Academic journal article Iranian Journal of Public Health

Trend in Cataract Surgical Rate in Iran Provinces

Academic journal article Iranian Journal of Public Health

Trend in Cataract Surgical Rate in Iran Provinces

Article excerpt

Introduction

Vision 2020: the Right to Sight is the joint pro- gram of the WHO and the International Agency for the Prevention of Blindness (IAPB) for elimi- nation of avoidable blindness. Since cataract is the leading cause of blindness throughout the world (1), the goals of this program include increasing the number of cataract surgeries and enhancing their quality to achieve satisfactory visual acuity and vision related quality of life in affected pa- tients (2).

Cataract surgical rate (CSR) or the number of cat- aract surgeries per million per year, is one of the WHO indicators for quantifying cataract surgical services (3). It is affected by the age structure of the population, the incidence and prevalence of cataract, and the visual impairment threshold for cataract surgery (4). WHO recommends a CSR of 3,000 as the minimum necessary (3), and the glob- al target is 2,000-5,000 (5).

According to an Iranian national survey, the CSR in 2005 was 1,331 (6), and lagged far behind the recommended minimum or even the minimum global target. In light of improved facilities and surgical equipment in recent years, it was expected this rate to have improved as well. Thus, the sur- vey was repeated for the 2006-2010 period to de- termine the percentage improvement and the per- centage increase required to close the gap. Knowledge of this trend is an essential element for health planning and policy making.

Since overall CSR changes did not reflect non-ho- mogenous changes throughout the country, the aim of this report was to describe five year CSR changes on a provincial level which is the first lev- el of subdivisions, and examine the rate of CSR increase or decrease in 2010 compared to 2006 in each province.

Materials and Methods

Study design

In Iran, provinces are the first level of national subdivisions. Each province is further subdivided into counties which are comprised of districts, and each district has one or more cities and/or one or more rural agglomerations. Every province has a capital city which is known as the focal political, economic, cultural, geographic, and social center of the province.

In this retrospective study, which is part of the cross-sectional 2011 CSR survey in Iran, sampling was done from the capitals of all 30 provinces as well as other cities that had cataract surgical cen- ters. The samplings team was trained by an oph- thalmologist to familiarize them with surgical rec- ords and data extraction before commencing the study. First, a list of all cataract surgical centers by province was obtained from the Ministry of Health, Treatment, and Medical Education. Sam- pling was done after identifying all surgical centers capable of accommodating eye surgeries, and 110 centers were selected in the study. Inclusion crite- ria were cataract surgery being recorded in the pa- tient charts and the charts being complete.

Sampling and Statistical analysis

To calculate the 2006 and 2010 CSR in the se- lected surgical centers, a random week was picked in each season for each surgical center after ex- cluding the first two weeks of the year which are a national holiday, and all records of surgeries per- formed during these weeks were reviewed. The total number of surgeries done in these 4 weeks was multiplied by 50/4 (12.5) to represent the to- tal annual number of surgeries in a given center. Coefficients for major (>3,000 annual surgeries) and minor centers (<3,000 annual surgeries) were computed separately for each province based on the number of centers randomly selected for the study from each province. The 2006 and 2010 CSRs were then determined based on the 2006 and 2010 populations of each province which were obtained from the Statistics Center of Iran. Data extraction was conducted by a team of 10 trained staff under supervision of an ophthalmol- ogist.

The following equation was used to compute CSR in each province:

(ProQuest: ... denotes formula omitted. …

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