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Barriers, Costs, and Attitudes Toward Pediatric Cataract Surgery at Two Large Facilities in China and India
Jun Wang1, Ling Jin1, Qing Lu2
1a Division of Preventive Ophthalmology, State Key Laboratory of Ophthalmology , Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , Guangdong , China.
Insights
Barriers to pediatric cataract surgery appear greater in India than China, with Indian families facing more socioeconomic challenges and delays in treatment. This impacts timely access to vision-saving procedures for children.
Area of Science:
- Ophthalmology
- Global Health
- Pediatric Surgery
Background:
- Pediatric cataract surgery is crucial for preventing vision loss in children.
- Understanding regional disparities in surgical access is vital for improving outcomes.
- Socioeconomic and cultural factors significantly influence healthcare-seeking behaviors.
Purpose of the Study:
- To investigate the cost and attitude barriers affecting pediatric cataract surgery in China and India.
- To compare the challenges faced by families in accessing timely surgical intervention for congenital cataracts.
- To identify demographic and socioeconomic factors associated with delayed or foregone surgery.
Main Methods:
- A comparative study was conducted between January 2014 and June 2015.
- Families of children (≤10 years) with bilateral, non-traumatic cataracts were surveyed at tertiary centers in China and India.
- Questionnaires assessed demographics, financial status, living environment, health-seeking behaviors, and medical burden.
Main Results:
- Chinese children presented younger for surgery (mean age 5.09 years) compared to Indian children (mean age 6.45 years).
- Lower maternal education levels and reduced consultation rates with medical practitioners were observed in India.
- Significant differences in age at presentation and cataract detection were noted between the two countries.
Conclusions:
- Socioeconomic challenges may be more pronounced in India, leading to greater delays in pediatric cataract surgery.
- Differences in healthcare-seeking behaviors and educational attainment contribute to disparities in surgical access.
- Findings suggest a need for targeted interventions to mitigate barriers to pediatric cataract surgery in India.
Purpose:
To better understand barriers of costs and attitudes toward pediatric cataract surgery in China and India.
Methods:
From January 2014 to June 2015, families of children ≤ 10 years old about to undergo or having completed surgery for bilateral, non-traumatic cataract at two tertiary centers in China and India completed questionnaires regarding their demographic characteristics, financial status, living environment, health seeking behaviors, and medical burden.
Results:
In China, 38 children (23 boys [60.5%], mean age 3.11 ± 2.88 years) were un-operated, and 44 (26 boys [59.1%], mean age 5.09 +/- 2.17 years) had undergone surgery, while in India there were 60 (44 boys [73.3%], mean age 4.61 +/- 3.32 years) and 39 (29 boys [74.4%], mean age 6.45 +/- 2.74 years) children respectively, 181 in total. Chinese children were younger at presentation (p ≤ 0.03 for both operated and un-operated) and also when cataract was detected (median [inter quartile range] 10 [3-34] versus 24 [6-60] months [p = 0.06] for un-operated, 5 [2-12] versus 36 [8-72] months [p < 0.001] for operated). Maternal education levels were lower in India (48.3% and 51.3% with elementary education only among un-operated [p = 0.11] and operated [p = 0.006] families in India versus 27.0% and 20.5% in China), as were rates of consulting medical practitioners for illness (44.7% and 36.4% for un-operated [p < 0.001] and operated [p = 0.001] in China versus 10% and 5.13% in India).
Conclusions:
Socioeconomic challenges to securing cataract surgery may be greater, and delays in obtaining surgery longer, in India compared to China, if these facilities are representative.
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