The impact of cataract surgery on activities and time-use: results from a longitudinal study in Kenya, Bangladesh and the Philippines.
BACKGROUND
Cataract is the leading cause of blindness in the world, and blindness from cataract is particularly common in low-income countries. The aim of this study is to explore the impact of cataract surgery on daily activities and time-use in Kenya, Bangladesh and the Philippines.


RESULTS
A multi-centre intervention study was conducted in three countries. Time-use data were collected through interview from cases aged >or=50 years with visually impairing cataract (VA <6/24) and age- and gender-matched controls with normal vision (VA>or=6/18). Cases were offered free/subsidized cataract surgery. Approximately one year later participants were re-interviewed about time-use. At baseline across the three countries there were 651 cases and 571 controls. Fifty-five percent of cases accepted surgery. Response rate at follow up was 84% (303 out of 361) for operated cases, and 80% (459 out of 571) for controls. At baseline, cases were less likely to carry out and spent less time on productive activities (paid and non-paid work) and spent more time in "inactivity" compared to controls. Approximately one year after cataract surgery, operated cases were more likely to undertake productive activities compared to baseline (Kenya from 55% to 88%; Bangladesh 60% to 95% and Philippines 81% to 94%, p<0.001) and mean time spent on productive activities increased by one-two hours in each setting (p<0.001). Time spent in "inactivity" in Kenya and Bangladesh decreased by approximately two hours (p<0.001). Frequency of reported assistance with activities was more than halved in each setting (p<0.001).


CONCLUSIONS
The empirical evidence provided by this study of increased time spent on productive activities, reduced time in inactivity and reduced assistance following cataract surgery among older adults in low-income settings has positive implications for well-being and inclusion, and supports arguments of economic benefit at the household level from cataract surgery.
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom. sarah.polack@lshtm.ac.uk
Sarah
S
Polack
Christina
C
Eusebio
Wanjiku
W
Mathenge
Zazkia
Z
Wadud
Mamunur
M
Rashid
Allen
A
Foster
Hannah
H
Kuper
D000203:Activities of Daily Living; D001459:Bangladesh; D002387:Cataract Extraction; D006801:Humans; D007630:Kenya; D008137:Longitudinal Studies; D008875:Middle Aged; D010679:Philippines; D011788:Quality of Life