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Low Uptake of Eye Services in Rural India
A Challenge for Programs of Blindness Prevention
Astrid E. Fletcher, PhD;
Martine Donoghue, MSc;
John Devavaram, MSc;
R. D. Thulasiraj, MBA;
Susana Scott, MSc;
Mona Abdalla, PhD;
C. A. K. Shanmugham, MD;
P. Bala Murugan, BA
Arch Ophthalmol. 1999;117:1393-1399.
Objectives To investigate service uptake in a rural Indian population served by outreach eye camps and to identify barriers to uptake.
Participants and Methods A routine eye camp was conducted within 5 km of each of 48 randomly selected villages of typically Hindu, backward-caste communities. Subsequently, participatory rural appraisal—community mapping, focus groups, matrix ranking, and semistructured interviews—was undertaken to explore community views of eye problems. An eye examination was conducted on persons with eye problems who did not attend the eye camp. Predictors of attendance were identified by multilevel regression analysis.
Results Of 749 adults with an eye problem, 51 (6.8%) attended the eye camp. Independent predictors of attendance were being male (odds ratio=2.3; 95% confidence interval, 1.2-4.5) and living within 3 km of the camp (odds ratio=4.5; 95% confidence interval, 1.7-12.5). Of the 552 persons who did not attend the eye camps and had an eye examination, 242 (43.8%) had low vision (visual acuity <6/18 to  3/60 in presenting better eye) and 38 (6.9%) were blind in both eyes. Cataract surgery was recommended for 197 (35.8%) of the persons who did not attend the eye camps. Of 109 persons with a previous cataract operation, 42 (38.5%) had low vision and 11 (10.1%) were blind. Fear (principally of eye damage), cost (direct and indirect), family responsibilities, ageism, fatalism, and an attitude of being able to cope (with low or no vision) were the principal barriers to attending the eye camps.
Conclusions A high proportion of people who could have benefited from eye treatment were not using available services. Poor visual outcomes were observed in surgically treated persons.
From the London School of Hygiene and Tropical Medicine (Drs Fletcher and Abdalla and Mss Donoghue and Scott), London, England; the Society for Peoples' Education and Economic Change (Messrs Devavaram and Bala Murugan) and the Aravind Eye Hospital (Mr Thulasiraj and Dr Shanmugham), Madurai, Tamil Nadu, India.
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