Cataract Services are Leaving Widows Behind: Examples from National Cross-Sectional Surveys in Nigeria and Sri Lanka

Jacqueline Ramke, Fatima Kyari, Nyawira Mwangi, Piyasena Mmpn, Murthy Gvs and Clare E Gilbert
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Jacqueline Ramke: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
Fatima Kyari: College of Health Sciences, Baze University, Abuja 900108, Nigeria
Nyawira Mwangi: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
Piyasena Mmpn: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
Murthy Gvs: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
Clare E Gilbert: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK

IJERPH, 2019, vol. 16, issue 20, 1-11

Abstract: The Sustainable Development Goals aim to leave no one behind. We explored the hypothesis that women without a living spouse—including those who are widowed, divorced, separated, and never married—are a vulnerable group being left behind by cataract services. Using national cross-sectional blindness surveys from Nigeria (2005–2007; n = 13,591) and Sri Lanka (2012–2014; n = 5779) we categorized women and men by marital status (married/not-married) and place of residence (urban/rural) concurrently. For each of the eight subgroups we calculated cataract blindness, cataract surgical coverage (CSC), and effective cataract surgical coverage (eCSC). Not-married women, who were predominantly widows, experienced disproportionate cataract blindness—in Nigeria they were 19% of the population yet represented 56% of those with cataract blindness; in Sri Lanka they were 18% of the population and accounted for 54% of those with cataract blindness. Not-married rural women fared worst in access to services—in Nigeria their CSC of 25.2% (95% confidence interval, CI 17.8–33.8%) was far lower than the best-off subgroup (married urban men, CSC 80.0% 95% CI 56.3–94.3); in Sri Lanka they also lagged behind (CSC 68.5% 95% CI 56.6–78.9 compared to 100% in the best-off subgroup). Service quality was also comparably poor for rural not-married women—eCSC was 8.9% (95% CI 4.5–15.4) in Nigeria and 37.0% (95% CI 26.0–49.1) in Sri Lanka. Women who are not married are a vulnerable group who experience poor access to cataract services and high cataract blindness. To “leave no one behind”, multi-faceted strategies are needed to address their needs.

Keywords: health equity; health inequality; universal eye health; universal health coverage; effective cataract surgical coverage; cataract services; healthy aging; widowhood (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
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