Clinical and cost impact of a pediatric cataract follow-up program in western Nepal and adjacent northern Indian States

Abstract

Background: High-quality, comprehensive pediatric cataract surgery programs have recently developed in low-income countries, but postoperative care has lagged. This study evaluated the post-cataract surgery follow-up program implemented in March 2011 at the Lumbini Eye Institute in Bhairahawa, Nepal, which included a full-time pediatric counselor and program director, a specific database, a tracking system, and cell phone reminders.

Methods: Baseline data for all cataract surgical patients <16 years of age were obtained retrospectively from hospital administrative records for 2009, the year prior to program introduction, and prospectively for all cases between March 1, 2011, and February 28, 2012. The statistical significance of the difference in the proportion of children attending follow-up in 2009 versus 2011-12 was calculated, and the overall program costs for 2011-12 was determined based on hospital records.

Results: In 2011-12, 334 children (248 males [74%]) underwent cataract surgery, including 89 Nepali (27%) and 245 Indian (73%) children. The proportion of boys was significantly higher in 2011-12 compared to 2009, but there were no differences in terms of age or distance to hospital. In 2009, 87%, 60%, and 37% attended their first, second, and third follow-up visits, respectively. Follow-up rates improved significantly to 96%, 81%, and 57%, respectively, after the implementation of the postoperative follow-up program. The 2011-12 program is estimated to have cost US$17,444.

Conclusions: The new post-cataract surgery program resulted in improved follow-up at relatively little additional cost.