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International Health, 2021
Background: Cataract is a major cause of visual impairment globally, affecting 15.2 million people who are blind, and another 78.8 million who have moderate or severe visual impairment. This study was designed to explore factors that influence the uptake of surgery offered to patients with operable cataract in a free-of-charge, community-based eye health programme. Methods: Focus group discussions and in-depth interviews were conducted with patients and healthcare providers in rural Zambia, Kenya and Uganda during 2018-2019. We identified participants using purposive sampling. Thematic analysis was conducted using a combination of an inductive and deductive team-based approach. Results: Participants consisted of 131 healthcare providers and 294 patients. Two-thirds of patients had been operated on for cataract. Two major themes emerged: (1) surgery enablers, including a desire to regain control of their lives, the positive testimonies of others, family support, as well as free surgery, medication and food; and (2) barriers to surgery, including cultural and social factors, as well as the inadequacies of the healthcare delivery system. Conclusions: Cultural, social and health system realities impact decisions made by patients about cataract surgery uptake. This study highlights the importance of demand segmentation and improving the quality of services, based on patients' expectations and needs, as strategies for increasing cataract surgery uptake.
British Journal of Ophthalmology, 2005
Aims: To describe and understand better the barriers that elderly cataract patients in Kilimanjaro region (Tanzania) experience at the family level in order to access surgery. Methods: A phenomenological study carried out in the catchment area of a teaching hospital in Kilimanjaro Region. 60 semi-structured interviews were conducted with patients and ex-cataract patients. Results: The perceived need for sight and for surgery appears partly socially constructed at the family level. It was found that women were less likely to express a need for sight for fear of being seen as a burden. Furthermore, young heads of family are more inclined to support old men than old women. The consensus is that asking children for help can be difficult. Going for cataract surgery must be seen as a social process where elderly patients might have to wait or negotiate support for weeks, months, or even years. Conclusions: Eye programmes must promote the benefits of cataract surgery to all family members, not just to the patient. A changing social climate, changing expectations of vision, and evolving cost sharing systems will have significant, sometimes contradictory, impacts on use of eye care services. Strategies for reaching those without access to financial resources need to be strengthened.
Social Science & Medicine, 2008
Cataract is the leading cause of avoidable blindness in Africa. There are various documented barriers to the uptake of cataract surgery, cost being one of them. There is, however, little evidence regarding the patients' willingness to pay for cataract surgery in Africa. Decision-makers often set the price of cataract surgery arbitrarily without a clear understanding of the long term impact of their policies on access and the sustainability of eye care programs. We conducted a grounded theory study in order to understand better cataract patients' willingness to pay (WTP) for surgery in Tanzania. A total of 47 cataract patients from three regions of Tanzania were interviewed. The interviews were tape-recorded and transcribed verbatim. The coding process involved identifying emerging themes and categories and their interconnection. Our study reveals that the main factors behind patients' WTP for cataract surgery are 1) the level of perceived need for sight and cataract surgery; 2) the decision-making processes at the family level and 3) the characteristics of local eye care programs. Our study shows that WTP concerns not only the patients but also their relatives. For most patients and families, the amount of 20−20-20−30 is deemed reasonable for a sight-restoring procedure. It does not appear realistic for eye care program managers to charge the real cost of cataract surgery at present ($60USD). However, eye care programs can influence WTP for cataract surgery by providing quality services and by offering adequate counseling about the procedure.
