Gender and eye care:
Evidence of the problem and
solutions
Paul Courtright, DrPH
Kilimanjaro Centre for Community Ophthalmology
Cape Town, South Africa & Moshi, Tanzania
(www.kcco.net)
Why are we here?
What do we hope to
accomplish today?
Why are we here?
Women account for 2 out of 3 blind
people….
…if we are to achieve VISION 2020
we must address eye care needs of
women
A bit of history….Understanding the
problem & generating the evidence
for action
1. Systematic review of literature & meta-analysis
2. Analysis of potential reasons for differences in
blindness figures
3. Disease specific assessments (including
measuring service utilization)
4. Implementing strategies to address the issues
Findings from meta-analysis of
70 population based surveys
(published between 1980-2000)
Age-adjusted odds of blindness
in women compared to men
– Africa:
– Asia:
– Industrialised:
1.39 (1.2-1.6)
1.41 (1.3-1.6)
1.63 (1.3-2.1)
– Overall:
1.43 (1.3-1.5)
Abou-Gareeb et al. Ophthal Epidem. 2001;8:39-56.
What about the last 12 years?
• Large national surveys (Ethiopia,
Pakistan, Bangladesh & Nigeria)
• Rapid Assessment of Avoidable
Blindness (RAAB) surveys
(about 28 in Africa)
• Indian (state) RAAB surveys
• Latin American RAAB surveys
Analysis of potential reasons
for gender disparity
• Longer life expectancy in women
– Women live longer and blindness is associated with
increasing age.
– However, age-specific rates of blindness show
female excess in most age groups
• Different risk for acquiring eye diseases
– Slightly higher incidence of cataract among women
– Higher incidence of trachomatous trichiasis among
women
• Unequal utilisation of eye care services
– Cataract, trachoma, congenital/ developmental
cataract
Cataract
Cataract Surgical Coverage (2002-8)
Males
Females
100%
80%
60%
40%
20%
0%
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(ranked by highest to lowest overall CSC)
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15
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Higher in
women -10
-15
Difference
Why are women less likely to
have surgery?
• Perceived need for eye
care different
• Willingness to assume
a “sick” role
• Financial decisionmaking in the family
• Inexperience in
traveling outside the
village
• Social support lacking
Key strategies for cataract
• Transport to hospital
• Counseling of family
members
• Women-to-women
contact
Childhood blindness
• Vitamin A/measles
related corneal
opacities now rare
• Retinal/optic nerve
conditions increasing
• Childhood cataract
– Congenital
– Developmental
– Traumatic
Still too few girls getting surgery
80
70
60
50
40
30
20
10
0
Girls
Boys
Malawi
Kenya
Tanzania
KCMC &
CCBRT
India
Children receiving surgery for congenital/developmental
cataract at tertiary eye hospitals
Trachoma
• Excess burden of trichiasis in women compared to
men 1.82 (95% CI1.6 to 2.1)
Surveys represent burden of TT
globally?
• Total survey sample =
43,677
– Men = 19,392
– Women = 24,285
• People with TT = 9,564
– Men = 2,826 (29.5%)
– Women = 6,738 (70.5%)
Men
Women
Why are we here?
What do we hope to
accomplish today?
How do we reduce gender inequity?
A disease specific approach?
•Cataract
•Trachoma
•Childhood blindness
A service delivery approach?
•Interacting at the community level
•Changing our eye care facilities
•Bridging communities and facilities
How do we reduce gender inequity?
A disease specific approach?
•Cataract
•Trachoma
•Childhood blindness
A service delivery approach?
•Interacting at the community level
•Changing our eye care facilities
•Bridging communities and facilities
Improving gender
equity =
Reducing
blindness