Blindness And Poverty: An Outreach-Based, Case-Control Study Assessing The Relationship Between Poverty And Visual Impairment From Cataract In Greater Accra, Central, Eastern, Western, Volta, And Ashanti Regions Of Ghana

Background Blinding cataracts have been linked to poverty, and are the most common form of preventable blindness in the developing world. The WHO has identified cataract surgery as one of the top five potential public health interventions in developing countries; however, studies exploring the initial economic attributes before cataract surgery and subsequent outcomes following the sight-restorative surgery in the developing world have not been undertaken. This study assesses the baseline economic and sociodemographic attributes of a cohort of 267 cataract cases in rural villages throughout southern Ghana and compares them with 100 controls to test whether those with existing cataracts are more likely to be impoverished than their peers. Furthermore, this study explores the economic and sociodemographic differences of patients who elect to undergo subsidized cataract surgery compared to those who referred for cataract surgery, but do not undergo the operation. Methods and Findings An outreach-based case-control study recruited 100 control patients and 267 cataract patients at village eye care outreaches in the months of June, July, and August 2011. Cases and controls were both 20 years or older, with cases having been diagnosed with a dense/blinding cataract. Controls were excluded if they were diagnosed with a dense/blinding cataract or if their visual acuity was 20/200 or worse. Enrolled patients completed a questionnaire where the Ghana-specific Poverty Scorecard was used to indirectly assess likelihood of poverty (defined as $2.50/day purchasing power parity (PPP)). Chi-square and multivariate logistic regression showed that cases were more likely to be living below the poverty line than controls (OR 0.91 (CI 0.89, 0.94)) and were 7.29 (CI 2.89, 18.62) times as likely to be in the lowest quintile of poverty. Among cases, unadjusted OR showed that those who underwent surgery were more likely to live bellow the established poverty level than those who did not go for surgery (OR 0.96 (CI 0.93, 0.98), p=0.0392)), however, this was no longer significant when controlling for age, sex, household size, and chorionic disease status (OR 0.97 (CI 0.94, 1.00) p=0.0974). Those that went for surgery were more often male (OR 2.54 (CI 1.09, 5.95) and unemployed (OR 5.62 (CI 1.55, 20.44). Conclusions Data from this study suggests that poverty and blindness from cataracts are linked in rural villages in Ghana. Whether the downward economic trends associated with cataracts are reversed following surgery remains a valuable question that will be explored in subsequent follow-up with this cohort. Additionally, evidence suggests that future interventions and policies should target women in the uptake of the sight-restoring surgery