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Establishing a Pediatric Ophthalmology Service in Malawi: Developments in Childhood Cataract Surgery
Aaron Jamison1, Jane R Mackinnon1, Timothy E Lavy1
1Vision 2020 Glasgow-Blantyre Link, Glasgow Team, Scotland, UK.
Insights
A new Pediatric Ophthalmology Service in Malawi successfully provided safe and effective childhood cataract surgery nationwide. The service improved patient age at presentation and referral systems, demonstrating its establishment and impact.
Area of Science:
- Ophthalmology
- Global Health
- Pediatric Surgery
Background:
- Establishing specialized pediatric eye care is crucial in low-resource settings.
- Childhood cataracts are a significant cause of preventable blindness in children.
- Malawi lacked a dedicated pediatric ophthalmology service prior to this initiative.
Purpose of the Study:
- To report the establishment of a Pediatric Ophthalmology Service in Malawi.
- To evaluate the service's effectiveness using childhood cataract surgery as a metric.
- To assess surgical outcomes and service reach within the country.
Main Methods:
- Retrospective review of pediatric cataract surgeries from 2011-2016.
- Analysis of 150 sampled cases due to record limitations.
- Calculation of childhood cataract surgical rates (CCSR) using theatre records and population data.
Main Results:
- 949 cataract operations performed; 55.8% in boys.
- Mean age at presentation decreased over the study period.
- Improved geographical distribution of patient referrals and positive visual outcomes (LogMAR improvement from 2.008 to 0.613).
- Low complication rates and a CCSR of 9.2/million population were recorded.
Conclusions:
- A nationwide Pediatric Ophthalmology Service has been successfully established in Malawi.
- The service delivers safe and effective childhood cataract surgery.
- Evidence suggests improved referral systems and earlier presentation of pediatric cataract cases.
Purpose:
The purpose of this study is to report on the establishment of a Pediatric Ophthalmology Service for Malawi using childhood cataract surgery as a surrogate measure of its effectiveness.
Materials And Methods:
A retrospective review of pediatric cataract surgery at Lions Sight First Eye Hospital, Blantyre, between 2011 and 2016. The paucity of comprehensive records allowed for the sampling of a maximum of 25 cases/year (n = 150) for comparison. Theatre records and population statistics were used to calculate childhood cataract surgical rates (CCSR).
Results:
A total of 949 cataract operations were performed during the six years studied - 55.8% of these were boys. The number of operations per year remained generally stable. Of the 150 cases reviewed, the mean age at presentation was 6.01 years, with a trend toward a slightly younger age over the period. Over the years studied, the geographical distribution of referrals became more reflective of the population's distribution. Where the logarithm of the minimum angle of resolution (LogMAR) visions were available, these demonstrated a mean improvement from 2.008 (n = 43) preoperatively to 0.613 (n = 51) postoperatively. The mean follow-up was 106 days (0 days-3.25 years). Complication rates were low. The CCSR was 9.2/million population.
Conclusions:
A Pediatric Ophthalmology Service has been established in Malawi delivering safe, effective surgery on a country-wide scale for childhood cataract. Over the period studied, the age at presentation reduced, and there was an improvement in the geographical distribution of patients, likely due to an improvement in referral systems throughout Malawi.
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