Gender Inequalities in Surgery for Bilateral Cataract among Children in Low-Income Countries: A Systematic Review

Abstract

Cataract is a common cause of avoidable blindness in children globally. Gender differences in service access among children are reported for several conditions, but not for surgery for bilateral cataract. In this review we compared the proportion of children undergoing surgery for bilateral, nontraumatic cataract who were girls, using data from high-income, gender-neutral countries as the reference. Systematic review. A systematic review of MEDLINE was undertaken in November 2014. Studies published only from 2000 onward were included because techniques and services have improved over time. A wide range of study designs was included such as: population-based data, registers, studies of surgical techniques, clinical trials, and so forth. All articles with 20 or fewer cases were excluded or were of long-term follow-up only, because this may reflect gender differences during follow-up. A meta-analysis was not planned. Thirty-eight studies (6854 children) were included from 1342 titles, 10 from high-income countries. Many did not present data disaggregated by gender. Overall, 36.5% of children were girls. In gender-neutral countries, 47.5% of children (777/1636) were girls, being similar in the Middle East, North Africa, and Central Asia (48.6%; 87/179) and in Latin America and the Caribbean (43.7%; 188/430). Proportions were significantly lower in sub-Saharan Africa (41.1%; 225/547), East Asia and the Pacific (36.0%; 237/658), and South Asia (29.1%; 991/3404). Access to surgery by girls with bilateral cataract is lower in some regions than by boys. Barriers to access specific to girls need to be identified, particularly in Asia, to assess interventions to improve uptake.