Eliminating the barriers to uptake of cataract surgery in a resource-poor setting: A focus on direct surgical cost

Background: Cataract remains a leading cause of blindness worldwide. Despite the high therapeutic efficacy of cataract surgical interventions, surgical uptake has been sub-optimal, especially in low- and middle-income countries. Objective: The objective was to investigate the effect of surgical fee reduction on the uptake of cataract surgical services at the University of Nigeria Teaching Hospital (UNTH) Enugu. Methods: In a retrospective comparative study, all patients who underwent cataract surgery at UNTH between January 2008 and December 2011 were identified from the eye theatre's surgical logbook. Their clinical charts were recalled and relevant demographic and clinical data were abstracted, categorized into pre (January 2008 to December 2009, Group A), and post (January 2010 to December 2011, Group B) surgical fee reduction groups. Descriptive and comparative statistical analyses were performed. Results: A total of 376 cataract surgeries (Group A, 164 [43.6%]; Group B, 212 [56.4%]) was performed during the 4-year study period. The surgeries were performed on 217 males, and 159 females aged 55.4 23.4 standard deviation years (range, 7 months to 89 years). The average annual uptake of cataract surgery was 94 overall, 82 pre and 106 postsurgical fee reductions. The two groups did not differ significantly by age (P = 0.8750) or gender (P = 0.8337). Conclusion: There is low uptake of cataract surgery at UNTH Enugu. Direct surgical fee reduction alone caused only a modest increase in uptake without alteration in age and gender balance. Further fee reduction and exploration of other uptake barriers are warranted.