Cataract-Related Visual Impairment and Cataract Surgery: Geographic Disparities Between Five Sudanese States Pubblico
Lichtenstein, Meredith Leslie (2012)
Published
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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