Barriers to Uptake of Free Pediatric Cataract Surgery in Malawi

Abstract

Purpose: To examine the demographic, sociocultural and socioeconomic factors that prevent families of cataract blind children from accepting free pediatric cataract surgery in Malawi.

Methods: A total 58 parents of 62 children were recruited into the study. Of these, 53 parents partook in in-depth interviews and focus group discussions after the children were screened and the parents offered free cataract surgery. Overall, 37 parents accepted (acceptors) and 16 parents did not accept (non-acceptors) cataract surgery. All interviews were transcribed and iteratively analyzed. Household economic status was quantified using the Progress out of Poverty Index for Malawi.

Results: Acceptors were better off economically (p = 0.13). Understanding of cataract, its causing blindness and impairment, as well as treatment options, by the decision makers in the families was poor. Decision-making involved a complex array of aspects needing consideration before accepting, of which distance to the health facility was a frequently mentioned barrier. Non-acceptors were more likely to come from twice the distance compared to acceptors (p = 0.0098). Non-acceptors were more likely to be peasant (subsistence) farmers than acceptors (p = 0.048). Non-acceptors were more likely to live in a house made of mud bricks with a roof of grass thatch (p = 0.001). There was no significant difference in acceptance rate between educated and non-educated mothers (p = 0.11). Intensive counseling as provided in this project increased the likelihood of accepting surgery.

Conclusion: Economic hardship and long distances to health facilities decrease acceptance even of free pediatric cataract surgical services, highlighting that just providing surgery free of cost may not be sufficient for the most economically disadvantaged in rural Africa.

• Africa
• cataract surgery
• community child health
• pediatric cataract
• sociocultural barriers

Acknowledgements

We thank Dr Gerald Msukwa, Head of Department, Lions Sight First Eye Hospital, for operating on children with cataract. We thank the whole team that was involved in data collection. We thank Else–Kröner–Fresenius Stiftung for supporting the College of Medicine, Blantyre, Malawi.

Notes

*The development and update of every Progress out of Poverty Index (PPI) is coordinated by the Grameen Foundation and includes the input of a variety of stakeholders. The Grameen Foundation usually tests a PPI in the field and creates supporting documentation in the interest of transparency. Mark Schreiner of Microfinance Risk Management, LLC is the developer of the PPI.