Cataract-Related Visual Impairment and Cataract Surgery: Geographic Disparities Between Five Sudanese States Público

Abstract

Objective: To determine the differences in the prevalence and leading causes of bilateral blindness and visual impairment, barriers to cataract surgery, and cataract surgical coverage between Kassala, Northern, North Kordofan, Sennar, and White Nile states in Sudan.
Methods: The Rapid Assessment of Avoidable Blindness (RAAB) survey methodology, a multistage cluster sampling design, was utilized to gather data on visual acuity, causes of vision loss, reasons for untreated cataract, and details about past cataract surgeries. Data were analyzed using SAS-Callable SUDAAN.
Results: A total of 10,499 eligible subjects were included in the analysis, and 550 suffered from bilateral vision loss. The prevalence of bilateral blindness ranged from 6.34 cases per 1,000 people in the Northern state to 13.10 cases per 1,000 people in Kassala. Cataract was the leading cause of all levels of vision loss in each state, and more than 80% of blindness and 85% of vision loss could have been avoided. Cost was the most popularly reported barrier to cataract surgery. Other important barriers included absence of surgical services, no knowledge of treatment, and awaiting cataract maturity. Cataract surgical coverage rates were moderate in each state, the lowest in Kassala and the highest in the Northern state. IOL implant surgery was most widely performed. Most cataract surgeries were performed in government hospitals, and eye camps and improvised settings were significantly more likely to provide surgical services free of charge. Patient satisfaction was significantly correlated with the type of surgery received.
Conclusions: Further efforts are needed in Sudan to help reach the goal of the VISION 2020 initiative to eliminate all avoidable global blindness. Based on the barriers to cataract surgery, educational efforts should target visually impaired groups to increase knowledge of treatment options and access to surgical services. Hospitals should work closely with community ophthalmology organizations to offer and promote discounted surgical services. Finally, to prevent further disparities between cataract surgery qualities, traditional surgery settings and couching practices should be the target of future interventions.

Table of Contents

TABLE OF CONTENTS
BACKGROUND...1
METHODS...9
RESULTS...17
DISCUSSION...22
REFERENCES...27
TABLES...30
APPENDIX A...40
APPENDIX B...41

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Palabra Clave	RAAB methodology Cataract Sudan Cataract Surgery Cataract surgical barriers Avoidable Blindness
Committee Chair / Thesis Advisor	Drews-Botsch, Carolyn D, Emory University
Committee Members	Lewallen, Susan, KCCO
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti) International Non-governmental organization (e.g., CARE, Inc.)

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