Health, 2013
Background: Late presentation to the hospital and poor post-operative follow-up after cataract surgery are associated with complications which compromise visual recovery and perpetuate disability among children with cataract. The objectives of the study were to understand the social, psychological and physical consequences of blindness in families, to understand why some parents with blind children access services and others do not, and to explore factors related to decision making within families that prevent access to health care services. Methodology: A mixed methodology quantitative and qualitative community study of blindness in children conducted in southern Malawi to compare "Doers": families with blind children from the same communities who had attended cataract surgical services with "Non-doers" versus families with blind children from the same communities who had not attended services. Individual, family, community socio-cultural and economic characteristics and other qualitative data on knowledge, perceptions, and beliefs were recorded and analyzed thematically, based on grounded theory. Results: A total of 53 in-depth interviews of parents; 21 in-depth interviews of children; 15 focus group discussions with community members; 62 children's clinical eye examinations, and 4 case studies were conducted over the study period. Doer families were likely to have a reliable source of income, have better housing and live closer to health centres than non-doer families. Visual acuity among doers was better than non-doers. Conclusion: This research has highlighted reasons why some families who have children with cataract are likely to be delayed to seek surgical intervention. Comprehensive counseling modules targeting such families need to be developed to increase acceptance and access to children's cataract surgical services.
British Journal of Ophthalmology, 2005
Background: The numbers of cataract surgeries done in sub-Saharan Africa fall short of Vision 2020 targets. Over a few years, two programmes in rural east Africa both achieved significant increases in the number of cataract surgeries they provide, resulting in cataract surgical rates of 1583 for Kwale District in Kenya and 1165 for Kilimanjaro Region in Tanzania. Key components of success in these two programmes are described. Methods: Data were collected on standard indicators and key personnel interviewed to describe the results and compare the methods employed to increase cataract surgical rates by the Kwale District Eye Centre programme and the Kilimanjaro regional Vision 2020 programme. Results: Key components of success shared by the programmes included: (1) programmes in the community and at the hospital are closely linked so that they increase capacity together; (2) community programmes are ''patient friendly,'' providing service in one stop; (3) the examination team includes eye workers with enough skill to provide treatment and decide who is operable so that patients are not transported needlessly or sent through a lengthy referral chain; (4) sites for visits in the community are selected according to population distribution and they are visited according to a regular schedule. Conclusion: The development of ''bridging strategies'' that create a strong link between hospitals providing clinical service and communities needing these services is a key component to realising Vision 2020 goals in sub-Saharan Africa.
Socio-demographic Determinants of Patients Accessing Free Cataract Surgical Services in Uyo, Nigeria
Globally, cataract blindness is the commonest, yet surgical intervention as a means of treatment is one of the most rewarding surgical interventions known because of the expected good visual outcome. Sadly, there are certain undetermined factors militating against accessing cataract surgeries. In our locality, no study has explored these factors. The objective of the study was to determine socio-demographic factors common to patients who had free cataract surgeries during an Eye Camp in Uyo, Nigeria. The study design was prospective and non-randomized of individuals who had free cataract surgeries during the period. During the one month program, Two Hundred and Fifty Three patients (n = 253) were operated upon; 146 (57.7%) were males and 107 (42.3%) were females with a mean age 59.50±14.1. Most participants were rural dwellers (152; 60.1%). Financial handicap was the commonest reason for delay in accessing cataract surgical services. In conclusion: Poor financial status of the participants was the main reason for delay in accessing treatment for cataract. Other identified barriers to cataract service uptake were fear of surgical outcome and non-maturity of cataracts. Keywords: Socio-demographic determinants, Cataract-blindness, Uyo
Barriers to Uptake of Free Pediatric Cataract Surgery in Malawi
Ophthalmic Epidemiology, 2014
Purpose: To examine the demographic, sociocultural and socioeconomic factors that prevent families of cataract blind children from accepting free pediatric cataract surgery in Malawi. Methods: A total 58 parents of 62 children were recruited into the study. Of these, 53 parents partook in in-depth interviews and focus group discussions after the children were screened and the parents offered free cataract surgery. Overall, 37 parents accepted (acceptors) and 16 parents did not accept (non-acceptors) cataract surgery. All interviews were transcribed and iteratively analyzed. Household economic status was quantified using the Progress out of Poverty Index for Malawi. Results: Acceptors were better off economically (p = 0.13). Understanding of cataract, its causing blindness and impairment, as well as treatment options, by the decision makers in the families was poor. Decision-making involved a complex array of aspects needing consideration before accepting, of which distance to the health facility was a frequently mentioned barrier. Non-acceptors were more likely to come from twice the distance compared to acceptors (p = 0.0098). Non-acceptors were more likely to be peasant (subsistence) farmers than acceptors (p = 0.048). Non-acceptors were more likely to live in a house made of mud bricks with a roof of grass thatch (p = 0.001). There was no significant difference in acceptance rate between educated and non-educated mothers (p = 0.11). Intensive counseling as provided in this project increased the likelihood of accepting surgery. Conclusion: Economic hardship and long distances to health facilities decrease acceptance even of free pediatric cataract surgical services, highlighting that just providing surgery free of cost may not be sufficient for the most economically disadvantaged in rural Africa.
