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Delay in presentation to hospital for surgery for congenital and developmental cataract in Tanzania
J Mwende1, A Bronsard, M Mosha
1Kilimanjaro Centre for Community Ophthalmology, Tumaini University, PO Box 2254, Moshi, Tanzania.
Insights
Delays in hospital presentation for childhood cataract surgery are common in Eastern Africa, with a mean delay of nearly 3 years. Early presentation is more likely in families with multiple children, suggesting educational outreach is crucial for remote and disadvantaged populations.
Area of Science:
- Ophthalmology
- Global Health
- Pediatric Medicine
Background:
- Childhood cataract is a primary cause of pediatric blindness in Eastern Africa.
- Surgical services are available but face challenges with patient presentation timeliness.
Purpose of the Study:
- To investigate the delay in presentation for childhood cataract surgery.
- To identify predictors of delayed presentation in Eastern Africa.
Main Methods:
- A study involving 178 children with congenital or developmental cataract at KCMC and CCBRT Hospitals.
- Interviews with parents/guardians on actions and timing before hospital presentation.
- Analysis of presentation delay, categorizing children as late ( >12 months) or not late presenters.
Main Results:
- The mean delay was 34 months (almost 3 years); median delay was 18 months.
- Developmental cataract, distance from hospital, and maternal socio-educational status predicted late presentation.
- Having another sibling was associated with earlier presentation for congenital cataract.
Conclusions:
- Significant delays in presentation persist for pediatric cataract surgery in the region.
- Multi-child families may present earlier, possibly due to experience.
- Targeted educational initiatives are needed for geographically and socio-economically disadvantaged families.
Background:
Childhood cataract is a leading cause of blindness in children in eastern Africa. High quality surgical services have been established at a few tertiary facilities in the region; however, there appears to be delay in presentation to hospital.
Methods:
Parents or guardians of all children presenting to KCMC Hospital or CCBRT Hospital with congenital (recognised since birth or within the first year) or developmental (cataract leading to reduction in vision after 1 year of age) cataract were interviewed regarding the actions taken (and timing of these) before coming to hospital. Demographic information was also collected. For analysis children were grouped as either late presenters (more than 12 months after recognition) or not late presenters (within 12 months of recognition) and predictors of late presentation were assessed.
Results:
Among 178 children (74 congenital cataract and 104 developmental cataract) analysed, the mean delay between recognition by the caregiver and presentation to hospital was 34 months, almost 3 years. The median delay was 18 months-9 months for congenital cataract and 24 months for developmental cataract. Long delay in presentation was associated with having developmental cataract, living far from the hospital, and low socio-educational status of the mother. Among children with congenital cataract, having another sibling increased the likelihood of early presentation.
Conclusion:
Delay in presentation remains a significant problem for children needing surgery for congenital or developmental cataract. Parents who have multiple children may be more likely to seek early treatment, possibly because their expectations of achievable sight at a young age are based on previous experience of their older children. Educational efforts should aim to reach the most "unreachable" (those living the furthest from the hospital and having the lowest socio-educational status of the mother).
