Follow-Up Survey of Cataract Surgical Coverage and Barriers to Cataract Surgery at Nkhoma, Malawi

Abstract

Our results demonstrate a 5-fold increase in coverage in the 6 years, primarily by increasing efficiency of the service provider and providing a community screening and referral service. Supporting the ophthalmic personnel with appropriate infrastructure and management has been central to this shift. Implementing an active case finding and referral mechanism has enabled this unit to provide regular high volume cataract surgery. There is a need to understand the factors influencing perceptions about cost as a barrier in this community and the disparity between need and access to services for women.

Barriers for Poor Cataract Surgery Uptake among Patients with Operable Cataract in a Program of Outreach Screening and Low-cost Surgery in Rural China

“…Yorston 26 highlighted four major obstacles that deter people from receiving cataract surgery in developing countries, each of which has been validated independently in a variety of settings: Lack of knowledge, 14,15,21 perception of poor surgical quality, 11,13,14 transportation, 12,15,16,21 and cost. 10,11,18,19 The major barrier for poor uptake of low-cost cataract surgery in our study was lack of family support, which is similar to earlier reports from other countries, 11,27 but differs from previous reports from China, 14,17,22 Recent reports from China showed that lack of knowledge about cataract, concerns about the quality of local services, 14,17 and cost 19,22 appeared to be the principal barriers. One possible explanation for this apparent discrepancy is that we mainly focused on a specific population who had already been provided with an option of low-cost surgery as well as a detailed explanation of the surgical procedure.…”

“…Barriers to uptake of cataract surgery have been well-described in Africa 6,[9][10][11] and Asia, [12][13][14][15][16][17] and appear to include direct and indirect costs, 10,11,18,19 lack of knowledge, 13,20 fear of surgery, 13,20 concerns about the quality of services, 11,13 transportation problems, 12,15,16,21 and discrimination on the basis of sex and age. 12,15,16 Information on barriers to cataract surgery in China is sparse; barriers 14,17,19,22 include lack of knowledge, concern over poor quality of local services and cost of cataract surgery.…”

Outcomes of manual small-incision cataract surgery using standard 22 dioptre intraocular lenses at Nkhoma Eye Hospital, Malawi

“…Using SICS in this population, an initial post-operative rise in IOP resolves by approximately 48 h [19]. Highvolume SICS has been instrumental for a fivefold increase in the cataract surgical coverage within a 10 mile radius of Nkhoma in 6 years [20].…”

Blindness and visual impairment due to age-related cataract in sub-Saharan Africa: a systematic review of recent population-based studies

“…First, performing serial cross-sectional population-based surveys to demonstrate evidence of a reduction in prevalence of cataract (and blindness and VI due to cataract) over time 14 34. Another indicator is to measure the CSC which represents a ratio of the met and unmet need for cataract surgery and is a measurement of the capability of a healthcare system to provide cataract surgical services to the population 35.…”