Global issue: Improving equal access to cataract surgery for boys and girls

Improving equal access to cataract surgery for boys and girls 

Drs. Bronsard and Shirima discuss their recent research at the Kilamanjaro Center showing that only half as many girls as boys received cataract surgery. Girls were also brought in later than boys and girls who did receive surgery were less likely than boys to be brought in for follow-up visits. Based on their research they offer strategies for improving access not just for girls, but for all children:

Experience in Tanzania suggests that the following strategies can improve access for all children:

• Mass media efforts (especially radio) may provide the first opportunity for rural villagers to learn about the need for early referral of young children with vision loss.
• Many health workers are not familiar with the need for early referral of children with a 'white pupil'. Brochures and posters have been useful as a continuing medical education tool.
• Cost (direct and indirect) is often the most important barrier preventing use of surgical services by children. Transport reimbursement (for parents and children) is often essential, particularly for parents living quite far away from tertiary hospitals.
• Cell phone penetration has grown significantly in many low- and middle-income countries and phone follow-up with parents has proven to be a very useful strategy for reminding parents to bring children for follow-up visits.

In addition, there are two strategies that will have a more direct impact on improving access for girls:

• Evidence suggests that it is helpful to use key informants to identify and refer children who need eye care. More girls are identified this way than when relying on parents alone to recognize the need for surgery.
• Pediatric ophthalmology tertiary facilities can benefit from having a dedicated childhood blindness coordinator who can provide high quality counseling and support services for parents and guardians. With the help of such a coordinator, parents learn the benefits of early surgery, follow-up, and rehabilitation and become more engaged in the care of their children, particularly girls. Using a tracking form helps the coordinator to monitor follow-up, counseling needs, and patient information efforts.

 Dr. Tsai has no financial interest to disclose