Assessing the cataract surgical rate and gender equity in cataract services in south-east Nigeria

• Published in: BMJ open ophthalmology Vol. 9; no. 1; p. e001326
• Main Authors: Onyia, Onyinye, Aghaji, Ada Ejealor, Ubaka, Christiana, Achigbu, Eberechukwu Ogbeanu, Ejiakor, Ifeoma Lilian, Mbatuegwu, Adaku I, Okeke, Chiamaka J P, Okoli, Barbara C, Ogborogu, Emmanuel U, Dike, Kenneth C, Nkwogu, Florence U, Gilbert, Clare
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 31.07.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Adult; Age; Aged; Aged, 80 and over; Blindness; Blindness - epidemiology; Blindness - etiology; Cataract; Cataract - epidemiology; Cataract Extraction - statistics & numerical data; Cataracts; Epidemiology; Eye surgery; Female; Gender differences; Gender Equity; Global Ophthalmology; Health facilities; Health Services Accessibility - statistics & numerical data; Hospitals; Humans; Industrialized nations; Male; Medical personnel; Middle Aged; Nigeria - epidemiology; Observational studies; Older people; Original Research; Outreach services; Patients; Population; Public health; Rehabilitation; Retrospective Studies; Rural areas; Sex Distribution; Surgical outcomes; Treatment Surgery; Urban areas; Visual impairment; Women; Nigeria; Africa; Cataract; Rehabilitation; Epidemiology; Public health; Treatment Surgery
• ISSN: 2397-3269; 2397-3269
• DOI: 10.1136/bmjophth-2023-001326

BackgroundIn 2020, almost 100 million people were blind or visually impaired from cataract. Cataract surgery is a cost-effective treatment for cataracts. In Nigeria, twice as many women are cataract blind as men. Cataract surgical rate (CSR, the number of cataract operations per million population per year in a defined geographical location) is an output indicator of cataract surgical services. The recommended target CSR for sub-Saharan Africa is 1000/year. The aim of this study was to assess the CSR in men and women in Imo state, Nigeria.MethodsA retrospective review of cataract surgery undertaken in all eye health facilities in Imo State in 2019. Data collected included the type and location of facilities, patient demographics and the number and type of cataract operations performed in each facility. The CSR was calculated overall, in men and women, and in younger and older women.ResultsThe CSR overall was 330/million and was slightly higher in women (347/million) than in men (315/million) (p<0.001). More elderly women (≥65 years) accessed cataract surgery through outreach than men and younger women (OR 1.5 (95% CI 1.03 to 2.22, p=0.03) and 1.6 (95% CI 1.07 to 2.44, p=0.02)), respectively.ConclusionThe overall CSR in Imo state was approximately one-third of that recommended for sub-Saharan Africa. Although the CSR was higher in women than in men, considerably higher CSRs are needed in women to address their higher burden of cataract blindness. Operational and intervention science research are needed, to identify and evaluate interventions which address demand and supply barriers to accessing cataract surgery, particularly for elderly women.