Changing patterns of cataract services in North-West Nigeria: 2005–2016

Abstract

PurposeThis study was conducted to assess the impact of the eye care programme on cataract blindness and cataract surgical services in Sokoto, Nigeria over a 12 year period 2005–2016.MethodsData from the 2005 population based cross-sectional study of blindness in Sokoto state was re-analysed to obtain baseline estimates of the prevalence of cataract blindness and cataract surgical coverage for persons 50 years and over in Wurno health zone. A population based survey of a representative sample of persons 50 years and over in Wurno health zone was conducted in July 2016. Data on eye health workforce, infrastructure and cataract surgical services between 2005 and 2016 were analysed from relevant documents.ResultsIn 2005 the unadjusted prevalence of bilateral cataract blindness (<3/60) in people 50 years and over in Wurno health zone was 5.6% (95% CI: 3.1, 10.1). By 2016 this had fallen to 2.1% (95% CI 1.5%, 2.7%), with the age-sex adjusted prevalence being 1.9% (95% CI 1.3%, 2.5%). The CSC for persons with visual acuity <3/60, <6/60, <6/18 for Wurno health zone was 9.1%, 7.1% and 5.5% respectively in 2005 and this had increased to 67.3%, 62.1% and 34.7% respectively in 2016. The CSR in Sokoto state increased from 272 (1005 operations) in 2006, to 596 (2799 operations) in 2014. In the 2005 survey, couching (a procedure used by traditional practitioners to dislocate the lens into the vitreous cavity) accounted for 87.5% of all cataract interventions, compared to 45.8% in the 2016 survey participants. In 2016 18% of eyes having a cataract operation with IOL implantation had a presenting visual acuity of <6/60 (poor outcome) with the main causes being postoperative complications (53%) and uncorrected refractive error (29%).ConclusionBetween 2005 and 2016 there was a doubling in cataract surgical rate, a 7 times increase in cataract surgical coverage (<3/60), and a decrease in cataract blindness and the proportion of eyes being couched. However, there remains a high prevalence of un-operated cataract in 2016 indicating a need to further improve access to affordable and good quality cataract surgical services.

Prevalence and causes of blindness and visual impairment; and cataract surgical services in Katsina state of Nigeria

“…The visual outcome with available correction in pseudophakic eyes is comparable to the finding in nearby districts of Sokoto state (18% poor outcome). 19 But the major causes of poor outcome in this study including couched eyes were ocular comorbidity, surgery-related complications and uncorrected refractive error. There is a need for the proposed eye care programme to support surgeons on appropriate patient selection, institute cataract services self-auditing and refresher courses to reduce on August 16, 2020 by guest.…”

Strengths, challenges and opportunities of implementing primary eye care in Nigeria

“…These were integrated into PHC activities in the states. An evaluation of the Sokoto eye-care programme shows that although the prevalence of unoperated cataract remains high, there has been a sevenfold increase in cataract surgical coverage (the proportion of people who have received cataract surgery as a percentage of all those who could have benefited from cataract surgery) and a doubling of the cataract surgical rate (he number of cataract operations performed per million population/year) since the inception of the programme 25. Again, this was part of a comprehensive blindness reduction strategy and the contribution of PEC could not be ascertained.…”

Optimizing Outcome of Cataract Surgery in Resource Scarce Sub-Saharan Africa

“…• Collaborative long-term partnership, strengthening of local eye care teams, and sustained intervention program appear to yield better cataract prevention services in sub-Saharan African setting [48].…”