Coverage of Hospital-based Cataract Surgery and Barriers to the Uptake of Surgery among Cataract Blind Persons in Nigeria: The Nigeria National Blindness and Visual Impairment Survey

Abstract

Purpose: To determine cataract surgical coverage, and barriers to modern cataract surgery in Nigeria.

Methods: Multistage stratified cluster random sampling was used to identify a nationally representative sample of 15,027 persons aged 40+ years. All underwent visual acuity testing, frequency doubling technology visual field testing, autorefraction, and measurement of best corrected vision if <6/12 in one or both eyes. An ophthalmologist examined the anterior segment and fundus through an undilated pupil for all participants. Participants were examined by a second ophthalmologist using a slit lamp and dilated fundus examination using a 90 diopter condensing lens if vision was <6/12 in one or both eyes, there were optic disc changes suggestive of glaucoma, and 1 in 7 participants regardless of findings. All those who had undergone cataract surgery were asked where and when this had taken place. Individuals who were severely visually impaired or blind from unoperated cataract were asked to explain why they had not undergone surgery.

Results: A total of 13,591 participants were examined (response rate 89.9%). Prevalence of cataract surgery was 1.6% (95% confidence interval 1.4–1.8), significantly higher among those aged ≥70 years. Cataract surgical coverage (persons) in Nigeria was 38.3%. Coverage was 1.7 times higher among males than females. Coverage was only 9.1% among women in the South-South geopolitical zone. Over one third of those who were cataract blind said they could not afford surgery (36%).

Conclusions: Cataract surgical coverage in Nigeria was among the lowest in the world. Urgent initiatives are necessary to improve surgical output and access to surgery.

Keywords::

• Blindness
• Cataract Surgery
• Cross Sectional studies
• Nigeria
• Ophthalmologic surgical procedures

ACKNOWLEDGMENTS

The Federal Ministry of Health, state governments and local governments provided accommodation to the survey teams and other administrative and logistical support during the survey. We would also like to thank Mrs Oye Quaye for managing the finances for the study; Auwal Shehu and Dania Charles for data entry; and the teams of ophthalmic nurses, enumerators, interviewers, liaison officers, drivers and cooks in the six geopolitical zones who assisted in data collection.

Funding Sources: The study was funded by Sightsavers, CBM, and Vellux Stiftung.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.