Barriers to the uptake of cataract surgical services in Merti division, Isiolo, Kenya
Mohammed, Liban A.
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The immense burden of blindness is prevalent in rural communities of developing countries, which are characterized by a high backlog of unoperated cataract and increasing incidence of cataract due to the ageing population. The factors that hinder people from accessing such sight-restoring services remain a major challenge for all eyecare professionals with a public health perspective. A cross-sectional descriptive study was carried out in all the six locations of Merti Division in Isiolo District of Eastern Province of Kenya. This study was aimed at identifying the barriers to the uptake of cataract surgical services where neither general eye-care services nor the cataract surgical services are available. Out of the 717 eye patients examined at rural health facilities, 98 (14%) operable cataract cases (vision less than 6/60 in one or both eyes) were detected by the use of the Snellen's Chart-E and a torch. More females (63; 64.3%) than males (35; 35.7%) attended the clinics during the screening exercise although statistically there was no significant difference between the sexes of the patients in different locations (x2 =4.643; df =5; P = 0.461). There was a significant number of the elderly (78; 80%) patients in attendance than the young adults (x˛ = 160.041; df = 3 ; P<0.001). Most patients with cataract significantly (x2 = 268.735; df = 5; P < 0.001) stayed at home for over two years (76; 78%) without seeking cataract surgical intervention. The number of cataract patients from Merti Division who received surgery at Isiolo Eye Unit within one month after booking were only 15 (15.3%) as compared to those who did not turn up for surgery (83; 84.7%). Out of the 15 who received surgery, 6 (40%) were males and 9 (60%) were females. This was made possible because of the support they got from the relatives (11; 11.2%) and the availability of funds to meet the cost (4; 4.1%). The respondents who did not turn up for cataract surgery when they were re-visited at their locations by the researcher gave the reasons as having nobody to take them to the hospital (23; 23.5%), generally unable to afford the cost of travel, meals and accommodation (22; 22.4%), nobody to leave behind to look after the homestead and property (6; 6.1%) and one patient did not get consent from the husband (1.0°19). The other hindering factors were the lack of knowledge of existence and services at Isiolo Eye Unit (64; 65.31 %) and the poor road network which was rough (33; 33.7%) and far (63; 64.3%). The burden of cataract blindness in Merti Division can be addressed through three-tier system where the full cost of surgery can be met by those who can afford; subsidized cost for the poor and free for the very poor. Effective cataract outreach programme is encouraged to enhance early detection, prompt referral and surgical intervention for the cataract patients. This effort requires intersectoral collaboration between all the stakeholders and the Ministry of Health. Cataract is not preventable, but sight restoration by surgery is the panacea to cataract blindness.