2019
Background Studies in South Africa showed that cataract was the second leading cause of blindness and the leading single cause of severe visual impairment. People living in the rural and remote areas of the world are usually of lower socio-economic status and therefore lack the opportunity to utilize eye care services adequately which could result to lack of knowledge regarding cataract surgery. The primary aim of the current study was to increase a better understanding of eye health inequalities in Limpopo province with specific reference to cataract surgery and care. The study sought to answer a central question “What are the barriers related to the uptake of cataract surgery and care in Limpopo. Methods This study used qualitative and descriptive designs through exploring barriers related to the uptake of cataract surgery and care from professional nurses’ perspective. The target population comprised of 20 ophthalmic supportive staff. A non-probability, purposive sampling was app...
Willingness to pay for cataract surgery in two regions of Tanzania
British Journal of Ophthalmology, 2006
Background: Knowing what rural populations are willing to pay for cataract surgery is essential if improvements in cost recovery in eye care service provision programmes are to take place. The authors sought to learn about willingness to pay for cataract surgery in two separate regions of Tanzania. Methods: Patients desiring cataract surgery were interviewed in Kilimanjaro Region and Iringa Region of Tanzania to learn how much they and their families were willing to pay for surgery and how ''wealthy'' (using ownership of several household objects as a proxy for wealth) the household was. Results: 60 cataract patients in Kilimanjaro and 49 in Iringa were interviewed. ''Wealth'' was significantly associated with willingness to pay in each region. The average expressed willingness to pay was 2457 Tsh (SD 4534) or approximately $US 2.30, which is far below the actual cost of providing the service. Conclusion: There were significant differences in the expressed willingness to pay between Iringa and Kilimanjaro patients, which may reflect differences in the services provided in the regions. Willingness to pay may increase as the population gains familiarity and trust in the service. It may also be increased by ensuring that pricing is uniform and clearly advertised throughout regions and by educating health workers and counselling patients about the real costs of providing high quality surgery. Offering ''free'' services to all may result in lower expressed willingness to pay.
Barriers to Cataract Surgery in Africa: A Systematic Review
Middle East African Journal of Ophthalmology, 2015
Background Cataract remains the leading cause of blindness in Africa. We sought to review the available literature relating to barriers to cataract surgery in Africa. Methods A review of the literature was undertaken using PubMed and Google Scholar using the search terms "barriers, cataract, Africa, cataract surgery, cataract surgical coverage (CSC), and Rapid Assessment of Avoidable Blindness (RAAB)". The review covered the period 1999-2014. Results In RAABs, barriers related to awareness and access were more commonly reported than acceptance, while non-RAAB studies reported cost as the most commonly reported barrier. The few qualitative studies tended to report community and family dynamics with regard to barriers to cataract surgery. CSC was reported as lower in females in 88.2% of the studies. Conclusion Studies of barriers to cataract surgery give variable responses. This may be due to the study context but also may be due to the type of data collection. It is likely that qualitative data will give a deeper understanding of the complex social, family, community, financial and gender issues relating to barriers to uptake of cataract surgery in Africa.