Understanding why patients with cataract refuse free surgery: the influence of rumours in Kenya

Abstract

Summaryobjectives To understand the reasons that hinder people from uptake of sponsored cataract surgery. methods A mixed methods (qualitative and quantitative) approach was used. During routine screening activities at Kwale District, Kenya, local residents with visually impairing cataract were clinically assessed and offered free surgery. Interviews were conducted using a semi-structured guide that covered different aspects related to acceptance of cataract surgery including knowledge of others who underwent surgery and their outcome. Analysis focused on differences between people accepting and people refusing surgery and the reasons for non-acceptance of surgery.results Ninety interviews were conducted, 48 with people accepting and 42 with people refusing free surgery. Those who accepted surgery generally reported good outcome in others, while people who refused surgery often reported to know someone who worsened or even become blind after surgery. Many of these 'failed cases' were prominent figures in the local community, and most of them had already died. Glaucoma was the single most common underlying medical condition. On being re-interviewed, several people admitted that they had actually never met someone who had unsuccessful surgery but only heard rumours.conclusion In Africa, a rumour of blinding eye surgery is not uncommonly being used by patients to justify their refusal to have cataract surgery. Underlying reasons appear to be related to shame, fear of surgery or missing social support. Improved awareness of the general population regarding eye conditions and their management, involvement of the family and local community in decision making, good surgical outcomes and appropriate counselling are possible methods to enhance acceptance.

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

“…5 This encouraging change can be attributed to the significant changes made at Nkhoma based on the Vision 2020 cataract services management principles for cataract case finding and improving efficiency of service delivery. 12 This increase in cataract surgery output has been achieved by active case finding; partnership with local community-based rehabilitation program, MACOHA (Malawi Council for the Handicapped), and constant support from an international NGO allowing free hospital arranged transport, accommodation and surgery. Internal management changes also ensured higher efficiency in utilizing available infrastructure and human resources.…”

Surgeons' opinions and practice of informed consent in Nigeria

“…From experience, old age, a poor prognosis and fear are some of the reasons why some patients or their families decline to provide consent for surgical operations. In Kenya, Briesen et al reported that the rumour that those who had cataract surgery would be blind prevented many people with cataract from consenting for free surgery 14. However, it was discovered during interview of these patients that none of them had actually seen anyone blind after surgery but that they heard about it from people who also had heard about it from other people.…”

The challenges in improving outcome of cataract surgery in low and middle income countries

“…[33] While this is only one of several reasons for refusing surgery it is important for service providers to maximize good outcomes so rumors such as this are minimized.…”