SummaryOBJECTIVES To understand the reasons for poor cataract surgery uptake in people with blindness or severe visual impairment in rural South Africa. METHODSMETHODS A qualitative analysis of detailed, domiciliary interviews with a community-based random sample of elderly Zulus who were blind or severely visually impaired as a result of operable cataract, who had previously been invited for surgery but had failed to attend. RESULTS RESULTSFear of surgery and a fatalistic attitude to the inevitability and irreversibility of blindness in old age were the main reasons for failure to attend for surgery. There was a lower level of disability and perceived need than had been assumed for people with such poor visual acuity. Non-surgical western style health care for systemic illness was common but few patients had sought any form of assistance for their poor vision. Issues of cost and accessibility were relatively unimportant.CONCLUSIO N CONCLUSION Provision of affordable and accessible cataract surgery for the blind and severely visually impaired members of a community does not guarantee that it will be taken up. Other barriers to surgery may be revealed when practical issues such as cost and accessibility are addressed. Perceptions of visual disability among subjects with cataract may differ from simple objective clinical standards.

Background: Children living with HIV (CLHIV) often experience HIV-related impairment and disability.Aim: The study sought to understand the level of child functioning and access to rehabilitative care in the context of South African healthcare in order to inform an integrated rehabilitative framework.Setting: District level semi-rural healthcare facility in KwaZulu-Natal.Methods: The Washington Group/United Nations International Children’s Emergency Fund Module on Child Functioning, was administered to carers of CLHIV aged between 5 and 10 years, and accessing care at the study setting.Results: Forty-four caregivers of children receiving treatment from June 2018 to March 2019, at the facility, participated. Four (9.1%) children had difficulty with seeing, 13 (29.5%) children had difficulty with hearing and 10 (22.7%) children had difficulty with walking. In the cognitive and behavioural domains, 17 (38.6%) children reported difficulties in communication and concentration, with 16 (36.4%) children experiencing difficulties in learning and remembering. Difficulties reported in accepting change and controlling behaviour were both experienced by 23 (52.3%) children. Although many children experiencing impairments were referred for rehabilitation, many caregivers did not follow-up after the initial assessment, because of financial constraints, lack of time and transport restrictions.Conclusion: Functional difficulties were frequently experienced by children living with HIV. Disability screening would be beneficial at various points of care to promote early identification and timely referral to healthcare professionals. Decentralising rehabilitative care to homes and communities could offer a solution to some of the reported barriers to accessing care.

Background Children living with HIV (CLHIV) often experience HIV-related impairment and disability. Aim The study sought to understand the level of child functioning and access to rehabilitative care in the context of South African healthcare in order to inform an integrated rehabilitative framework. Setting District level semi-rural healthcare facility in KwaZulu-Natal. Methods The Washington Group/United Nations International Children’s Emergency Fund Module on Child Functioning, was administered to carers of CLHIV aged between 5 and 10 years, and accessing care at the study setting. Results Forty-four caregivers of children receiving treatment from June 2018 to March 2019, at the facility, participated. Four (9.1%) children had difficulty with seeing, 13 (29.5%) children had difficulty with hearing and 10 (22.7%) children had difficulty with walking. In the cognitive and behavioural domains, 17 (38.6%) children reported difficulties in communication and concentration, with 16 (36.4%) children experiencing difficulties in learning and remembering. Difficulties reported in accepting change and controlling behaviour were both experienced by 23 (52.3%) children. Although many children experiencing impairments were referred for rehabilitation, many caregivers did not follow-up after the initial assessment, because of financial constraints, lack of time and transport restrictions. Conclusion Functional difficulties were frequently experienced by children living with HIV. Disability screening would be beneficial at various points of care to promote early identification and timely referral to healthcare professionals. Decentralising rehabilitative care to homes and communities could offer a solution to some of the reported barriers to accessing care.