Clinical and Experimental Ophthalmology
`_`\jd@ 2006;
HV_5
+ 34
*}mk$b
A : 880–885
#^|"dIZ_M doi:10.1111/j.1442-9071.2006.01342.x
NGsG4y^g?z © 2006 Royal Australian and New Zealand College of Ophthalmologists
BhJag L ^o :Kc9k(3&r Correspondence:
HB+{vuN*L Dr Garry Brian, 5 Hazelmere Parade, Sherwood, Qld 4075, Australia. Email:
grbrian@tpg.com.au 2`2S94' Received 11 April 2006; accepted 19 June 2006.
-u!{
8S~wA Original Article
kkA5pbS Cataract and its surgery in Papua New Guinea
/XfE6SBz Jambi N Garap
&w4~0J>v! MMed(Ophthal)
V4~`yT?*" ,
<$ H-/~Y 1,2
JerueF;J Sethu Sheeladevi
>ZX&2 { MHM
'fIBJ3s[o ,
6;JlA}) 3
()Cw;N{E Garry Brian
{:peArO FRANZCO
%yr(i 6L ,
k;)t}7(
2,4
$0(~ID BR Shamanna
86_`Z$ s MD
yu^n;gWH ,
Vdpvo;4uy 3
,lsoxl Praveen K Nirmalan
iS/faXe5 MPH
J~"h&>T 3
vv 7T/C and Carmel Williams
sTmY'5ry MA
Uu}a! V 4
o?T01t= 1
|mHxkd The Fred Hollows Foundation – Papua New Guinea Eye Care Program,
Y\Grf$e 2
,o?yS>L_r Department of Ophthalmology, School of Medicine and Health
czp .q Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea;
y?r:`n 3
w%Bo7 'o)V International Center for Advancement of Rural Eye Care,
4fuKpLA L.V. Prasad Eye Institute, Hyderabad, India; and
#<4/ * < 5 4
z]\CI: The Fred Hollows Foundation (New Zealand), Auckland, New Zealand
+DpiX&^h Key words:
)^D:VY92 blindness
KeIk9T13O ,
-_4ZT^.Lna cataract
u djahI<{ ,
eG
F{.] Papua New Guinea
KcW]"K>p! ,
{&qB!axj surgery
dM^1O-K: ,
--t5jSS44 vision impairment
/-mo8]J#2~ .
CSBk I
VvS ^f NTRODUCTION
jcY:a0 [{D Just north of Australia, tropical Papua New Guinea (PNG)
O!
t>
@%) has more than five million people spread across several major
|Nfi y and hundreds of other smaller islands. Almost 50% of the
x9lG$0k:V land area is mountainous, and 85% of inhabitants are rural
=Eimbk dwellers. Forty per cent of the population is age 14 years or
,[j'OyR younger, and 9% is 50 years or older.
>h> 1
*It`<F| Papua New Guinea was administered by Australia until
b5Sgf'B^ 1975, when independence was granted. Since that time, governance,
"T?hIX/p_ particularly budgetary, economic performance, law
[og_0; and justice, and development and management of basic
HuCzXl health and other services have declined. Today, 37% of the
WF!u2E+ population is said to live below the poverty line, personal
=;!$Qw4 and property security are problematic, and health is poor.
Alh"ZT^* There are significant and growing economic, health and education
F6vN{FI disparities between urban and rural inhabitants.
Z}E.s@w Papua New Guinea has one referral hospital, in Port
#$ Q2ijT0 Moresby. This has an eye clinic with one part-time and two
vp#A D9h1 full-time consultant ophthalmologists, and several ophthalmology
6y4&nTq[ training registrars. There are also two private ophthalmologists
b_p/ 1W: in the city. Elsewhere, four provincial hospitals
7"iUyZ( have eye clinics, each with one consultant ophthalmologist.
HLa3lUo One of these, supported by Christian Blind Mission and
FU~xKNr based at Goroka, provides an extensive outreach service.
[;E~A Visiting Australian and New Zealand ophthalmology teams
, '_y@9?I and an outreach team from Port Moresby General Hospital
3a_=e
B provide some 6 weeks of provincial service per year.
YVpsf8R Cataract and its surgery account for a significant proportion
]3%(
'8/ of ophthalmic resource allocation and services delivered
x
bsk in PNG. Although the National Department of Health keeps
RF,[1O-\O some service-related statistics, and cataract has been considered
Qel2OI `b in three PNG publications of limited value (two district
cKb jW service reports
}K8W%h<3S 2,3
}ob&d.XZ and a community assessment
)rqb<O 4
?$>#FKrt ), there has
zP
F0M( been no systematic assessment of cataract or its surgery.
