title: Blindness and cataract surgical services in Atsinanana region, Madagascar.
abstract: OBJECTIVE
  To assess the prevalence and causes of avoidable blindness in Atsinanana Region, Madagascar, with the Rapid Assessment of Avoidable Blindness (RAAB) survey. We analyzed the hospital records to supplement the findings for public health care planning.
  
  
  METHODS
  Only villages within a two-hour walk from a road, about half of the population of Atsinanana was included. Seventy-two villages were selected by population-proportional-to-size sampling. In each village, compact segment sampling was used to select 50 people over age 50 for eye examination using standard RAAB methods. Records at the two hospitals providing cataract surgery in the region were analyzed for information on patients who underwent cataract surgery in 2010. Cataract incidence rate and target cataract surgery rate (CSR) was modeled from age-specific prevalence of cataract.
  
  
  RESULTS
  The participation rate was 87% and the sample prevalence of blindness was 1.96%. Cataract was responsible for 64% and 85.7% of blindness and severe visual impairment, respectively. Visual impairment was due to cataract (69.4%) and refractive error (14.1%). There was a strong positive correlation between cataract surgical rate by district and the proportion of people living within 2 hours of a road. There were marked differences in the profiles of the cataract patients at the two facilities. The estimated incidence of cataract at the 6/18 level was 2.4 eyes per 100 people over age 50 per year.
  
  
  CONCLUSIONS
  Although the survey included only people with reasonable access, the main cause of visual impairment was still cataract. The incidence of cataract is such that it ought to be possible to eliminate it as a cause of visual impairment, but changes in service delivery at hospitals and strategies to improve access will be necessary for this change.
authors.affiliation: Eye Department, University Hospital, Tamatave, Madagascar.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Randrianaivo
authors.affiliation: Department of Ecosystem and Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: R Michele
authors.initials: RM
authors.lastname: Anholt
authors.affiliation: Eye Department, University Hospital, Tamatave, Madagascar.
authors.forename: Diarimirindra Lazaharivony
authors.initials: DL
authors.lastname: Tendrisoa
authors.affiliation: Eye Department, University Hospital, Tamatave, Madagascar.
authors.forename: Nestor Jean
authors.initials: NJ
authors.lastname: Margiano
authors.affiliation: Kilimanjaro Centre for Community Ophthalmology Tanzania, Moshi, Tanzania ; Kilimanjaro Centre for Community Ophthalmology International, University of Cape Town, Cape Town, South Africa.
authors.forename: Paul
authors.initials: P
authors.lastname: Courtright
authors.affiliation: Kilimanjaro Centre for Community Ophthalmology Tanzania, Moshi, Tanzania ; Kilimanjaro Centre for Community Ophthalmology International, University of Cape Town, Cape Town, South Africa.
authors.forename: Susan
authors.initials: S
authors.lastname: Lewallen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000453:epidemiology* / Q000209:etiology; D002386:Cataract / Q000453:epidemiology* / Q000209:etiology; D002387:Cataract Extraction / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014792:Visual Acuity; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*
keywords: Blindness; Cataract; Incidence; Madagascar