ABSTRACT

CORRESPONDING AUTHOR:
Dr. Roshan Chanchlani,
1/6 – IdgahKothi,
Doctor’s Enclave,
Near Filter Plant,
Idgah Hills, Bhopal – 462001,M. P.
E-mail: roshanchanchlani@gmail.com

ABSTRACT: INTRODUCTION: Blindness is one of the significant social problems in India with 7 million of the total 45 million blind people in the world residing in our country. Apart from health and status of vision, there are many other socio-economic factors and perceptions, which influence the decision making of the people for getting operated for cataract. But very few studies have been done on the social factors influencing the utilization of cataract surgery. MATERIAL AND METHODS: It was a hospital-based, descriptive study. The study subjects were recruited from the Ophthalmology department from cataract camp held in Chirayu medical College, Hospital during October 2013 to January 2014. RESULTS: In present study, insufficient family income and no one to accompany (60% and 10%) was responded by majority of the subjects. In present study, the barriers for delayed utilization of cataract surgery like could manage to do daily work was responded by 513 (85.5%) out of total 600 subjects, could see with the other eye clearly 470 (78.3%), busy with work 118 (19.6%), being female70 (11.6%), fear of surgery 115 (19.1%), old age 200 (33.3%), fear that surgery could lead to loss of eyesight 55 (9.1%), it was Gods will 35 (5.8%), fear about the cost of surgery 375 (62.5%) and fear that surgery could lead to death was responded by 15 (2.5%) out of total 600 subjects. CONCLUSION: Expansion of outreach programmes to different communities rather than concentrate in urban areas, and offering cataract surgical services at affordable rates will also be of help. Health Education has a great role to play as well, especially in creating awareness. Adequate dissemination of information through various media is usually will be very helpful.

KEYWORDS: Cataract surgery, Eye camp, Barriers, Utilization.

INTRODUCTION: Blindness is an increasing problem affecting almost 50 million people worldwide. The majority of them live in Asia and Africa (India 23.5 %, China 17.6 %, Sub- Saharan Africa 18.8 %).¹ Almost 80 % chances of developing these kinds of blindness are either preventable or curable. Blindness is one of the significant social problems in India with 7 million of the total 45 million blind people in the world residing in our country.² Prevalence of blindness ³ was found to be 1.49%, with cataract contributing to 77% of it. With the increasing life expectancy and expanding population, the number of cases is expected to increase in the near future. This increase is due to increasing life expectancy of human population in the world and due to barriers preventing them seeking eye care service. Cataract though avoidable remains as leading cause of blindness responsible for approximately 50%⁴ of worldwide blindness and is curable. There are 20 million cataract blind people estimated in the world and the numbers are increasing despite of 7 million cataract sight restoring surgery performed per year.⁵

Strategy for reducing cataract backlog includes increasing the number of cataract surgeries performed. However, despite the rapid increase in the availability of quality services, surgical feasibility is still low in India. Apart from health and status of vision, there are many other socio-economic factors and perceptions, which influence the decision making of the people for getting operated for cataract. But very few studies have been done on the social factors influencing the utilization of cataract surgery. Knowledge about these factors can improve the operational efficiency to reduce the prevalence of blindness to 0.5% by the year 2010 as aimed by NHP 2002.² Few studies, mostly from developing countries, have addressed barriers to cataract surgery or the factors that delay access to cataract.^{6, 7} Studies from Ghana, East Africa, Myanmar, and India have identified cost, accompanying problems, gender, fear of surgery, coping ability, immature cataract, too busy, old age, lack of transport, and long distances to the hospital as barriers to or factors against uptake of cataract surgical services. This study is an attempt to identify the socioeconomic factors influencing the utilization of cataract surgery and the factors motivating the patients to utilize the services.

MATERIAL AND METHODS: It was a hospital-based, descriptive study. The study subjects were recruited from the Ophthalmology department from cataract camp held in Chirayu medical College, Hospital during October 2013 to January 2014. The Inclusion criteria were consecutive patients, aged 45 years or above, with vision <20/60, the principal cause was cataract. Patients who did not give consent to participate were excluded.