GO|1O|? A
6BnP"R. BSTRACT
dkr[B'n Purpose:
g$(<wWsU To determine the prevalence of visually significant
D #`o cataract, unoperated blinding cataract, and cataract surgery
d;<
gwCc for those aged 50 years and over in Papua New Guinea.
a&?SRC'x Also, to determine the characteristics, rate, coverage and
Vg>\@ C.s outcome of cataract surgery, and barriers to its uptake.
H;eGBVi Methods:
{`Jr$*; Using the World Health Organization Rapid
t,f)!D$ Assessment of Cataract Surgical Services protocol, a population-
\$iU#Z based cross-sectional survey was conducted in
P Tc@MH) 2005. By two-stage cluster random sampling, 39 clusters of
tJ_6dH8Y 30 people were selected. Each eye with a presenting visual
EGY'a*]cU acuity worse than 6/18 and/or a history of cataract surgery
Tx+Bkfj was examined.
swfcA\7R Results:
;?*`WB Of the 1191 people enumerated, 98.6% were
GW29Rj1 examined. The 50 years and older age-gender-adjusted
l$1z%|I prevalence of cataract-induced vision impairment (presenting
|2YkZ nJn acuity less than 6/18 in the better eye) was 7.4% (95%
n'
XvPV| confidence interval [CI]: 6.4, 10.2, design effect [deff]
:nt 7jm, =
6<uJ}3 1.3).
V[w Y;wj That for cataract-caused functional blindness (presenting
7eM:YqT/# acuity less than 6/60 in the better eye) was 6.4% (95% CI:
'R{XqHP 5.1, 7.3, deff
H(JgqbFB* =
tiTJ.uz6 1.1). The latter was not associated with
Nx%]dOa gender (
e]1&f.K P
ae&i]K; =
TpHvZ]c 0.6). For the sample, Cataract Surgical Coverage
/uh?F at 6/60 was 34.5% for Eyes and 45.3% for Persons. The
^ -*q Cataract Surgical Rate for Papua New Guinea was less than
MM+xm{4l 500 per million population per year. The age-genderadjusted
@y|ZXPC# prevalence of those having had cataract surgery
zKY 9'y was 8.3% (95% CI: 6.6, 9.8, deff
FnoE\2}9 =
i42M.M6D $ 1.3). Vision outcomes of
j56#KNAha surgery did not meet World Health Organization guidelines.
9*thqs3J#d Lack of awareness was the most common reason for not
.nN>Ipv seeking and undergoing surgery.
0wh4sKm[X Conclusion:
%![%wI? Increasing the quantity and quality of cataract
-
L.U4x surgery need to be priorities for Papua New Guinea eye
UdIl5P care services.
RS8
tE( Cataract and its surgery in Papua New Guinea 881
,y>%m;jL © 2006 Royal Australian and New Zealand College of Ophthalmologists
by:"aDGK. This paper reports the cataract-related aspects of a population-
! H^,p$`[i based cross-sectional rapid assessment survey of
Q^B !^_M those 50 years and older in PNG.
;$VQRXq M
]]EOCGZ" ETHODS
=SY`Xkj[ The National Ethical Clearance Committee of The Medical
\\Z{[{OZ Research Advisory Committee granted ethics approval to
dr54D survey aspects of eye health and care in Papua New Guinea
cLZaQsS% (MRAC No. 05/13). This study was performed between
eB]R<a60 December 2004 and March 2005, and used the validated
Xf"B\%,(` World Health Organization (WHO) Rapid Assessment of
q2pq~LI Cataract Surgical Services
Z{MR#.I 5,6
LdPA`oI3j protocol. Characterization of
n/&}|998? cataract and its surgery in the 50 years and over age group
kT=KxS{ was part of that study.
}Qqi013E L As reported elsewhere,
cl'#nLPz; 7
Os5Xejh`I the sample size required, using a
L]syDn prevalence of bilateral cataract functional blindness (presenting
%xJ6t5.- visual acuity worse than 6/60 in both eyes) of 5% in the
wH<'*>/ target population, precision of
}OJ,<!v2pc ±
KkCA*GS 20%, with 95% confidence
;ATn& intervals (CI), and a design effect (deff) of 1.3 (for a cluster
G<MX94? size of 30 persons), was estimated as 1169 persons. The
z0v|%&IK