Prevalence of Visual Impairment and Coverage of Cataract Surgical Services: Associations with Sex, Disability, and Economic Status in Five Diverse Sites

Abstract

Purpose: Prevalence of visual impairment (VI) and access to services can vary significantly across and between different population groups. With renewed focus on universal health coverage and leaving no one behind, it is important to understand factors driving inequitable eye health. This paper presents results from five population-based surveys where prevalence of VI and cataract surgical coverage (CSC) were measured and examined for differences by sex, economic-status, and disability. Methods: Rapid assessments of avoidable blindness took place in four rural sites: Kalahandi, Jhabua and Sitapur in India; and Singida, Tanzania; and one urban site: Lahore, Pakistan. In addition, the Equity Tool was used to measure economic status and the Washington Group Short Set was used to measure disability. Prevalence of VI and CSC were calculated and associations with sex, disability, and relative wealth examined. Results: Prevalence of VI varied from 1.9% in Lahore to 15.0% in Kalahandi. CSC varied from 39.1% in Singida to 84.0% in Lahore. Additional disability was associated with greater levels of VI in all sites and lower CSC in Singida. Being female was associated with higher VI in Kalahandi, Lahore and Singida and lower CSC in Lahore and Singida. Being poorer was associated with higher VI in Singida and lower CSC in Singida and Sitapur. Conclusion: Relationships between VI and relative wealth, sex, and disability are complex and variable. Although certain characteristics may be associated with lower coverage or worse outcomes, they cannot be generalized and local data are vital to tailor services to achieve good coverage.

Changes in prevalence and causes of visual impairment and cataract surgical coverage in Nampula, Mozambique between 2011 and 2018: findings from two cross-sectional surveys

“…However, the data indicates a worrying trend towards increased, rather than decreased equality of outcomes for males and females, and indicates further effort is required to identify effective strategies to improve equity of access for females. This nding is in line from other research from sub-Saharan Africa and further a eld (10,12,24,25).…”

“…Within eye health therefore, suggestions have been made to create the indicators of effective cataract surgical coverage, and effective refractive error coverage, to be used alongside the crude service coverage indicators. (8,9) In addition to measuring these indicators in the population as a whole, it is important to understand how such measures differ between different sub-groups, men and women, rich and poor, urban and rural and those with and without disabilities (8,10,11). Evidence exists to suggest that health needs and access to health services varies between different population sub-groups but often to different extents in different locations (10,12,13).…”

“…The Sustainable Development Goal mantra of leaving no one behind, as well as renewed focus from WHO on achieving universal health coverage, mean that political pressure is greater than ever for governments to demonstrate that they are including all members of society in all they do, including health service provision. Population based surveys, including those focused on visual impairment, need to incorporate measures of equity, to ensure that results can be examined by different population subgroups (1,8,10,14).…”

Measuring Equity of Access to Health Services in Practice: Example of Eye Health Outreach Camps in Rural Malawi

“…Data on eye health service coverage in different population sub-groups are also rare. RAABs, which are the main source of population-based data on visual impairment, only recently started collecting data on variables other than sex and age (12). Data from the studies available show that women, people from poorer households and those with additional (non-visual) disabilities are disadvantaged in accessing eye care services.…”

Measuring equity of access to health services in practice: test and application of existing measuring tools in eye health outreach camps in rural Malawi

“…Data on eye health service coverage in different population sub-groups are rare. Rapid Assessments of Avoidable Blindness (RAABs), which are the main source of population-based data on visual impairment, only recently started collecting data on variables other than sex and age (10). Data from the studies available show that women, people from poorer households and those with additional (non-visual) disabilities are disadvantaged in accessing eye care services.…”