Cataract surgery programmes in Africa.

نویسنده

  • T Y Wong
چکیده

R eaders of the BJO will be aware that cataract is the leading cause of blindness in Africa, affecting an estimated half of the seven million blind people in that continent. This number is likely to increase substantially, as approximately 600 000 Africans become blind from cataract each year. Despite the enormity of the problem, few cataract operations are performed in Africa. The cataract surgery rate (CSR), a measure of the volume of cataract surgery performed in a population, is about 500 per million per year in Africa. To tackle cataract blindness, the Vision 2020 initiative, a programme involving the World Health Organization, the International Agency for Prevention of Blindness, and various governmental and non-governmental organisations, aims to increase the CSR in Africa to about 2000 per million per year. Substantial progress has been made on several fronts over the past few years. There has been a steady stream of information on the epidemiology, distribution, and impact of cataract in different parts of Africa. 4 There is also increasing evidence that well designed and well executed cataract surgery programmes can provide effective high volume and high quality cataract surgical services in selected communities in Africa. Despite encouraging signs, there remain significant challenges and barriers. Thus, there may be important lessons in the few ‘‘successful’’ cataract surgery programmes that emerge from Africa. In this month’s issue of the BJO (p 1237), Lewallen and colleagues share their experience of two such programmes, both of which appeared to have contributed towards a significant increase in the number of cataract surgeries performed in their communities. Since the introduction of these programmes, the authors estimate that CSR have risen to 1583 per million in the Kwale District in Kenya, and 1165 per million in the Kilimanjaro Region in Tanzania in 2004. These are remarkable figures, all the more so given that previous estimates of the CSR were approximately 644 per million in Kenya and 313 per million in Tanzania in 2002. What were the key lessons learnt from these ‘‘successful’’ cataract surgery programmes? The authors describe several. These include a close link between the community screening programmes and the hospital services that provide the cataract surgery services, a seamless ‘‘patient friendly’’ referral chain, the utilisation of a community screening examination team that has appropriate ophthalmic expertise to identify people most likely to benefit from cataract surgery, and selecting populations that both need the services and have the ability to sustain such programmes. None of these concepts is very new, of course. Indeed, many of the features described in this article have been proposed in other African communities, and apply elsewhere in other developing countries (for example, India).

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Cataract Surgery in Africa

1. Background 1.1. Definition of cataract 1.2. Applied anatomy and physiology 1.3. Diagnosis of Cataract 1.4. Causes of Cataract 1.5. The prevalence of Blindness and Cataract Blindness in Africa 1.6. The impact of cataract blindness 1.7. Management of cataract 1.8. Complications 1.9. Expected Results 1.10. The cost of cataract surgery 2. Equipment and human resources required to establish a cat...

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عنوان ژورنال:
  • The British journal of ophthalmology

دوره 89 10  شماره 

صفحات  -

تاریخ انتشار 2005