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ORIGINAL ARTICLE
Year : 2015  |  Volume : 7  |  Issue : 1  |  Page : 10-12

Barriers to the uptake of cataract surgical services in Sudan: A population based study in Kassala State


1 Faculty of Medicine, Alneelain University, Khartoum, Sudan
2 Department of Contact Lenses, Faculty of Optometry and Visual Science, Alneelain University, Khartoum, Sudan

Date of Web Publication17-Jun-2015

Correspondence Address:
Mustafa Abdu
Faculty of Optometry and Visual Science, Alneelain University, Khartoum
Sudan
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DOI: 10.4103/1858-540X.158990

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  Abstract 

Aim: To determine the barriers to cataract surgery as reported by those with cataract-induced visual impairment in Kassala state, eastern Sudan. Materials and methods: A cross-sectional, population-based survey of people aged 50 years and older. Around 2146 eligible people were identified and 2050 examined (95.5%). Participants with cataract-induced visual impairment (acuity <6/18 in better eye) were also invited to respond to a verbal questionnaire about barriers to cataract surgery. Results: Main barriers for not up-taking cataract surgery services were inability to afford (45.7%), unaware of treatment (14.2%), waiting for maturity (7.1%), contra-indication (7.1%) and unavailability of services (6.3%). Conclusion: Cost and lack of awareness are the most frequent barriers in Kassala state.

Keywords: Barriers, cataract, Kassala, visual impairment


How to cite this article:
Binnawi KH, Abdu M. Barriers to the uptake of cataract surgical services in Sudan: A population based study in Kassala State. Sudanese J Ophthalmol 2015;7:10-2

How to cite this URL:
Binnawi KH, Abdu M. Barriers to the uptake of cataract surgical services in Sudan: A population based study in Kassala State. Sudanese J Ophthalmol [serial online] 2015 [cited 2020 Nov 27];7:10-2. Available from: https://www.sjopthal.net/text.asp?2015/7/1/10/158990


  Introduction Top


A cataract is known to be the major cause of avoidable blindness responsible for about 50% of global blindness [1] and only 5% in the well developed countries. [2] It has been reported that the more developed and economically well-off countries have a predominantly skilled workforce with higher visual demands. Their cataract services are better adapted to meet the needs of the population, and, as a result, there is a lower prevalence of blindness due to cataract. [2],[3]

Several strategies have been proposed after launching of global initiative "Vision 2020" the right to sight. The strategy planned to increase the number of cataract surgeries per year from the 7 million (at present) to 32 million by the year 2020. [3]

Many published data have addressed barriers to cataract surgery (mostly in the developing countries) or the factors that can delay access to cataract surgery. Studies held in South Africa, [4] Ghana, [5] Ethiopia, [6] Nigeria, [7] Nepal, [8] and China [9],[10] have identified cost, fear of surgery, immature cataract, and old age as barriers to or factors against uptake of cataract surgical services.

The WHO estimates for the East Mediterranean Region, which includes Sudan, suggest that the prevalence of blindness is 7% in the population aged 50 years and above. [11] Population-based data in relation to prevalence of blindness in Sudan are rather deficient. The national program for prevention of blindness estimates that 1.5% of the population is blind due to cataract (60%), trachoma (18%), glaucoma (17%), and other diseases including onchocerciasis (5%). [12] Binnawi et al., [13] reported that the main cause of blindness in Sudan is cataract and three-quarters of blindness is due to avoidable causes.

The aim of this study was to determine the barriers to cataract surgery among people with cataract-induced visual impairment in Kassala State, Eastern Sudan


  Materials and methods Top


This study used a cross-sectional, population based survey among people aged 50 years and older in Kassala State, Eastern Sudan. The study conducted between September and November 2009.

A total of 2146 eligible people were identified and 2050 (95.5%) were undergone a careful ophthalmic examinations, while 85 (2.7%) were not available for examinations, 23 (1.15) were not capable, and 14 (0.7%) persons were refused to be checked.

From the total number of the study population, subjects with cataract induced visual impairment regarding best corrected visual acuity (BCVA) (VA <6/18 in better eye) were selected to respond to a verbal questionnaire surveying the barriers to access or reasons that delayed access to cataract surgery.

Ethical approval for this study was granted by the Sudanese Federal Ministry of Health. Prior establishment of examinations, participants were informed in brief about the purpose and procedure of the study.


  Results Top


From the total 2050 subjects (49.50% males and 50.50% females) who undergone Ophthalmic examinations, 272 subjects were found with unilateral blind due to cataract (BCVA <6/60-3/60).

All the 272 were recruited in the second part of the study, and subjected to a verbal questionnaire surveying the barriers of the uptake of cataract surgery. Males/females ratio was found to be 1:0.9. Around 127 (46.7%) subjects were detected with bilateral blindness due to cataract (BCVA <6/60-3/60). Further analysis showed that 58 (21.3%) subjects with males/females ratio of 1:2 had severe unilateral visual impairment (BCVA <3/60), and 18 (6.62%) subjects with males/females ratio of 2:1 had severe bilateral visual impairments (BCVA <3/60). [Table 1] illustrates the clinical profile of the study sample.
Table 1: Clinical profile of the study sample

