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Open AccessArticle

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

1
International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
2
School of Optometry and Vision Science, University of Auckland, Auckland 1010, New Zealand
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College of Health Sciences, Baze University, Abuja 900108, Nigeria
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Department of Clinical Medicine, Kenya Medical Training College, Nairobi 00100, Kenya
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Ministry of Health, Indigenous Medicine and Nutrition, Policy Analysis and Development Unit, Colombo 10, Sri Lanka
6
Public Health Foundation of India, Hyderabad, Telangana 122002, India
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(20), 3854; https://doi.org/10.3390/ijerph16203854
Received: 17 September 2019 / Revised: 6 October 2019 / Accepted: 10 October 2019 / Published: 12 October 2019
(This article belongs to the Special Issue Leaving no one behind: Equity and Eye Health)
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. View Full-Text
Keywords: health equity; health inequality; universal eye health; universal health coverage; effective cataract surgical coverage; cataract services; healthy aging; widowhood health equity; health inequality; universal eye health; universal health coverage; effective cataract surgical coverage; cataract services; healthy aging; widowhood
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Ramke, J.; Kyari, F.; Mwangi, N.; Piyasena, M.; Murthy, G.; Gilbert, C.E. Cataract Services are Leaving Widows Behind: Examples from National Cross-Sectional Surveys in Nigeria and Sri Lanka. Int. J. Environ. Res. Public Health 2019, 16, 3854.

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