title: Follow-up survey of cataract surgical coverage and barriers to cataract surgery at Nkhoma, Malawi.
abstract: OBJECTIVE
  Nkhoma Eye Hospital, Malawi provides high volume, high quality free cataract surgery to people in its catchment region of Central-Malawi. However, a previous survey in 2000 indicated that only 1 in 7 people with bilateral blindness from cataract had received surgery in a 10-mile radius of Nkhoma.
  
  
  METHODS
  We conducted a population-based survey in 2006 in the 32 villages within a 10-mile radius of Nkhoma Hospital in people aged ≥ 40 years in order to investigate the cataract surgical coverage (CSC) and barriers to cataract surgery.
  
  
  RESULTS
  The prevalence of blindness (visual acuity [VA] <3/60 in better eye) in 835 people aged ≥ 40 was 1.3% (95% CI 0.5-2.1), of which 36.4% was due to cataract. Overall, the CSC was 83.3%, and for eyes (VA<3/60) was 66.0%. The CSC was lower in females compared to males (73.3% vs. 100.0%. P < 0.001). The most common barrier to surgery was cost (58%).
  
  
  CONCLUSIONS
  Our results demonstrate a 5-fold increase in coverage in the 6 years, primarily by increasing efficiency of the service provider and providing a community screening and referral service. Supporting the ophthalmic personnel with appropriate infrastructure and management has been central to this shift. Implementing an active case finding and referral mechanism has enabled this unit to provide regular high volume cataract surgery. There is a need to understand the factors influencing perceptions about cost as a barrier in this community and the disparity between need and access to services for women.
authors.affiliation: Nkhoma Eye Hospital, Nkhoma, Malawi. whd1_uk@hotmail.com
authors.forename: William H
authors.initials: WH
authors.lastname: Dean
authors.forename: Daksha
authors.initials: D
authors.lastname: Patel
authors.forename: Justin C
authors.initials: JC
authors.lastname: Sherwin
authors.forename: Nick H
authors.initials: NH
authors.lastname: Metcalfe
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000453:epidemiology*; D002386:Cataract / Q000453:epidemiology*; D002387:Cataract Extraction / Q000706:statistics & numerical data*; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006302:Health Services Research; D006306:Health Surveys; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D011795:Surveys and Questionnaires