Interventions to improve access to cataract surgical services and their impact on equity in low- and middle-income countries

Ramke, Jacqueline; Petkovic, Jennifer; Welch, Vivian; Blignault, Ilse; Gilbert, Clare; Blanchet, Karl; Christensen, Robin; Zwi, Anthony B.; Tugwell, Peter

doi:10.1002/14651858.cd011307.pub2

Cited by 27 publications

(26 citation statements)

References 44 publications

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“…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).…”

Section: Discussionsupporting

confidence: 92%

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

Jolley¹,

Cumaio²,

Vilanculos³

et al. 2020

Preprint

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Abstract Background Globally, there are few examples of repeated eye health surveys to assess changes in prevalence and causes of visual impairment, and service coverage over time. Two separate, unlinked rapid assessments of avoidable blindness (RAAB) were conducted in Nampula province, Mozambique in 2011 and 2018. This paper reports the observed changes and examines how the trends differ for males and females. Methods Standard RAAB methodology was used in both studies. Two-stage cluster sampling was used to generate random samples of adults aged over 50 years. Participants underwent a simplified visual acuity exam focusing on presenting and pinhole visual acuity (VA), a lens exam and posterior segment exam using a direct ophthalmoscope for all subjects with presenting VA < 6/18. Data were analysed using Stata and logistic regression models were developed to assess changes. Results The 2011 study enrolled 3,050 people and examined 96.9% (2,954 people). The 2018 survey enrolled 4,191 people and examined 95.8% (4,015 people). Age and sex adjusted estimates of blindness decreased from 6.2% in 2011 to 4.5% in 2018 (z=-2.21, p = 0.028), severe visual impairment remained the same (2.6% in 2011 and 2.7% in 2018, z = 0.1, p = 0.9) and moderate visual impairment increased (5.9% in 2011 to 11.0% in 2018, z = 5.78, p < 0.001). Cataract surgical coverage was higher among males in both surveys (13.4% among males vs 7.7% among females in 2011, and 40.0% among males vs 19.4% among females in 2018) and the gender disparity grew between surveys. Conclusions Significant changes were observed in the eye health and service coverage between 2011 and 2018. An increase in the proportion of good visual acuity among operated eyes between the surveys is of note and may correspond with improvements made to the services provided in the province. Further improvements to services are required to improve access for women and people with moderate visual impairment.

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Section: Discussionsupporting

confidence: 92%

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

Jolley¹,

Cumaio²,

Vilanculos³

et al. 2020

Preprint

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“…More efforts are needed to address inequitable access to eye care and the barriers faced by older people in rural areas. Ramke et al (2014) provide a useful framework. Ageist attitudes remain a problem.…”

Section: Barriers To Receiving Eye Care Servicesmentioning

confidence: 99%

“…The views of those most directly affected can help to inform policies and plans regarding the allocation of resources, encouragement to elders to seek vision care, and strengthening of equitable eye health care systems (Ramke et al, 2014). During focus group discussions (FGDs) for the Better Vision Healthy Ageing Program in the Nuwara Eliya district of Sri Lanka, we explored the impact of poor vision in old age, the barriers older people face in accessing vision care services, and their suggestions to overcome these.…”

Section: Introductionmentioning

confidence: 99%

Impact of vision impairment and self-reported barriers to vision care: The views of elders in Nuwara Eliya district, Sri Lanka

Holmes

Shajehan

Kitnasamy

et al. 2016

Global Public Health

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“…This systematic review aimed to synthesise all available evidence on the uptake of cataract surgeries in LMICs, including reported uptake rates, factors influencing the uptake and interventions reported to improve it. The review builds on two other systematic reviews [23] and [24], which investigated interventions to improve equity in eye care. Although this study expands upon the findings of those reviews by including studies with a broader range of methodological approaches, the lack of robust intervention studies remains a major weakness in this area.…”

Section: Discussionmentioning

confidence: 99%

“…There is also an urgent need to identify interventions that work to address these barriers and increase surgery uptake [ 19 – 22 ]. Several studies have been conducted to identify such interventions, and in 2018, Ramke et al published a systematic review, which examined strategies to reduce eye health inequalities through cataract interventions focusing on disadvantaged groups [ 23 ]. The eligibility criteria for their review included randomised controlled trials (RCTs), quasi-experimental studies, before and after designs and time-series.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with the uptake of cataract surgery and interventions to improve uptake in low- and middle-income countries: A systematic review

Mailu¹,

Virendrakumar²,

Bechange³

et al. 2020

PLoS ONE

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Despite significant evidence around barriers hindering timely access to cataract surgery in low-and middle-income countries (LMICs), little is known about the strategies necessary to overcome them and the factors associated with improved access. Despite significant evidence that certain groups, women for example, experience disproportionate difficulties in access, little is known about how to improve the situation for them. Two reviews were conducted recently: Ramke et al., 2018 reported experimental and quasi-experimental evaluations of interventions to improve access of cataract surgical services, and Mercer et al., 2019 investigated interventions to improve gender equity. The aim of this systematic review was to collate, appraise and synthesise evidence from studies on factors associated with uptake of cataract surgery and strategies to improve the uptake in LMICs. We performed a literature search of five electronic databases, google scholar and a detailed reference review. The review identified several strategies that have been suggested to improve uptake of cataract surgery including surgical awareness campaigns; use of successfully operated persons as champions; removal of patient direct and indirect costs; regular community outreach; and ensuring high quality surgeries. Our findings provide the basis for the development of a targeted combination of interventions to improve access and ensure interventions which address barriers are included in planning cataract surgical services. Future research should seek to examine the effectiveness of these strategies and identify other relevant factors associated with intervention effects.

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Interventions to improve access to cataract surgical services and their impact on equity in low- and middle-income countries

Cited by 27 publications

References 44 publications

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

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

Impact of vision impairment and self-reported barriers to vision care: The views of elders in Nuwara Eliya district, Sri Lanka

Factors associated with the uptake of cataract surgery and interventions to improve uptake in low- and middle-income countries: A systematic review

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