Razafinimpanana Narivony, Nkumbe Henry, Courtright Paul, Lewallen Susan
SALFA Eye Clinic Sambava, Sambava, Madagascar.
Int Ophthalmol. 2012 Apr;32(2):107-11. doi: 10.1007/s10792-012-9523-7. Epub 2012 Mar 20.
The number of people coming for cataract surgery in Madagascar remains low and most ophthalmologists could do many more surgeries than currently done. Knowing why people identified with cataract do not accept surgery will help to design programs that use existing resources more effectively. The study was carried out in Sava Region of Madagascar. People with blinding (<6/60) cataract were identified by cataract case finders in the community, interviewed, and given a referral card for surgery at the hospital. We then monitored uptake of surgery at the hospital. Overall, 142 people were identified, interviewed and referred. Among the referrals, 35 (24.6%) presented at the hospital for surgery. The most important factors associated with acceptance were proximity to hospital (people from Sambava district were twice as likely to present as people from more distant districts) and perceived price of transport and food (being higher for people not accepting). The actual price of surgery was not the main barrier to acceptance of surgery; instead it appears that distance to the hospital and the willingness to pay are important predictors. Strategies to improve uptake need to be revised in order to ensure that people have access to and use cataract surgical services.
在马达加斯加，前来接受白内障手术的人数仍然很少，大多数眼科医生能够进行的手术量比目前实际开展的手术量要多得多。弄清楚已确诊患有白内障的人为何不接受手术，将有助于设计出能更有效利用现有资源的项目。该研究在马达加斯加的萨瓦地区开展。社区中的白内障筛查人员找出患有致盲性（视力<6/60）白内障的患者，对其进行访谈，并发放医院手术转诊卡。随后，我们对医院的手术接受情况进行了监测。总体而言，共识别出142人，对其进行了访谈并转诊。在这些转诊患者中，有35人（24.6%）到医院接受了手术。与接受手术相关的最重要因素是距离医院的远近（来自桑巴瓦区的人前来就诊的可能性是来自更远地区的人的两倍）以及对交通和食物费用的认知（不接受手术的人认为费用更高）。手术的实际费用并非接受手术的主要障碍；相反，距离医院的远近和支付意愿似乎是重要的预测因素。需要修订提高手术接受率的策略，以确保人们能够获得并利用白内障手术服务。
