Abstract
BackgroundThe link between poverty and health is central to the Millennium Development Goals (MDGs). Poverty can be both a cause and consequence of poor health, but there are few epidemiological studies exploring this complex relationship. The aim of this study was to examine the association between visual impairment from cataract and poverty in adults in Kenya, Bangladesh, and the Philippines.Methods and FindingsA population-based case–control study was conducted in three countries during 2005–2006. Cases were persons aged 50 y or older and visually impaired due to cataract (visual acuity < 6/24 in the better eye). Controls were persons age- and sex-matched to the case participants with normal vision selected from the same cluster. Household expenditure was assessed through the collection of detailed consumption data, and asset ownership and self-rated wealth were also measured. In total, 596 cases and 535 controls were included in these analyses (Kenya 142 cases, 75 controls; Bangladesh 216 cases, 279 controls; Philippines 238 cases, 180 controls). Case participants were more likely to be in the lowest quartile of per capita expenditure (PCE) compared to controls in Kenya (odds ratio = 2.3, 95% confidence interval 0.9–5.5), Bangladesh (1.9, 1.1–3.2), and the Philippines (3.1, 1.7–5.7), and there was significant dose–response relationship across quartiles of PCE. These associations persisted after adjustment for self-rated health and social support indicators. A similar pattern was observed for the relationship between cataract visual impairment with asset ownership and self-rated wealth. There was no consistent pattern of association between PCE and level of visual impairment due to cataract, sex, or age among the three countries.ConclusionsOur data show that people with visual impairment due to cataract were poorer than those with normal sight in all three low-income countries studied. The MDGs are committed to the eradication of extreme poverty and provision of health care to poor people, and this study highlights the need for increased provision of cataract surgery to poor people, as they are particularly vulnerable to visual impairment from cataract.
Highlights
Improvements in health are at the heart of the Millennium Development Goals, with the recognition that better health is central to the primary aim of reducing poverty as well as important in its own right
The Millennium Development Goals (MDGs) are committed to the eradication of extreme poverty and provision of health care to poor people, and this study highlights the need for increased provision of cataract surgery to poor people, as they are vulnerable to visual impairment from cataract
Cases were less likely to be married than controls, in Kenya, Bangladesh (0.6, 0.4–1.0), and the Philippines (0.7, 0.4–1.0), this only reached statistical significance in Bangladesh (p 1⁄4 0.03)
Summary
Improvements in health are at the heart of the Millennium Development Goals, with the recognition that better health is central to the primary aim of reducing poverty as well as important in its own right. Extrapolations on a global level indicate that a successful eye care programme could prevent more than 100 million cases of blindness between 2000 and 2020, and save at least US$102 billion, which would otherwise be lost to reductions in productivity associated with blindness [12] These estimates are based on extrapolations from limited data and were not based on individual-level data. Cataract can be treated with an inexpensive, simple operation in which the cloudy lens is surgically removed and an artificial lens is inserted into the eye to restore vision In developed countries, this operation is common and accessible but many poor countries lack the resources to provide the operation to everyone who needs it. Blind people often cannot afford to travel to the hospitals where the operation, which may come with a fee, is done
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