International Journal of Community Medicine and Public Health Bulus SS et al. Int J Community Med Public Health. 2021 Mar;8(3):1066-1071 http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040 DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20210783 Original Research Article Socio-demographic factors of patients who underwent free cataract surgery in Kafanchan, Nigeria Ulus Stanley Sano, Pamela Diyale Sarki Department of Ophthalmology, College of Medicine, Kaduna State University, Nigeria Received: 22 December 2020 Accepted: 05 February 2021 *Correspondence: Dr. Bulus Stanley Sano, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: The aim of this study is to determine the socio-demographic profile of people accessing cataract surgery at a free cataract surgical Camp in Kafanchan. Methods: One hundred and nine participants had manual small cataract incision surgery with intraocular lens over a three-month period (September to November 2018) and were followed up for two months. Visual acuity was assessed at first day and two months post-op along with refraction and best corrected visual acuity. Their socio-demographic features along with duration of lost vision and cause of delay in cataract surgery were also noted. Results: Fifty-five males and fifty- four females had cataract surgery and were followed up for two months post-op. Fifty (45.9%) had no formal education while fifty-nine (54.1%) had formal education. Among those with formal education 59% (34) were males while 41% (20) were females. Majority of participants earned less than two hundred and fifty thousand naira (six hundred and twenty-five US dollars) annually. Eighty-two (75%) of participants were Christians and 71 (65%) lived in rural areas. Sixty-five (60%) had lost vision in the index eye more than one year prior to presentation for surgery and the main reason in this study for delay in having cataract surgery was immaturity of the cataract. Conclusions: Some socio-demographic factors are barriers to cataract surgery. Keywords: Cataract surgical camp, Free cataract surgery, Kafanchan, Socio-demographic factors INTRODUCTION backlog.6 However, with increased availability of quality surgical services cataract surgical rate in many regions of The commonest cause of blindness and visual impairment Africa is still lower than the 2000 per million advocated worldwide is cataract with estimated 37 million blind in by the World Health Organization.6-8 Therefore, there is 2002 from cataract.1 Blindness burden from cataract is need to determine factors that influence uptake of more in remote communities of developing countries, available cataract surgical services to guide program who also have high backlog of un-operated cataract.2,3 planning and policy making. In Nigeria, cataract causes 42.9% of blindness with Studies from some developing countries has identified majority of the cataract blind not able to have surgery.4 cost, old age, coping ability, lack of transport and long Challenges in accessing cataract surgical care could be distance from hospital as barriers to up-take of cataract due to individual, environmental or factors associated surgical services.9,10 with the health system.5 Free cataract surgical outreach programs are targeted at increasing the number of cataract It was in view of these challenges that the Federal surgeries performed thereby reducing the cataract Government of Nigeria in collaboration with International Journal of Community Medicine and Public Health | March 2021 | Vol 8 | Issue 3 Page 1066 Bulus SS et al. Int J Community Med Public Health. 2021 Mar;8(3):1066-1071 ophthalmologists in Nigeria decided to sponsor 300 free was used to record information on duration of lost vision cataract surgeries in each of the 36 states including the and cause of delay in cataract surgery. Questionnaire was Federal Capital Territory. This study was done to identify prepared in English but can be translated to the local the socio-demographic features of people undergoing free dialect when the need arises. It was administered by cataract surgery in Kafanchan so as to provide baseline nurses experienced in similar studies. Ethical clearance data for similar programs by groups or individuals in the was not obtained from any Ethical Review Board but future. informed written consent was obtained from all participants and the study adhered to the tenets of METHODS Helsinki Declaration. The WHO standard cataract surgery outcome was used, where 6/6 – 6/18 was regarded as Study design and setting good while borderline was <6/18 – 6/60 and <6/60 was regarded as poor. It was a descriptive, cross sectional, non-randomized study of consecutive patients undergoing cataract surgery All information was entered into