Cataract surgical quality and cost in a hill region of Western Nepal: comparing outreach eye camps with base hospital

Abstract

Background: Base hospitals that provide cataract surgical services in outreach settings need evidence that the cataract surgical quality is maintained in the camp setting and that patients achieve cost savings. Aims and Objective: To know whether the same quality cataract surgical care could be maintained in the Primary Eye Care Centres (PECCs) as the base hospital. Material and Methods: A prospective study at was carried out at Palpa Lions Lacoul Eye hospital (PLLEH) Gulmi, Arghakhanchi and Rampur PECCs. Total 1038 patients were examined and admitted one day prior to or on the same day of surgery. All patients were examined first post-operative day and after 2 - 3 weeks. Surgical complications, Visual acuity(VA) at discharge, 2-3 weeks were reported. Result: Out of 1038 patients, the male patients were 556 (53.6%) and females were 482 (46.4%). Five hundred six eyes (47.2%) had VA <3/60 and 179 eyes (16.7%) had VA <6/60-3/60 and 385 eyes (36%) had <6/18-6/60 preoperatively. On first postoperative day, 853 eyes (80%) had good, 144 (13 %) had borderline and 74 (7 %) had poor outcome. 5.6% eyes had intra-operative complications. On day one, Arghakhanchi had significantly worse (p < 0.05) Gulmi not significantly different and Rampur significantly better (p < 0.05) VA compared to PLLEH. Cost per surgery was $25 for PLLEH, $37 for Arghakhanchi, $54 for Gulmi, and $ 62 for Rampur respectively. Conclusions: The same quality and cost saving cataract surgery can be attained primary eye care centers as base hospital. Application of better patient selection criteria will reduce intra-operative complications in the PECCs.

Keywords

• manual small incision cataract surgery
• base hospital
• eye camps