DR. SHEILA MARCO

Objective: To assess the cataract surgical coverage, outcome of cataract surgeryand barriers to uptake of cataract surgical services.
Setting: Kericho, Bureti and Bomet districts CES Project.
Design: Cross-sectional population based survey using rapid assessment of avoidable blindness (RAAB) method.
Participants: Fifty one clusters of 50 people aged 50 years or older were selected by probability proportionate to size sampling of clusters. Compact segment sampling was used to select households within the clusters. Two thousand five hundred and forty six people were eligible for the survey of which 2419 (95%)
were examined.
Methods: Participants underwent a comprehensive ocular examination in their homes by an ophthalmologist. The visual acuity was measured using a tumbling E chart. The cause of visual impairment was established. Those who had
undergone cataract surgery were questioned about the details of the operation and their satisfaction with the surgery. Those who were visually impaired from cataract were asked why they had not gone for surgery.
Results: Cataract was found to be the main cause of blindness (42.9%) and visual impairment (42.7%) in those aged 50 years and older. The cataract surgical coverage was high, with 87.2% of those with bilateral cataract who needed surgery having had surgery at V/A<3/60. The quality of surgery was of concern with 20.7% of the 222 eyes that had undergone cataract surgery
having a best corrected vision of <6/60. The main barriers to cataract surgery were cost and lack of awareness.
Conclusions: The cataract surgical coverage in Kericho, Bureti and Bomet districts is high. The outcome of surgery is below the WHO standard and needs improvement.

Objectives: To conduct a rapid assessment of cataract surgical services in Embu District.

Design: Community based survey Setting: Embu district of the Eastern Province of Kenya

Subjects: 85 clusters selected by systematic method. Each cluster had 40 people aged >50 years.

Conclusions: The prevalence of blindness in people aged >50 years in Embu district is 2.0% (95%CI: 1.5%-2.5%). Cataract is the commonest cause of blindness (39.7%; 95%CI: 38.9%-40.5%). The Cataract surgical coverage for cataract blind persons is 65.7 %. The outcome of cataract surgery with IOL is good in 39.5% of all the operated eyes and improved to 53.5% with best correction/VA with pinhole. Most of the cataract operations are done in voluntary/charity hospitals (47.4%) and in government hospitals (44.9%). The main barriers to utilization of cataract surgical services in the district are lack of awareness and cost of surgery.

Conclusions: Most of the cataract blind patients (65.7%) have assess to surgical services. The proportion of cataract surgeries resulting in good surgical outcomes is low.

Recommendations: There is need to improve the outcome of cataract surgery in Embu
through continuing skills update courses for existing staff, supply of biometry equipment and vitrectomy machine plus establishing a cataract audit system. Collaboration between the Government and charitable eye care institutions should be strengthened because they are equal partners in delivery of cataract surgical services in the district. There is need to initiate community eye health promotion activities and cost-containment strategies in order to break the barriers to utilization of surgical services.