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Indian Journal of Community Medicine

Knowledge, Attitude and Practices Regarding Cataract Surgery among Senile Cataract Cases in Haryana

Author(s): J. Bhagwan,1 I.M. Rastogi2, J.S. Malik2, C.S. Dhull2

Vol. 31, No. 2 (2006-04 - 2006-06)

Abstract

Research Question: How the senile cataract cases perceive cataract and its surgery? Objectives: To know the knowledge, attitude and practices regarding cataract surgery among senile cataract cases. Design: Cross sectional study; Interview technique. Settings: Senile cataract cases in Urban and Rural areas of District Rohtak in Haryana. Participants: 1240 senile cataract and aphakic cases. Statistical Analysis: Proportion (Percentages) Results: 90.1% cases were aware about cataract; major source of knowledge being peer groups/ relatives (73.73%). 57.58% cases related it to old age and preferred treatment from, allopathic doctors (57.11%). Only 65.69% responded for surgery for treatment; majority for camps (73.3%). 70.69% cases wanted operation only when able to see nothing. At the same time; majority (72.36%) preferred surgery without intraocular lens implant (IOL). Conclusion: There is a definite need for exploring the myths regarding cataract and its surgery, through various IEC activities as there is large gap in public's knowledge and understanding of cataract blindness. Much and more emphasis has to be on advance eye surgery so that quality care is provided.

Keywords: Knowledge; Attitude; Practices; Cataract Surgery; Senile Cataracts.

Introduction

Blindness is a disease which has severe economic repercussions and adversely affects the productivity of country. Cataract blindness; in itself; is a public health problem of major proportions in the developing world.1 41.8% of global blindness; in which 23.5% is contributed by India2; is caused by cataract alone. A major proportion of total blindness in India (81%) and that of Haryana (79%)2 is constituted by cataract blinds.

It has been assumed that there is a poor access to the causation and treatment of cataract in cataract blinds and when some information on these aspects is available, they don't know where to go for surgical services.3 Therefore, the present study was carried out to assess the knowledge, attitude and practices regarding cataract and its surgery in rural and urban cataract cases in Rohtak district in Haryana.

Material and Methods

Out of 653 Anganwadis in the district; 30 were selected at random. An Anganwadi centre, covering a population of 135 persons above 40 years of age; was considered as a "cluster unit". The clusters were distributed proportionately in urban to rural population i.e. 22 clusters were rural and 8 clusters were urban. Thus, out of total number of 4050 cases examined in these clusters; 1240 (30.7%) cases were having cataract or aphakia. The information from these cases was collected by the interview technique; on a predesigned questionnaire; which contained questions such as age; sex; occupation; education and general awareness about cataract and its surgery such as 'Have you heard about Safed Motia'; 'Is it curable/incurable'; 'How can it be treated'; etc. All the questions were asked in the local language.

Results

Out of the 1240 cases, the majority i.e. 520 (41.93%) were in age group of 60-69 years and 296 (23.87%) and 287 (23.15%) cases were in age group of 50-59 years and 70- 79 years respectively.

Table I: Age and Sex distribution of 1240 cataract and aphakic cases

Age Group
(years)
Males Females Total
n (%) n (%) n (%)
40-49 17 (1.37) 32 (2.58) 49 (3.95)
50-59 148 (11.94) 148 (11.94) 296 (23.87)
60-69 242 (19.52) 278 (22.42) 520 (41.94)
70-79 174 (14.03) 113 (9.11) 287 (23.15)
> 80 40 (3.23) 48 (3.87) 88 (7.10)
Total 621 (50.08) 619 (49.92) 1240 (100)

700 (56.45%) were illiterates rest being literates (43.5%).

In the present study, the number of cases having bilateral cataract; bilateral aphakia and cataract in one eye and aphakia in the other eye were 778 (62.74%); 199 (16.05%) and 263 (21.21%) respectively.

