Low uptake of eye services in rural India - A challenge for programs of blindness prevention

Objectives: To investigate service uptake in a rural Indian population serv ed by outreach eye camps and to identify barriers to uptake. Participants and Methods: A routine eye camp was conducted within 5 km of e ach of 48 randomly selected villages of typically Hindu, backward-caste com munities. Subsequently, participatory rural appraisal-community mapping, fo cus 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 eve camp. Predictors of attendance were identified by multilevel regression analysis. Results: Of 749 adults with an eye problem, 51 (6.8%) attended the eve camp . Independent predictors of attendance were be: mg 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 v ision (visual acuity <6/18 to greater than or equal to 3/60 in presenting b etter eye) and 38 (6.9%) were blind in both eyes. Cataract surgery was reco mmended 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 a nd 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 obse rved in surgically treated persons.