After Institutional Ethical Committee approval, patients were briefed in appropriate local language about the purpose and procedure of the study. Socio-demographic data were noted on a proforma and included age, gender, rural or urban residence, literacy, and socio economic status. Socio-economic status was determined as per the B. G. Prasad’s method for social classification of family.⁸A questionnaire surveying knowledge about cataract and barriers to acceptance of cataract surgery was administered after written informed consent, in the local language (Hindi). The questions on barriers were devised from the existing literature and required yes/no responses only. Barriers relating to patient attitude, service delivery, cost, and affordability were investigated.^9-12The interviews were conducted in a separate room away from relatives and other patients.

The diagnosis of cataract was based on torchlight and distant direct ophthalmoscopy. Vision was assessed by Snellen's chart and the World Health Organization definitions of normal vision (best corrected visual acuity (BCVA) ≥20/60 in the better eye), visual impairment (BCVA <20/60 but ≥/10/200 in the better eye), and blindness (BCVA <10/200 in the better eye) were used.¹³ Data were entered into an excel worksheet and was calculated using the statistical package SPSS-20.

RESULTS: The study included 600 patients (255 men and 345 women), with age ranging from 45-81 years (median 61 years). The socio-demographic and other characteristics of the patients are given in Table no. 1. Patients had known that they had cataract for periods varying from 6 month to 12 years.

In present study, insufficient family income and no one to accompany (60% and 10%) was responded by majority of the subjects, when the patients were asked about the barriers for delayed utilization of cataract surgery. Barriers relating to service delivery, cost, and affordability are given in Table no. 2.

In present study, the barriers for delayed utilization of cataract surgery like could manage to do daily work was responded by 513 (85.5%) out of total 600 subjects, could see with the other eye clearly 470 (78.3%), busy with work 118 (19.6%), being female70 (11.6%), fear of surgery 115 (19.1%), old age 200 (33.3%), fear that surgery could lead to loss of eyesight 55 (9.1%), it was Gods will 35 (5.8%), fear about the cost of surgery 375 (62.5%) and fear that surgery could lead to death was responded by 15 (2.5%) out of total 600 subjects. Barriers relating to patient attitude in delayed utilization of cataract surgery are given in Table no. 3.

DISCUSSION: This study has identified different reasons for delay in cataract surgery uptake in the study population. Cost was one of the major barrier, cost has been cited in some other studies as the commonest cause of delay in presenting for cataract surgery.^14-18 In present study insufficient family income was the major response by 360(60%) of the total study subjects. The Snellingen study in Nepal revealed that low socio-economic status was a barrier to the utilization of cataract surgery¹⁸ and our study also showed similar conclusions.

Brilliant et al showed that cataract surgery utilization is less in illiterates, same was observed in our study also.¹⁹

Barriers like able to do their daily works and good vision in the fellow eye, were the major responses in our study population i.e. 85.5% and 78.3% respectively. Similar findings were observed in a study done by Dhaliwal U, Gupta SK in Delhi in 2006.²⁰

In our study barriers like fear of surgery or surgery causing blindness, old age were responded by 19.1%, 33.3%, and 9.1% of the subjects respectively. Whereas in other study done by Dhaliwal U, Gupta SK. 25-55% patients responded, fear of surgery or surgery causing blindness, old age as the barriers.²⁰

Barriers like long distance from the hospital and no one to accompany were the least responded by only 9.1% and 10% of the subjects. The similar findings were observed in a study done by Josephine N. Ubah, Micheline A. Isawumi, Caroline O. Adeoti in 2013.²¹

CONCLUSION: The current study has identified the barriers like able to manage daily work, better vision in the fellow eye and cost as the greatest cause of delay of cataract operation. This seems to be the general trend in the other parts of the country where this type of study has been conducted. To take care of this and the other causes of delay, continual effort by the government and well-meaning organizations and individuals cannot be under estimated. Certain measures can be taken to tackle these problems. Expansion of outreach programmes to different communities rather than concentrate in urban areas, and offering cataract surgical services at affordable rates will also be of help. Health Education has a great role to play as well, especially in creating awareness. Adequate dissemination of information through various media is usually will be very helpful.

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* Being female was responded only by females.