statistical packages for at a free cataract outreach camp. Sir Ibrahim Patrick social sciences 20 (SPSS 20, IBM, corp; Armonk, NY, Yakowa General Hospital (SIPYGH) Kafanchan was USA) and analyzed. chosen as the Centre for the southern senatorial zone of Kaduna State which consists of 7 local government areas Operational definitions (Sanga, Jema’a, Kaura, Zangon Kataf, Jaba, Kagarko and Kachia). Kafanchan town is about 207km from Kaduna Cataract: dense opacity of the lens that causes vision to be the State capital in north west Nigeria. The hospital less than 6/60. provides secondary health and eye care services including Cataract blindness: presenting visual acuity of less than cataract surgical and refraction services for the southern 3/60 in the better eye due to lens opacity. part of Kaduna State. About 200-300 cataract surgeries Operable cataract: cataract in which cataract surgery is are done in this facility yearly. The surgeries in this study expected to restore vision. were done in 4 batches over a three months period Cataract backlog: number of unoperated cataracts (September to November) since all the cataract cases awaiting cataract surgery. could not be recruited at once. The team consisted of 2 Uptake of cataract surgical services: number of people Ophthalmologist, 5 Ophthalmic Nurses, 2 optometrist and with cataract that utilize cataract surgical service. 2 Medical Assistants. Rural area of residence: residence away from the town of local government headquarter. All those presenting for the screening were examined Urban area of residence: residence within the town of with a pen torch light and direct ophthalmoscope (Heine local government headquarter. Germany, BETA 2OO US Pat. 4.963.014) in some cases. RESULTS Those with operable cataract were registered and their visual acuity (VA) assessed using Snellen “E” chart in a One hundred and sixteen (116) patients were recruited well-lit environment 6m from the chart. In those with and had cataract surgery between September and bilateral cataract only one eye was operated (Eye with November 2018 but one hundred and nine (109) denser cataract). Those 40 years and above with VA completed the follow-up giving an attrition rate of 94%. <6/60 from operable cataract, well controlled diabetes and Hypertension were included in the study, while those Age-sex distribution with traumatic cataract, coexisting glaucoma, poorly controlled systemic diseases and those that could not A total of 109 patients were operated and followed up for complete follow-up were excluded. They all had manual 2 months post- operative period. There were 55 males and small incision cataract surgery (MSICS) with intraocular 54 females with a male to female ratio of 1.02:1. Their lens (IOL). Surgery was done by the two Ophthalmologist ages ranged from 40-80years with a mean age of who are competent in doing the procedure. The choice of 64.4±7.26 years. The age-sex distribution is as seen in IOL was based on the patient’s need since biometry was Table 1 below. not available. Presenting VA first day post-op and two months post-op were assessed along with refraction at Table 1: Age and gender distribution of population. two months post-op. VA was done by an experienced ophthalmic Nurse while refraction was done by the Age Group Sex Total (%) optometrists. (years) Male (%) Female (%) 40-50 0 (0) 2 (4) 2 (2) Data collection and analysis 51-60 5 (9) 3 (6) 8 (7) 61-70 18 (33) 18 (33) 36 (33) A Questionnaire was used to record information on socio- > 70yrs 32 (58) 31 (57) 63 (58) demographic factors such as age, gender, education rural Total 55 (100) 54 (100) 109 (100) or urban residence and annual income. Another section International Journal of Community Medicine and Public Health | March 2021 | Vol 8 | Issue 3 Page 1067 Bulus SS et al. Int J Community Med Public Health. 2021 Mar;8(3):1066-1071 More people were operated at >70 yrs than other age Table 3: Sex distribution of annual income. groups with 32 males (58%) and 31 females (57%) operated at more than 70 years of age. Only 10 patients Amount (Naira) Males Females Total (9%) out of 109 were operated at age 40-60 years. < 250,000 34 46 80 250,000 13 6 19 Educational status >500,000 8 2 10 Total 55 54 109 From the result, 50 (45.9%) had no formal education while 59 (54.1%) had formal education. Among those Place of residence with formal education 59% (34) were males and 41% (20) were females (P>0.05). While 31 (28.4%) had primary Sixty-five percent (60) reside in rural area while 35% (49) education only, 18 (16.5%) had up to secondary school reside in urban area. education and 10 (9.2%) had tertiary education. Among men 35 (63.6%) were literates while among women only Religious beliefs 24 (44.4%) were literate.