Regional disparities in effective cataract surgical coverage and relative quality gap in India: A systematic review...

This study aimed to generate national-level pooled estimates of effective Cataract Surgical Coverage (eCSC)and Relative Quality Gap (RQG) and describe heterogeneity in these estimates across India. We registered the review protocol in PROSPERO (ID-CRD42024609587). We conducted and reported the systematic review and meta-analysis in accordance with the PRISMA 2020 reporting guidelines. Literature searches in PubMed, Scopus, Web of Science, and Embase identified studies in India published until November 4, 2024. Population-based cross-sectional and cohort studies reporting Cataract Surgical Coverage (CSC) and eCSC were included. Study characteristics and estimates were extracted, and quality was assessed using the JBI tool for prevalence studies. We estimated the pooled CSC, eCSC and RQG using random-effects meta-analysis (DerSimonian and Laird estimator) and performed the subgroup analyses and sensitivity analysis for heterogeneity assessment (I² statistic) using R. Seven studies were included in the systematic review, and four studies (34 survey reports) in the meta-analysis. Pooled estimates for CSC [57% (95% CI: 52% to 61%)], eCSC [36% (95% CI: 32% to 40%)], and RQG [37% (95% CI: 33%-40%)] showed high heterogeneity (I² >90%; P < 0.001). Subgroup analysis indicated regional differences for the coverage rates (P < 0.001), with the Northeast showing low coverage rates and low heterogeneity (CSC:36%, 95% CI (32%-42%), I2 = 0%; eCSC: 23%, 95% CI (16%-31%), I2 = 12.6%]. Low CSC, eCSC, and high RQG indicate that quality improvement must accompany efforts to increase coverage. High heterogeneity supports a decentralized, district-focused approach. A task force addressing barriers in the Northeast region could reduce regional inequities.