Changes in Eye Health and Service Coverage in Nampula, Mozambique between 2011 and 2018

ABSTRACT

Purpose

Globally, there are few examples of repeated eye health surveys to assess changes in prevalence and causes of visual impairment, and service coverage over time. Two separate, unlinked rapid assessments of avoidable blindness (RAAB) were conducted in Nampula province, Mozambique in 2011 and 2018. This paper reports the observed changes and examines how the trends differ for males and females.

Methods

Standard RAAB methodology was used in both studies. Two-stage cluster sampling was used to generate random samples of adults aged over 50 years. Participants underwent a simplified visual acuity (VA) exam, a lens exam and posterior segment exam using a direct ophthalmoscope for all subjects with presenting VA<6/18. Data were analysed using Stata and logistic regression models were developed to assess changes.

Results

The 2011 study enrolled 3,050 people and examined 96.9% (2,954 people). The 2018 survey enrolled 4,191 people and examined 95.8% (4,015 people). Age- and sex-adjusted estimates of blindness decreased from 6.2% in 2011 to 4.5% in 2018 (z = −2.21, p = .028). Cataract surgical coverage was higher among males in both surveys (13.4% among males vs 7.7% among females in 2011, and 40.0% among males vs 19.4% among females in 2018) and the gender disparity grew between surveys.

Conclusion

Significant changes were observed in the eye health and service coverage between 2011 and 2018. Further improvements to services are required to improve access for women and people with moderate visual impairment.

KEYWORDS:

• Visual impairment
• prevalence
• equity
• mozambique

Acknowledgments

The authors acknowledge the support of Abrão Banqueiro Chale and Dr Stevens Bechange for the planning and implementation of the 2018 study. We thank Dr Margarida Chagunda for her support to both studies. Both studies took place thanks to the hard work of the data collectors: the ophthalmologists, ophthalmic technicians, cluster informers and drivers who went throughout in Nampula to collect the data – thank you.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Disclosure statement

None of the authors have any proprietary interests or conflicts of interest related to this submission:

Geolocation information

Nampula Province, Mozambique

Additional information

Funding

This work was supported in 2011 by Sightsavers, and in 2018 by the UK Department for International Development (DFID/UKAID) under Grant number [84001].