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Clinical Trial
. 2010 Nov 9;5(11):e15431.
doi: 10.1371/journal.pone.0015431.

Does cataract surgery alleviate poverty? Evidence from a multi-centre intervention study conducted in Kenya, the Philippines and Bangladesh

Hannah Kuper  1 , Sarah Polack, Wanjiku Mathenge, Cristina Eusebio, Zakia Wadud, Mamunur Rashid, Allen Foster
Affiliations
Clinical Trial

Does cataract surgery alleviate poverty? Evidence from a multi-centre intervention study conducted in Kenya, the Philippines and Bangladesh

Hannah Kuper et al. PLoS One. .

Abstract

Background: Poverty and blindness are believed to be intimately linked, but empirical data supporting this purported relationship are sparse. The objective of this study is to assess whether there is a reduction in poverty after cataract surgery among visually impaired cases.

Methodology/principal findings: A multi-centre intervention study was conducted in three countries (Kenya, Philippines, Bangladesh). Poverty data (household per capita expenditure--PCE, asset ownership and self-rated wealth) were collected from cases aged ≥50 years who were visually impaired due to cataract (visual acuity<6/24 in the better eye) and age-sex matched controls with normal vision. Cases were offered free/subsidised cataract surgery. Approximately one year later participants were re-interviewed about poverty. 466 cases and 436 controls were examined at both baseline and follow-up (Follow up rate: 78% for cases, 81% for controls), of which 263 cases had undergone cataract surgery ("operated cases"). At baseline, operated cases were poorer compared to controls in terms of PCE (Kenya: $22 versus £35 p = 0.02, Bangladesh: $16 vs $24 p = 0.004, Philippines: $24 vs 32 p = 0.0007), assets and self-rated wealth. By follow-up PCE had increased significantly among operated cases in each of the three settings to the level of controls (Kenya: $30 versus £36 p = 0.49, Bangladesh: $23 vs $23 p = 0.20, Philippines: $45 vs $36 p = 0.68). There were smaller increases in self-rated wealth and no changes in assets. Changes in PCE were apparent in different socio-demographic and ocular groups. The largest PCE increases were apparent among the cases that were poorest at baseline.

Conclusions/significance: This study showed that cataract surgery can contribute to poverty alleviation, particularly among the most vulnerable members of society. This study highlights the need for increased provision of cataract surgery to poor people and shows that a focus on blindness may help to alleviate poverty and achieve the Millennium Development Goals.

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Conflict of interest statement

Competing Interests: Professor Allen Foster is president of CBM, but other organisations were not involved in preparing the manuscript, the data collection, data analysis or the decision to publish. Professor Allen Foster was involved in this study in his position as Director of the International Centre for Eye Health at the London School of Hygiene & Tropical Medicine. At the time of the study Professor Foster was also the Medical Advisor to CBM. In January 2006, two years into the study, Professor Foster was appointed president of CBM. He contributed to the conception of the study question, study design and critically reviewed the draft of the article. He was not involved in the data collection, data analysis or interpretation of results. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Change in allocation of expenses between baseline and follow-up among operated cases.
See this image and copyright information in PMC

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