A study of equity in availing free adult cataract surgery in northeastern Indian states of Mizoram and Meghalaya
DOI:
https://doi.org/10.18203/2320-6012.ijrms20262181Keywords:
Equity, Access, Cataract surgery, Northeastern India, Socioeconomic factors, Follow-up careAbstract
Background: Equitable access to free cataract surgery is essential for eliminating preventable blindness. This study evaluates equity in the uptake and follow-up of free adult cataract surgery in the Northeastern Indian states of Mizoram and Meghalaya.
Methods: A cross-sectional study was conducted over a period of nine months, enrolling adults with operable cataracts. Participants were categorised based on the timing of diagnosis and surgery. Structured interviews were administered to 238 patients (Mizoram: n=100; Meghalaya: n=138) to collect data on demographics, economic status, surgery attendance, and post-operative follow-up. Data were analysed using SPSS to identify determinants of service utilisation and assess disparities.
Results: Significant inter-state disparities were observed. Mizoram demonstrated higher surgery uptake (58% vs. 36%) and post-operative follow-up (95% vs. 45%) compared to Meghalaya. The Meghalaya cohort had a higher proportion of female participants (72% vs. 53%), illiteracy (52% vs. 8%), and low-income individuals (44% vs. 21%). While attendance did not differ significantly by gender or marital status, socioeconomic factors were critical. Higher post-operative attendance was associated with adequate income (77.5% vs. 61.1%, p=0.07) and lower indirect costs. Patients who did not attend follow-up incurred higher mean travel expenses (INR 1119 vs. INR 683, p=0.008). Living with adult children significantly increased attendance for both surgery and follow-up.
Conclusions: Despite the provision of free surgery, uptake and follow-up are inequitable, heavily influenced by socioeconomic status, indirect costs, and household support structures. Targeted interventions to reduce indirect expenses and mobilize family support are necessary to achieve equitable access to cataract care in these regions.
References
Vashist P, Senjam SS, Gupta V, Gupta N, Shamanna BR, Wadhwani M, et al. Blindness and visual impairment and their causes in India: results of a nationally representative survey. PLoS One. 2022;17(7):e0271736.
Chandrashekhar TS, Bhat HV, Pai RP, Nair SK. Coverage, utilisation and barriers to cataract surgical services in rural South India: results from a population-based study. Publ Heal. 2007;121(2):130-6.
Murthy GVS, Vashist P, John N, Pokharel G, Ellwein LB. Prevalence and causes of visual impairment and blindness in older adults in an area of India with a high cataract surgical rate. Ophtha Epidemiol. 2010;17:185-95.
Bharath B, Krishnaiah S, Imtiaz A, Ramani RV. Prevalence and determinants of cataract surgical coverage in India: findings from a population-based study. Int J Commu Med Publ Heal. 2017;4(2):320-7.
Sobti S, Sahni B, Bala K. Surgical coverage of cataract in a rural area of north India: a cross-sectional study. J Fam Med Prim Care. 2020;9(8):4112-7.
Kumar SGP, Mondal A, Vishwakarma P, Kundu S, Lalrindiki R, Kurian K. Factors limiting the Northeast Indian elderly population from seeking cataract surgical treatment: evidence from Kolasib district, Mizoram, India. Ind J Ophthalmol. 2018;66:969-74.
Prasad M, Malhotra S, Kalaivani M, Vashist P, Gupta SK. Gender differences in blindness, cataract blindness and cataract surgical coverage in India: a systematic review and meta-analysis. Br J Ophthalmol. 2020;104(2):220-4.
International Agency for Prevention of Blindness. 2030 in sight: ending avoidable sight loss. London: International Agency for Prevention of Blindness, 2021. Available at: https://www.iapb.org/about/2030-in-sight/. Accessed 11 October 2022.
McCormick I, Butcher R, Evans JR, Mactaggart IZ, Limburg H, Jolley E, et al. Effective cataract surgical coverage in adults aged 50 years and older: estimates from population-based surveys in 55 countries. Lancet Glob Health. 2022;10(11):e1584-93.
The North Eastern Council. Basic statistics of North Eastern Region - 2015. Shillong: North Eastern Council Secretariat, Government of India; 2015. Available at: https://necouncil.gov.in/sites/default/files/BasicStatistic2015-min_0.pdf. Accessed 11 October 2022.
Marmamula S, Yellapragada S, Khanna RC. Population based assessment of prevalence and causes of vision impairment in the north-eastern state of Tripura, India - the Tripura Eye Survey. Ophthalmic Epidemiol. 2020;27(4):283-8.
Das R, Sengupta B, Debnath A, Bhattacharjya H. Cataract and associated factors among OPD attendees in a teaching institute of north east India: a baseline observation. J Fam Med Prim Care. 2021;10(9):3223-7.
Ramke J, Zwi AB, Palagyi A, Blignault I, Clare GE. Equity and blindness: closing evidence gaps to support universal eye health. Ophthalmic Epidemiol. 2015;22(5):297-307.
Ramke J, Evans JR, Habtamu E, Mwangi N, Silva JC, Swenor BK, et al. Grand challenges in global eye health: a global prioritisation process using Delphi method. Lancet Healthy Longev. 2022;3:e31-41.
Blanchet K, Finger RP. A need for more equity in prevention of blindness. Ophthalmic Epidemiol. 2015;22(5):293-4.
Khanna RC, Marmamula S, Rao GN. International vision care: issues and approaches. Annu Rev Vis Sci. 2017;3:53-68.
National Health Portal. Universal health coverage. New Delhi: Ministry of Health and Family Welfare, Government of India. Available at: https://www.nhp.gov.in/universal-health-coverage_pg. Accessed 11 October 2022.
Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18.
World Health Organization. International statistical classification of diseases and related health problems. 10th ed. Vol. 1. Geneva: World Health Organization. Chapter I to chapter XII (Part A); 1992:429-58.
Downloads
Published
How to Cite
Issue
Section
