Abstract
BackgroundBilateral cataract is a significant cause of blindness in children in Ethiopia. This study aimed to identify the resources available for cataract surgery in children, and to assess current surgical practices, surgical output and factors affecting the outcome of surgery in Ethiopia.MethodsA Google Forms mobile phone questionnaire was emailed to nine ophthalmologists known to perform cataract surgery in young children (0–5 years).ResultsAll nine responded. All but one had received either 12- or 3–5-month’s training in pediatric ophthalmology with hands-on surgical training. The other surgeon had received informal training from an experienced colleague and visiting ophthalmologists. The surgeons were based in seven health facilities: five in the capital (Addis Ababa) and eight in six public referral hospitals and one private center.Over 12 months (2017–2018) 508 children (592 eyes) aged 0–18 years (most < 15 years) were operated by these surgeons. 84 (17%) had bilateral cataract, and 424 (83%) had unilateral cataract mainly following trauma. A mean of 66 (range 18–145) eyes were operated per surgeon. Seventy-one additional children aged > 5 years were operated by other surgeons. There were substantially fewer surgeons per million population (nine for 115 million population) than recommended by the World Health Organization and they were unevenly distributed across the country.Methylcellulose and rigid intraocular lenses were generally available but less than 50% of facilities had a sharp vitrectomy cutter and cohesive viscoelastic. Mean travel time outside Addis Ababa to a facility offering pediatric cataract surgery was 10 h.ConclusionDespite the high number of cases per surgeon, the output for bilateral cataracts was far lower than required. More well-equipped pediatric ophthalmology teams are urgently required, with deployment to under-served areas.
Highlights
Bilateral cataract is a significant cause of blindness in children in Ethiopia
Similar findings have been reported from Ethiopia, where bilateral cataract was responsible for 33% of severe visual impairment and blindness in a key informant study [2], and 10% in two studies of children attending special education [3, 4]
All nine surgeons believed to undertake cataract surgery in children aged 0–5 years responded to the questionnaire, and none were aware of any others operating on this age group
Summary
Bilateral cataract is a significant cause of blindness in children in Ethiopia. This study aimed to identify the resources available for cataract surgery in children, and to assess current surgical practices, surgical output and factors affecting the outcome of surgery in Ethiopia. In 2020, SSA was the region with the Asferaw et al BMC Ophthalmology (2021) 21:437 highest number of blind and severely visually impaired and blind children (350,000, excluding refractive error), with approximately 300 affected children per 10 million population [1]. Corneal blindness from measles and vitamin A deficiency is declining, largely as a result of public health interventions, and in many countries cataract is the principal cause of avoidable blindness, estimated to account for 17% of blindness in SSA in 2020 [1]. To address blinding eye diseases in children in low and middle income countries, in 2002 the World Health Organization (WHO) recommended that one tertiary eye care facility for children be established for every million population [5]. Ethiopia currently has a population of 115 million, which indicates that there should be or of these facilities across the country
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