PPI Used to Assess Health Services >

Frank Ballard

One child in ten thousand in Sub-Saharan Africa is blind due to cataracts. In developed countries, cataract blindness is a very treatable condition. However, in Malawi, despite efforts to offer free cataract surgery to children in need, at least a third of cataract blind children identified at outreach clinics do not seek surgery within three months of being identified. Uptake of this free medical service remains concerning. There were a number of reasons identified by researchers for this problem:

  • poor communication between the health providers, families and communities;
  • a lack of parental awareness of cataract treatment;
  • a complicated and poorly understood referral process;
  • a lack of financial resources;
  • distance to the hospital; and
  • poor (perceived and actual) outcomes of survey reinforcing fear associated with surgery.

A team of researchers led by M. Schulze Schwerin of the University of Malawi recently conducted a study on pediatric cataract surgery in Malawi in order to make recommendations to redesign community interventions for pediatric surgery. The goal was to increase the uptake of surgical services for blind and visually impaired children in poorer communities.

The researchers used detailed databases that listed children who had been identified as having cataracts, and, of those, which had sought treatment and those which had not. The critical behavior examined was whether a family with a child blind from cataract acted on the advice of the health worker and sought free surgery.

A total of 53 in-depth interviews of families were completed to identify the socioeconomic characteristics that may affect use of eye care services. Thirty-seven had accepted free surgery, while sixteen had not. Research showed that children of acceptors and non-acceptors were not different in age (approximately 9.5 years) or sex (an average of 42% were female). In addition, there was no significant difference in acceptance rates between educated and non-educated mothers.

Poverty levels of acceptors vs. non-acceptors

However, one striking difference between acceptors and non-acceptors in the study was that non-acceptors were much more likely to be poor according to the PPI, with 64% of families living below the national poverty line and 86% living on less than $1.25 per day versus only 39% living below the national poverty line and 69% living on less than $1.25 per day. This led researchers to conclude that practices aimed at targeting the poor such as offering free access to cataract surgery was not fully sufficient. The poorest were unable to take advantage of the free services. Reasons given during in-depth interviews were that the cost of transportation and loss of work time for poorer families to take their children to cataract eye centers were prohibitive.

The team of researchers concluded that addressing hidden costs, such as providing transport, might increase uptake of pediatric cataract surgery services.

You can read the full report: Barriers to Uptake of Free Pediatric Cataract Surgery in Malawi.