Aim: To estimate the prevalence of avoidable blindness, provide baseline data and identify barriers to the uptake of cataract surgical services in Ekiti-West Local Government Area (LGA) of Ekiti state, Nigeria.
Methods: Participants aged 50 years and above were enrolled in the study using stratified cluster sampling with probability proportional to size procedures. Subjects were assessed based on the WHO (World Health Organization) RAAB (Rapid Assessment of Avoidable Blindness) methodology. Household selection was by compact segment method and Visual Acuity measurement was performed on every subject but ocular examination was limited to subjects with Visual Acuity of <6/18 (pinhole) to determine the causes of visual impairment. Interviews and discussions were also held to identify the barriers to the uptake of cataract surgical services. Data analysis was done using the RAAB software package for Windows programmed in Visual FoxPro version 7.0 and statistical tests were done using Statistical Package for Social Science, version 16.0 (SPSS, Inc, Chicago III).
Results: A total of 1,394 subjects were examined out of 1,450 registered eligible subjects giving a coverage of 96.1%. The prevalence of blindness in the study was 3.7% (95% CI: 2.9% - 4.5%) while those of severe visual impairment and visual impairment were 2.9% (95% CI: 1.9% - 3.9%) and 9.7% (95% CI: 8.1% - 11.3%) respectively. The prevalence of low vision was 12.6%. Majority of the causes of blindness (88.5%), severe visual impairment (80%) and visual impairment (98.5%) were avoidable. Cataract was the commonest cause of blindness (80.8%) and severe visual impairment (47.5%) while uncorrected refractive error was the commonest cause of visual impairment (78.7%). Glaucoma was the second common cause of blindness (9.6%). Other principal causes of blindness included surgical complications (3.8%) and other posterior segment diseases (1.9%). The prevalence of bilateral cataract blindness was 2.9% (95% CI: 2.1% - 3.6%). The greatest barrier to uptake of cataract surgery was lack of awareness that their blindness could be cured simply by surgery (27.5%). Other barriers included lack of fund to procure surgery (21.3%), lack of knowledge to access surgery (15%) and non-availability of services (13.8%). Most surgeries were Intracapsular Cataract Extraction (ICCE) without intra ocular Lens (IOL) implant. Poor surgical outcome was mainly due to lack of IOL implantation, lack of aphakic correction and surgical complications. Satisfaction with surgery was high among IOL implant subjects. The cataract surgical coverage (CSC) (eyes) was 10.1% and the CSC (persons), 16.7%.
Conclusion: The study revealed a high burden of blindness, severe visual impairment and visual impairment due to avoidable causes. Blindness prevention programmes have not made significant impact on the communities due to lack of awareness, poverty and non -availability of eye care services at the community level. Blindness prevention programmes and provision of eye care services should be integrated into the existing primary health care delivery system to ensure accessibility and availability. Sustainability should be guaranteed by subsidizing eye care services and encouraging community ownership and participation.