05-22
- Languages
- English
- Scope
- School-age children 5–18 years; combined vision and hearing screening at community/school level
- Audience
- Programme planners, screening coordinators, school nurses, primary healthcare workers, teachers, community health workers
- Pages
- 96
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-010520-1
- Evidence
- Expert consensus; references WHO guidelines and validated screening methods
- Record history
- Created 17 Oct 2026 · updated 17 Oct 2026 · next check Apr 2027
World Health Organization. Vision and hearing screening for school-age children: implementation handbook. Geneva: World Health Organization; 2025. 96 p. ISBN 978-92-4-010520-1.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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