Exploring the Reasons for Low Cataract Surgery Uptake Among Patients Detected in a Community Outreach Program in Cameroon: Focused Ethnographic Mixed Methods Study (Preprint)

Abstract

BACKGROUND Cataract, a leading cause of blindness in Sub-Saharan Africa is the clouding effect of the eye’s natural lens that can be treated through surgery. Given the many barriers surrounding cataract surgery, district eye care delivery was emphasized by Vision 2020: The Right to Sight, as one potential way to improve access to eye care. To this effect, the Magrabi ICO Cameroon Eye Institute has been involved in community eye care services since its inception, with more than 1000 sight-restoring cataract surgeries performed among patients referred from outreach camps. That notwithstanding, quite a good number of patients diagnosed with cataracts during community screening camps fail to present for surgery. This study sought to explore some of the challenges to accepting cataract surgery among community-diagnosed cataract patients. OBJECTIVE The objective of this study was five-fold including to (1) assess the level of awareness about cataract and available treatment, (2) explore barriers to cataract surgical uptake, (3) assess people’s perception about the outcome of cataract surgery, (4) understand people’s perception about free cataract surgery, and (5) explore reasons for outright refusal of cataract surgery. METHODS This was an ethnographic study from December 2018 through February 2019 in three different communities of the Lekié Division in Cameroon, in which cataract patients were diagnosed. The study sample was composed of operated cataract patients (identified through the hospital database), cataract blind patients, key informants, and community members identified through a purposeful snowball sampling technique. Focus group discussions, personalized in-depth interviews, and a short demographic questionnaire were used to collect data. Data were analyzed using an excel spreadsheet and Stata 14. Data was presented using tabular and graphical methods. RESULTS A total of 29 subjects (19 males) with a mean age of 54.5±14.5 years took part in the study. The most prominent barriers to cataract surgery were found to be cost (86.2%, 25/29) and fear of surgery (58.6%, 17/29). It was also found that 41.4% of those who do not take up cataract surgery turn to traditional medicine which itself turns out to be a major barrier to cataract surgery. Other barriers included the lack of awareness of available treatment (20.7%), no perceived need (17.24%), cultural beliefs and superstition (13.79%), and negligence (13.79%). CONCLUSIONS This study aimed at exploring the reasons for the low uptake of cataract surgery among community-diagnosed cataract patients. We found that cost (86.2%, 25/29) and fear (58.6%, 17/29) to be the main barriers. Belief in traditional medicine and superstition were the main drivers of fear. The implementation of a tiered pricing system, counselling training for Key Informants, incentives for referral of cataract patients, mass media engagement, advocacy, training and active involvement of traditional doctors as Key Informants, acquisition of a 4X4 outreach van, and motorbikes for camp organizers are some of the recommendations based on our results.