Table II: Distribution of cases according to the diagnosis

Diagnosis Urban Rural Total
n (%) n (%) n (%)
Cataract 133 (46.83) 645 (67.47) 778 (62.74)
Aphakia JEty 66 (23.24) 133 (13.91) 199 (16.05)
Both (cataract aphakia) 85 (29.93) 178 (18.62) 263 (21.21)+
Total 284 (22.90) 956 (77.10) 1240 (100)

Regarding knowledge; attitude and practices related to cataract, 1117 (90.08%) cases were aware about "Safed Motia", 123 (9.91%) had not heard about safed motia. Out of 1117 cases; 88 cases (7.9%) came to know about this from radio; 148 (13.22%) from television; 57 (5.08%) from newspapers and 824 (73.79%) from other agency like peer groups/relatives.

534 (47.82%) cases responded that cataract commonly affects after 60 years of age, while 301 (26.94%) cases responded about 40-60 years of age group rest 282 (25.24%) did not know the exact age group affected. Out of 1117 cases; 240 (21.45%) cases related the cataract to religious reasons; 643 (57.58%) linked it to old age while 367 (32.9%) with socio-environmental factors rest 47 (4.19%) could not cite any specific reasons.

Regarding sources of treatment; 62 (5.56%) cases were ready to take the treatment from quacks. Majority i.e. 638 (57.1%) preferred the treatment from allopathic doctor and 405 (36.28%) thought it better to try for alternative medicinal system.

Concerning treatment; 284 (25.4%) cases believed that cure can be instilling medicines, while 814 (65.64%) responded for surgery, rest 19 (1.7%) were not sure about treatment. 982 cases (87.9%) opined that facility for surgery might be available in nearby government hospitals. 608 (54.43%) cases responded for private doctors. 819 cases (73.3%) responded regarding camp surgery. Regarding reasons for not getting cataract surgery by 111 (9.92%) cases; 46 cases (41.46%) cited the economic constraint as the main reason. As far as surgery was concerned; majority i.e. 714 (70.64%) cases wanted to get it operated upon till able to see nothing. 212 (20%) cases were ready for surgery at the advise of doctor.

As far as knowledge regarding type of cataract surgery was concerned; 726 (72.36%) preferred surgery without intraocular lens (IOL). Only 180 cases (27.64%) preferred IOL surgery if at all needed.

Discussion

It becomes difficult to sit back and relax when 3.8 million Indians are blinded by cataract annually4 and curable blindness backlog is increasing day by day. There is always a definite need for better quality information, education and communication (I.E.C.) on eye care to reach the public so that existing facilities can be availed. People may be unaware of the possibilities to get their sight restored through operation. Thus, to explore the myths and attitude of the people towards cataract blindness; this study was conducted.

Majority of cases (41.93%) interviewed; in our study; were in age group of 60-69 years similar to those reported by Soundarssanane et al5 (40.37%), Chatterjee et al6 (43.3%).

In Haryana; literacy rate is 55.33%.7 43.55% cases in our study were literate. Less number of literates in the study may be because of characteristic of rural population.

Bilateral cataracts cases were higher in rural areas (67.46%) in comparison to urban areas (46.83%). Similarly, bilateral aphakic cases were less in rural areas in comparison to urban areas i.e. 13.19% and 29.92% of their respective cataract population. This may be due to less awareness and less facilities for surgery in rural areas in comparison to urban areas.

Ignorance regarding disease may be a factor for the existing blindness. 90.08% cases were aware about safed motia similar to studies of Brilliant and Brilliant88 (93.5%). Majority of cases (73.79%) in our study got the knowledge regarding safed motia from peer group/relatives. While Das and Venkataswami9 reported that 76.46% of people came to know about cataract surgery from other agencies. Reason may be different I.E.C. activities in different areas.

Poor knowledge regarding cataract in community is reflected from the facts that only 47.8% opined that above 60 years of patients are affected by cataract. Only 4.19% cases couldn't cite any specific reasons for cataract. Brilliant and Brilliant8 found majority of the cases citing unspecific causes. This shows that the awareness campaigns needs to be sped up so that public is given right information.

