title: Disparity in access to cataract surgical services leads to higher prevalence of blindness in women as compared with men: results of a national survey of visual impairment.
abstract: OBJECTIVE
  The aim of the survey was to estimate the prevalence and determinants of visual impairment and blindness in Botswana 50 years and older and assess access to cataract surgical services.
  
  
  METHODS
  a multistage cluster randomized sampling with probability proportional to size was used to select a cross-sectional nationally representative sample of 2,662 subjects. The distance visual acuity was measured and the lens examined for cataracts in each subject. Where pinholes did not improve vision to 6/18 or better, fundus examination was done after mydriasis. Blindness was defined as vision <3/60 and visual impairment as <6/18 to 3/60 in the better eye with available correction.
  
  
  RESULTS
  Two thousand one hundred twenty-seven eligible subjects were examined (79.9%). Age- and sex-adjusted prevalence of blindness and severe visual impairment was 3.69% (95% CI: 2.38%-5.00%) and 1.69% (95% CI: 1.04%-2.33%), respectively. Cataracts were the main cause of blindness (46.9%), and severe (58.9%) and moderate (40.2%) visual impairment. After adjusting for age and sex, the prevalence of bilateral cataract blindness and bilateral severe visual impairment in men is 1.0% (95% CI: 0.001%-2.1%) and 1.5% (95% CI: 1.3%-1.7%) compared with 1.6% (95% CI: 0.6%-2.7%) and 2.1% (95% CI: 1.8%-2.8%) in women. 76.9% of men, bilaterally blind from cataract, had cataract surgery in one or both eyes compared with 59.4% of women. Overall, 65.4% of people bilaterally blind from cataract had surgery in one or both eyes. For vision <6/60, the cataract surgical coverage (CSC) for persons is 73.0%, 55.2%, and 61.5% for men, women, and the sample population, respectively. The CSC for persons at vision <6/18 is 62.3%, 48.3%, and 53.2% for men, women, and the sample population, respectively.
  
  
  CONCLUSIONS
  Inequity in access to cataract surgery between men and women in Botswana has contributed to the higher prevalence of cataract-related blindness in women.
authors.affiliation: Botswana-UPenn Partnership, Gaborone, Botswana. nkomazanao@botswana-upenn.co.bw
authors.forename: Oathokwa
authors.initials: O
authors.lastname: Nkomazana
mesh_terms: D001766:Blindness / Q000453:epidemiology* / Q000601:surgery; D001902:Botswana / Q000453:epidemiology; D002386:Cataract / Q000453:epidemiology*; D002387:Cataract Extraction / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D016387:Women's Health