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Measuring cataract surgical services in children: an example from Tanzania
P Courtright1, T Williams, C Gilbert
1Kilimanjaro Centre for Community Ophthalmology, Tumaini University, PO Box 2254, Moshi, Tanzania. pcourtright@kcco.net
Insights
Childhood cataract surgery rates in Tanzania varied significantly by region and gender. A new monitoring method revealed service delivery gaps, highlighting an inequity in care for girls needing childhood cataract surgery.
Area of Science:
- Ophthalmology
- Global Health
- Pediatric Eye Care
Background:
- Childhood cataract is a significant cause of preventable blindness in developing nations.
- Existing methods for monitoring surgical services are inadequate, relying on sporadic reports.
Purpose of the Study:
- To establish a standard method for monitoring childhood cataract surgery services in Tanzania.
- To identify regional and gender-based disparities in service utilization.
Main Methods:
- Collected data on pediatric cataract surgeries from 2004-2006 at two tertiary eye care facilities in Tanzania.
- Calculated the annual childhood cataract surgical rate (CCSR) per region.
- Analyzed male-to-female ratios for surgical interventions.
Main Results:
- The overall CCSR in Tanzania was 9.9 per million population in 2006.
- CCSR was substantially higher in regions with facilities (32.3) compared to non-adjacent regions (5.4).
- Surgery rates showed a disparity, with approximately 148 boys operated on for every 100 girls.
Conclusions:
- The developed CCSR metric effectively identified regional and gender-based gaps in service delivery.
- The findings indicate a potential inequity in accessing childhood cataract surgery for girls.
- Further testing of this monitoring approach in other regions is recommended.
Background:
Childhood cataract is becoming increasingly recognised as a priority for reducing childhood blindness in developing countries. However, there have been no standard methods to monitor progress in providing this service, besides sporadic reports of surgeries performed.
Methods:
Information on all children receiving surgery for congenital/developmental cataract in the two Child Eye Health Tertiary Facilities (CEHTF) in Tanzania was collected for 2004-6. An annual childhood cataract surgical rate (CCSR) was calculated per region. Male-to-female ratios were also generated by region of residence.
Results:
Overall, the CCSR (2006) in Tanzania was 9.9 per million population, ranging from 32.3 for regions where CEHTF are located to 5.4 for regions not adjacent to CEHTF regions. There were, on average, 148 boys for every 100 girls receiving surgery.
Conclusion:
Practical application of a measure of service delivery for childhood cataract has been useful in identifying gaps in utilisation of existing services by region as well as by gender. Testing in other settings would be helpful. An apparent inequity in use of services by girls requires attention.
