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There is little epidemiological information about cataract in children globally and thus a lack of evidence to guide policy related to childhood cataract. Early presentation for cataract surgery in children is an important first step for effective treatment. The overall aim of this research was to determine the age at childhood cataract surgery in India and to understand the barriers and enablers to accessing childhood cataract services in the region. A mixed methods approach was used. Quantitative data were obtained via a questionnaire in nine different eye hospitals in eight states in India. Qualitative data were collected from the perspectives of parents and carers and primary eye care providers using in-depth interviews and focus group discussions respectively and Theoretical Domains Framework (TDF) of behaviour change was used for analysis. A systematic review was conducted to estimate global prevalence of childhood cataract. This was estimated to be 1.14 /10000 overall, and 0.46 /10000 in low and lower middle income economies. The mean age at surgery for congenital cataract in India was 4 years and for developmental cataract it was 8 years, but these numbers varied significantly between the regions in the country. Delays to surgery occurred at recognition, when accessing the hospital and delayed surgery at the hospital. The barriers and enablers identified from the perspectives of the parents and carers suggest a need for behavioural change intervention to enhance health seeking behaviour in the communities. The findings suggest gaps in knowledge and awareness among the primary care team which should be further investigated and addressed. Based on these research findings several recommendations were identified and a preliminary recommended intervention strategy was developed to achieve behaviour changes with the aim of increasing early uptake of childhood cataract services in India. |
