Background: Cataract is the leading cause of blindness in Malawi. We sought to determine the cataract surgical coverage and the outcome of cataract surgery in a rural district in Malawi to assess past performance of cataract surgical services.
Methods: From July to October 1999 we conducted a multistage random cluster survey to include 1630 residents aged 50 years or more in Chikwawa District. Visual acuity, cause of vision loss, history of cataract surgery and cause of poor vision (if less than 6/60) were assessed. Cataract surgical coverage, sight restoration rate and outcome were calculated by person and eye and for men and women separately.
Results: We examined 1384 people (84.9% of target). Twenty-one people (12 men and 9 women) (30 eyes) had received cataract surgery. The cataract surgical coverage rate was 35.6% (44.4% for men and 28.1% for women [odds ratio 2.0, 95% confidence interval 0.6-7.0]) at a visual acuity level of 6/60, and 55.3% (60.0% for men and 50.0% for women [odds ratio 1.5, 95% confidence interval 0.3-6.7]) at a level of 3/60. Only one eye of one subject had received an intraocular lens. Presenting visual acuity was 6/18 or better in 7 eyes (23.3%), 6/24 to 6/60 in 7 eyes, and worse than 6/60 in 16 eyes (53.3%). Among the 16 eyes with visual acuity less than 6/60, the vision could be improved in 8 with provision of aphakic spectacles.
Interpretation: Cataract surgical coverage in this population is similar to that reported from other countries in Africa. As in other settings, cataract surgical coverage was lower in women than in men. Poor outcomes in this population are partly due to surgical complications and partly due to a lack of aphakic correction. Surgical promotion programs will need to focus on differentiating intraocular lens surgery from (previously practised) intracapsular cataract extraction surgery.