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The major reasons for not undergoing cataract surgery were inability to afford (45.75), unaware of the treatment (14.2%), wait for maturity (7.1%), contraindications (7.1%), and unavailability of the services (6.3%). [Figure 1] [Figure 2] [Figure 3] [Figure 4] is showing the barriers to uptake cataract surgery in our sample regarding the laterality and severity of the cataract.
Figure 1: Barriers in males and females (bilaterally blind)

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Figure 2: Barriers in males and females (Unilaterally blind)

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Figure 3: Barriers to cataract surgery in persons with bilateral severe visual impairment

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Figure 4: Barriers to cataract surgery in persons with unilateral severe visual impairment

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  Discussion Top


According to the WHO estimates, cataract surgery uptake is lower in Middle East and Africa compared to other developed regions. [3] Many barriers were reported to reduce cataract surgical rates. It have been also reported that lack of awareness, cost of surgery, distance from services, cultural beliefs, escort and fear, immature cataract, and lack of transport were the major barriers against cataract surgery uptake. [6],[14] While these barriers affect both genders, some other studies have reported a more female preponderance. [4],[15] This difference was however not significant in this study.

The cost of cataract surgery was found to be the major (45.7%) barrier to the uptake of cataract surgery in this study. These results are similar to other findings that have already been reported from Ethiopia, [6] Nigeria, [14] South Africa, [4] and India [15] in which the financial limitations of cataract surgical uptake were ranked first, which contributing over 50% of responses.

Lack of information about cataract and its treatment, waiting for maturity, contraindication, and the absence of services were the other factors identified in this study. These findings also concur with other previous studies reported from developing countries as barriers to the uptake of cataract surgery. [4],[6]


  Conclusion Top


The findings from this study are similar to other regions of Africa and developing regions. Poverty and lack of information were the major barriers preventing or delaying access to cataract surgery.


  Acknowledgments Top


The authors of this work would like to thank Dr. Awad Hassan and Dr. Balgis Alshafae from National Program of Prevention of Blindness and Prevention of Blindness team in Sudan.

 
  References Top

1.
Thylefors B, Négrel AD, Pararajasegaram R, Dadzie KY. Global data on blindness. Bull World Health Organ 1995;73:115-21.  Back to cited text no. 1
    
2.
Lawani R, Pommier S, Roux L, Chazalon E, Meyer F. Magnitude and strategies of cataract management in the world. Med Trop (Mars) 2007;67:644-50.  Back to cited text no. 2
    
3.
Wong TY. Cataract surgery programmes in Africa. Br J Opthalmol 2005;89:1231-2.  Back to cited text no. 3
    
4.
Shah A. Barriers to the uptake of cataract surgery for women in urban Cape Town. Community Eye Health 2005;18:80.  Back to cited text no. 4
    
5.
Gyasi M, Amoaku W, Asamany D. Barriers to cataract surgical uptake in the upper East region of Ghana. Ghana Med J 2007;41:167-70.  Back to cited text no. 5
    
6.
Mehari ZA, Zewedu RT, Gulilat FB. Barriers to cataract surgical uptake in central ethiopia. Middle East Afr J Ophthalmol 2013;20: 229-33.  Back to cited text no. 6
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7.
Ukponmwan C, Afekhide OM, Uhunmwangho OM. Reducing the barriers to the uptake of cataract surgical services in a tertiary hospital. Orient J Med 2010;4:16-9.  Back to cited text no. 7
    
8.
Sapkota YD, Pokharel GP, Dulal S, Byanju RN, Maharjan IM. Barriers to up take cataract surgery in Gandaki Zone, Nepal. Kathmandu Univ Med J (KUMJ) 2004;2:103-12.  Back to cited text no. 8
    
9.
Yin Q, Hu A, Liang Y, Zhang J, He M, Lam DS, et al. A two-site, population-based study of barriers to cataract surgery in rural china. Invest Ophthalmol Vis Sci 2009;50:1069-75.  Back to cited text no. 9
    
10.
Li Z, Song Z, Wu S, Xu K, Jin D, Wang H, et al. Outcomes and barriers to uptake of cataract surgery in rural northern China: The Heilongjiang Eye Study. Ophthalmic Epidemiol 2014;21:161-8.  Back to cited text no. 10
    
11.
Resnikoff S, Pascolini D, Etya'ale D, Kocur I, Pararajasegaram R, Pokharel GP, et al. Global data on visual impairment in the year 2002. Bull World Health Organ 2004;82:844-51.  Back to cited text no. 11
    
12.
Five-year National Eye-care Plan (2006-2007). Sudan National Program for Prevention of Blindness; 2006.  Back to cited text no. 12
    
13.
Binnawi KH, Mohammed AH, Alshafae BA, Abdalla Z, Alsanosi M, Ahmed MM, et al. Prevalence and causes of blindness: Results from the rapid assessment of avoidable blindness survey in Gazera State, Sudan. Sudanese J Ophthalmol 2013;5:17-22.  Back to cited text no. 13
  Medknow Journal  
14.
Rabiu MM. Cataract blindness and barriers to uptake of cataract surgery in a rural community of northern Nigeria. Br J Ophthalmol 2001;85: 776-80.  Back to cited text no. 14
    
15.
Brilliant GE, Lepkowski JM, Zurita B, Thulasiraj RD. Social determinants of cataract surgery utilization in south India. The Operations Research Group. Arch Ophthalmol 1991;109:584-9.  Back to cited text no. 15
    


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Abstract
Introduction
Materials and me...
Results
Discussion
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Acknowledgments
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