Guy's and St Thomas' NHS Foundation Trust, London, UK.
Disabil Rehabil. 2013 Sep;35(19):1660-7. doi: 10.3109/09638288.2012.748843. Epub 2013 Jan 23.
Cataract is the leading cause of blindness worldwide, and is particularly common in low- and middle-income countries. Our study aims to identify the predictors for and barriers to acceptance of cataract surgery in Kenya, Bangladesh and the Philippines.
Cases were individuals aged ≥50 years and with best corrected VA of <6/24 in the better eye due to cataract who were identified through population-based surveys and community-based case detection. Cases were asked why they had not attended for surgery. They were offered free cataract surgery and followed-up at one year. Non-acceptors were interviewed to identify barriers to accepting surgery.
Of all participants, 58.6% attended for cataract surgery in Kenya, 53.9% Bangladesh and 47.1% the Philippines. Younger age was a predictor for attendance for surgery in all three countries. In Bangladesh and Kenya, male gender and psychosocial score were predictors. At baseline "cost" and "unaware of cataract" were most frequently reported barriers to uptake of surgery in the three settings. At follow-up, "surgical services inaccessible" was one of the two most frequently reported barriers in Kenya and the Philippines while "fear" was most frequently reported in Bangladesh and the Philippines. There were no consistent predictors of the most frequently reported barriers across the different settings.
Future services need to focus on increasing uptake among older people and women. Cost is often reported as a barrier but this may conceal more complicated underlying barriers which need to be explored through in-depth qualitative research.
Cataract is the leading cause of blindness worldwide, and is particularly common in low- and middle-income countries. Evidence suggests that even when surgical services are available, there can be a lack of demand and low utilization resulting from barriers to uptake. Older cataract patients, females and especially older females are least likely to attend for surgery. Future cataract surgical programmes should put special emphasis on targeting and increasing uptake in these groups.
白内障是全球致盲的主要原因，尤其在中低收入国家较为常见。本研究旨在确定肯尼亚、孟加拉国和菲律宾接受白内障手术的预测因素和障碍。
通过基于人群的调查和基于社区的病例发现，确定符合以下条件的病例：年龄≥50 岁，最佳矫正视力（BCVA）<6/24 的单眼白内障患者。询问他们未接受手术的原因。为他们提供免费的白内障手术，并在一年后进行随访。对未接受手术者进行访谈以确定手术接受的障碍。
在所有参与者中，58.6%的肯尼亚人、53.9%的孟加拉国人、47.1%的菲律宾人接受了白内障手术。在所有三个国家中，年龄较小是接受手术的预测因素。在孟加拉国和肯尼亚，男性和心理社会评分是预测因素。在基线时，“费用”和“不知道白内障”是三个地区最常报告的手术接受障碍。在随访时，“手术服务不可及”是肯尼亚和菲律宾两个最常报告的障碍之一，而“恐惧”是孟加拉国和菲律宾最常报告的障碍之一。在不同的环境中，没有一致的预测因素可以预测最常报告的障碍。
未来的服务需要重点关注增加老年人和女性的参与度。费用通常被报告为障碍，但这可能掩盖了更复杂的潜在障碍，需要通过深入的定性研究来探索。
白内障是全球致盲的主要原因，尤其在中低收入国家较为常见。有证据表明，即使手术服务可用，由于接受手术的障碍，也可能存在需求不足和利用率低的情况。年长的白内障患者、女性，尤其是年长的女性，最不可能接受手术。未来的白内障手术计划应特别注重针对这些群体并增加其参与度。