638 (57.1%) cases preferred to take the treatment from allopathic doctors while 284 (25.4%) opined that medicine instilled can cure it which shows that still adequate and right knowledge regarding treatment is not there in the population which may be a reason for untreated cataract blindness. Though majority i.e. 65.64% opined that ultimately some form of surgery is required to use it. So campaigns have to be there to overcome these beliefs regarding cataract.

Majority; 982 (87.9%) cases; though not sure; had belief that government hospitals are providing surgical facilities. At the same time, a good number 819 (73.3%) responded favourably regarding camp surgery. It may be because camps are being organised regularly in most of the areas and in some areas; knowingly these are organised in government hospitals.

Economic constraints and poor/no knowledge were the main reasons for not getting cataract surgery in 41.46% and 31.7% cases respectively; out of 111 cases who could not avail services, similar to findings of Brilliant and Brilliant8 (29%). For 11.38% cases, no helper was available. Other reasons like too old to get surgery done or lack of transportation were also cited. To remove all these barriers; services has to be provided at the door step or within the reach of the people: 20% cases were ready to get the cataract surgery done at the advice of doctor while 70.64% cases wanted it only at a time when nothing is visible: The same has been confirmed by Limburg H et al10. It may be a factor for increasing backlog and unwillingness or misbelief may be a hindrance to total cure of blindness.

One of interesting finding was that 726 (72.36%) cases preferred cataract surgery without IOL and 180 (27.64%) preferred IOL which are contrary to findings of Gupta et al11 regarding data on surgeries performed. The reason may be that in our study, number of cases from rural areas were more where IOL surgery has still not gained confidence of patients. There is also a direct link between acceptance of IOL surgery with literacy and literacy rate is less in rural areas.

Thus to make cataract surgery more acceptable; affordable and within the reach of the patients, a definite propaganda has to be there in masses. People are to be told more and more about its benefits and only then ever increasing cataract blindness can be cured. Communication packages need to be devised to educate especially the rural population on the importance of curable blindness and prompt advanced surgery.

References

  1. Ellwein LB, Kupfer C. Strategic issues in cataract blindness prevention in developing countries. Bull WHO 1995; 73(3): 681-90.
  2. Thylefors B, Negrel AD, Pararajasegaram R, Dadzie KY. Global data on blindness. Comm Eye Health 1996; 9 (17): 1-8.
  3. Gupta SK et al. Social implications of cataract related blindness in rural India. In: Kumar V, ed. Aging-Indian Perspective and Global Scenario. New Delhi: All India Institute of Medical Sciences. 1996; 126-9.
  4. Minassian DC, Mehra V. 3.8 million blinded by cataract each year: Projection from the first epidemiological study of incidence of cataract blindness in India. Br J Ophthalmol 1990; 74: 341-9.
  5. Soundarssanane MB, Bansal RD, Narayan KA. An epidemiological study of cataract in a rural area of Pondicherry. Ind J Med Sci 1986; 40: 273-7.
  6. Chatterjee A, Milton RC, Thyle Sydney. Prevalence and aetiology of cataract in Punjab. Br J Ophthal 1982; 66: 35-42.
  7. Registrar General and Census Commissioner of India. Census of India 1991, Provisional Population Totals, page 1 & 2.
  8. Brilliant GE, Brilliant LB. Using social epidemiology to understand who stays blind and who gets operated for cataract in rural setting. Soc Sci Med 1985; 21: 553-8.
  9. Das T, Venkataswamy. Social, economic and behavioural determinants of utilisation of cataract surgery in Mobile Eye Camps. Ind J Ophthalmol 1985; 33: 273-6.
  10. Limburg H, Vaidyanathan K, Pampattiwar KN. - Cataract blindness on the rise? Results of a door-to-door examination in Mohadi. Ind J Ophthalmol 1996; 44(4): 241-4.
  11. Gupta AK, Ellwein LB. The pattern of cataract surgery in India: 1992. Ind J Ophthalmol 1995; 43: 3-8.

1. H.C.M.S., Haryana.
2. Deptt. of Opthalmology 3. Deptt. S.P.M.,
Pt. B.D. Sharma PGIMS, Rohtak.
Received: 18-7-2000

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