Predictors of Poor Follow-up in Children that had Cataract Surgery

Abstract

Background: Centers for high quality cataract surgery for children have been developed in a number of sub-Saharan African countries. Surgery, however, is only the first stage of a long, often complex, rehabilitation program. There are indications that follow-up in these settings is poor. In a setting with a high quality surgical service an active program to identify and manage children with cataract and a newly developed low vision program, we sought to measure routine follow-up and to determine the factors associated with good or poor follow-up. Methods: This prospective study included all children (under the age of 16 years) having surgery for congenital, developmental, or traumatic cataract at KCMC Hospital between March 2003 and October 2004. Standardized data was collected pre-, intra-, and postoperation. Follow-up was assessed at two weeks and ten weeks. Results: Among the 154 children included 35.1% had congenital cataract, 32.5% had developmental cataract, and 31.8% had traumatic cataract. Overall, 66.9% attended two-week follow-up and 42.9% attended ten-week follow-up. Multivariate analysis revealed that sex (being a boy), close proximity to a hospital, and minimal delay in presentation for surgery all independently predicted good follow-up at two weeks. Only distance from a hospital and preoperative vision (not blind in operative eye) predicted good ten-week follow up. Discussion: Current follow-up practices are inadequate. Significant investment in surgical interventions may not lead to improved visual rehabilitation or quality of life, if investments in follow-up are not increased. Linking individual children, their families, and the hospital needs to be approached systematically, if follow-up is to be improved. Improved hospital-based counseling should focus on families who bring their child late for surgery and with girls.

KEYWORDS:

• Childhood cataract
• follow up
• gender
• Tanzania