Abstract
BackgroundUn-operated cataract is the leading cause of vision loss worldwide, responsible for 33% of visual impairment, and half of global blindness. The study aimed to build a fast evaluation method utilizing Andersen’s utilization framework and identify predictors of cataract surgical rate in sub-Saharan Africa and China.MethodsThe study was a cross-over ecological epidemiology study with a total of 19 countries in sub-Saharan Africa, and 31 provinces in China. Information was extracted from public data and published studies. Linear regression and structural equation modeling with Bootstrap were used to analyze predictors of CSR and their pathways to impact in sub-Saharan Africa and China separately.ResultsCataract surgical resources in sub-Saharan Africa were linearly correlated with CSR (β = 0.74, 95% CI: 0.09, 0.91), while GDP/P didn’t impact cataract surgical resources (β = 0.29, 95% CI: − 0.12, 0.75). In China, residents’ average ability to pay was confirmed as the mediator between GDP/P and CSR (p = 0.32, RMSEA = 0.07; βCSR-paying = 0.77, 95% CI: 0.25, 0.90; βpaying-GDP/P = 0.89, 95% CI: 0.82, 0.93).ConclusionsIn sub-Saharan Africa, CSR is determined by health care provision. Local economic development may not directly influence CSR. Therefore, international assistance aimed to providing free cataract surgery directly is crucial. In China, CSR is determined principally by health care demand (ability to pay). To increase CSR in underserved areas of China, ability to pay must be enhanced through social insurance, and reduced surgical fees.
Highlights
Un-operated cataract is the leading cause of vision loss worldwide, responsible for 33% of visual impairment, and half of global blindness
cataract surgical rate (CSR) varied from 150 in DR Congo to 2000 in Gambia. (Table 1) CSR was not linearly correlated with Gross domestic product per capita (GDP/P) (β = 0.07, 95% Confidence Intervals (CI) = -0.23 to 0.27)
CSR only showed a linear relationship in our model with the number of ophthalmologists per million population, which is by provision of healthcare service in Anderson’s terms. (Table 2) In addition, GDP/P was linearly correlated with the number of general practitioners per unit population, but not with the number of ophthalmologists
Summary
Un-operated cataract is the leading cause of vision loss worldwide, responsible for 33% of visual impairment, and half of global blindness. Vision loss due to cataract is reversible with surgery [2]. Cataract surgery has been recommended by the World Health Organization (WHO) as critical primary eye care service [2], and is one of the most important components of VISION 2020. It has been shown that surgery for cataract increases the economic well-being of affected patients and their families [3], an impact persisting over at least 6 years [4]. Ready access to cataract surgery is important for achieving the Sustainable Development Goals (SDGs) of improved health, and poverty alleviation. The cataract surgical rate (CSR), defined as the number of cataract surgeries performed per year, per million population, is one of the key indicators in WHO reports
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