Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE credits
Background: Age related cataract is the commonest cause of cause of cataract that affect both eyes. Cataract surgery is expected to improve the quality of life of people who are treated. This study investigates and compares the prevalence of self-reported cataract, self-reported cataract symptoms and quality of life following cataract surgery in six low and middle income nations.
Method: Secondary data was obtained from World Health Organization Study on Global AGEing and adult health (SAGE Wave 1) which was conducted between 2007 and 2010 in China, Ghana, India, Mexico, Russian Federation and South Africa. Multistage cluster sampling was used by WHO SAGE to obtain data by face to face interview from individuals 50 years and above and a comparable sample form individuals 18-49 years old. From the total SAGE sample of 47,443 individuals, this study restricted its sample to those who were between 50-100 years bracket who had completed the survey. A total of 29,649 participants were included in the analysis which constituted of 11,675 from China, 4,038 from Ghana, 6,168 from India, 1,917 from Mexico 3,095 from Russian Federation and 2,756 from South Africa. Prevalence of cataract, cataract symptom and quality of life was analyzed for the individual countries and the pooled sample. Multiple linear regression was used to analyze the difference in quality of life of persons without a cataract diagnosis, had cataract surgery and have not had cataract surgery. WHOQOL-8 was the main dependent variable.
Results: India had the highest prevalence of cataract and cataract symptoms 17.7% and 61.3% respectively while South Africa had the least prevalence of cataract and cataract symptoms 4.5% and 6.3% respectively. China, Ghana, Mexico and Russian federation had a cataract prevalence of 8.0%, 5.4%, 10.0% and 13.0% respectively. The prevalence of cataract symptom in China, Ghana, Mexico and Russian Federation was 28.4%, 25.4%, 38.9% and 30.8% respectively. Aging and female gender was associated with a higher prevalence of cataract and cataract symptoms in all countries. High socioeconomic status (SES) was associated with cataract prevalence in Ghana, China and India while low SES was associated with higher cataract prevalence in Russian federation and Mexico. Persons who had cataract surgery had a better quality of life in China, South Africa, India, Mexico and Russian Federation. Quality of life was worse following cataract surgery in Ghana.
Conclusion: The prevalence of cataract and cataract symptoms in this study for each country and the total sample is as follows: China (8%, 28.4%), Ghana (5.4%, 25.4%), India (17.7%, 61.3%), Mexico (10%, 38.8%), Russian Federation (13%, 30.8%) and South Africa (4.5%, 6.3%). cataract prevalence increases with aging, less education, female sex. Mean quality of life differed significantly in countries. While Mexico had the highest mean QOL in people who had cataract surgery, Ghana had the least. Hypertension, diabetes was associated with a worse QOL in all countries. Cataract surgery improved QOL in China, India, Mexico, Russian Federation and South Africa except in Ghana where it was associated with worse QOL. Cataract surgical outcome could play a big role in the difference in QOL following cataract surgery. Improving access to modern cataract surgery by well-structured eye camps and partnership with local clinics, educating people on the negative effects of couching and the need for post-operative assessment could improve surgical outcome. Improving volume and quality of cataract surgery should be the aim of improving QOL following cataract surgery.
2016. , 63 p.