Addressing cataract in rural Malawi: the Nkhoma Eye Programme

its population of 14.8 million. The eye unit based at Nkhoma Eye Hospital opened in 1955, and CBM has been supporting it since 1977. The hospital is the home of the Nkhoma Eye Programme (NEP), which was started as a VISION 2020 district programme in 2000. In cooperation with the Malawi Ministry of Health (MOH) and other, non-governmental, organisations, the programme provides eye care services in central-western and centraleastern Malawi (population 4.5 million). Cataract operations are performed by an ophthalmologist and a clinical officer who trained as a cataract surgeon. In 1999, the prevalence of blindness (visual acuity [VA]<3/60 in the best eye) in people aged 40 years or older in Nkhoma was estimated at 3.7%, of which 62% was due to cataract.1 Only one in seven people who were blind from cataract and living within 10 miles of Nkhoma had been operated on. A survey conducted seven years later, in 2006, estimated the prevalence of blindness at 1.3%2, of which 36% was due to cataract.3 By then, four out of every five people who were blind from cataract and living within 10 miles of Nkhoma had been operated on. Here, we discuss the strategies that led to improved management of cataract.