Research Article: A Case-Control Study to Assess the Relationship between Poverty and Visual Impairment from Cataract in Kenya, the Philippines, and Bangladesh

Date Published: December 16, 2008

Publisher: Public Library of Science

Author(s): Hannah Kuper, Sarah Polack, Cristina Eusebio, Wanjiku Mathenge, Zakia Wadud, Allen Foster, Peter McCluskey

Abstract: BackgroundThe link between poverty and health is central to the Millennium Development Goals (MDGs). Poverty can be both a cause and consequence of poor health, but there are few epidemiological studies exploring this complex relationship. The aim of this study was to examine the association between visual impairment from cataract and poverty in adults in Kenya, Bangladesh, and the Philippines.Methods and FindingsA population-based case–control study was conducted in three countries during 2005–2006. Cases were persons aged 50 y or older and visually impaired due to cataract (visual acuity < 6/24 in the better eye). Controls were persons age- and sex-matched to the case participants with normal vision selected from the same cluster. Household expenditure was assessed through the collection of detailed consumption data, and asset ownership and self-rated wealth were also measured. In total, 596 cases and 535 controls were included in these analyses (Kenya 142 cases, 75 controls; Bangladesh 216 cases, 279 controls; Philippines 238 cases, 180 controls). Case participants were more likely to be in the lowest quartile of per capita expenditure (PCE) compared to controls in Kenya (odds ratio = 2.3, 95% confidence interval 0.9–5.5), Bangladesh (1.9, 1.1–3.2), and the Philippines (3.1, 1.7–5.7), and there was significant dose–response relationship across quartiles of PCE. These associations persisted after adjustment for self-rated health and social support indicators. A similar pattern was observed for the relationship between cataract visual impairment with asset ownership and self-rated wealth. There was no consistent pattern of association between PCE and level of visual impairment due to cataract, sex, or age among the three countries.ConclusionsOur data show that people with visual impairment due to cataract were poorer than those with normal sight in all three low-income countries studied. The MDGs are committed to the eradication of extreme poverty and provision of health care to poor people, and this study highlights the need for increased provision of cataract surgery to poor people, as they are particularly vulnerable to visual impairment from cataract.

Partial Text: Improvements in health are at the heart of the Millennium Development Goals, with the recognition that better health is central to the primary aim of reducing poverty as well as important in its own right. Empirical data are needed to back up this claim. Unravelling the relationship between blindness and poverty therefore has important implications, and may also be informative for the association between poverty and other disabilities.

This large, multicentre population-based case–control study provides evidence that people with visual impairment from cataract are poorer than control participants with normal vision matched for age and sex. This pattern was evident whether poverty was measured in terms of PCE, assets, or self-rated wealth. Marital status seemed to be protective for cataract visual impairment, possibly indicating the role of social support in health-seeking behaviour. Reduced self-rated health was also strongly related to cataract visual impairment. This demonstrates the impact of poor vision on overall assessments of health and supports our previous finding of a relationship between cataract and quality of life [17].



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