Identifying the Influencing Factors for Cataract Surgery Uptake in Malaysia

Background/Aims

Six simultaneous population surveys using the Rapid Assessment of Avoidable Blindness (RAAB) technique, a World Health Organisation (WHO) - recommended methodology, were done in Malaysia in 2014 (National Eye Survey, NES II). The findings revealed discrepancies in the country’s key eye care regional indicators. Mobile outreach community programs were piloted in Sarawak and the Eastern Region as part of a post-survey action plan. Despite being endorsed for outreach service brands and receiving regular operational funds, hospital and community-based cataract surgery data differed between regions. We postulate that this disparity could be due to community-related factors and their interactions. Follow-up surveys were done in both regions in 2023 (NES III), and findings were compared to the previous survey. The eligible subjects in the RAAB survey were consecutively recruited for a questionnaire interview to identify factors influencing cataract surgery uptake.

Methods

RAAB involved a multistage cluster sampling method, with each cluster comprising 50 residents aged 50 years and older. Subjects with Pinhole Visual Acuity (PinVA) worse than 6/18, either due to cataract or following cataract surgery, were consecutively identified and interviewed using a validated questionnaire focused on Knowledge, Perception, Attitude and Practice (comprising six factors and 22 response items), along with demographic and socioeconomic variables. The data were subsequently analysed using multiple logistic regression methods.

Results

A total of 1,119 subjects (Eastern = 711, Sarawak = 408) were recruited. The identified factors that influenced individuals with unilateral operable cataracts to have “no surgery” in Sarawak included their “perception to own sight” [AOR: 0.67, 95% CI (0.53, 0.84) P =0.001] and “attitude towards treatment [AOR:1.47, 95% CI (1.17, 1.85) P =0.001].” Meanwhile, in the Eastern region, the factors were “perception to own sight” [AOR: 0.67, 95% CI (0.53, 0.84) P =0.001], “attitude towards treatment” [AOR:1.47, 95% CI (1.17, 1.85) P =0.001], and “practice towards information” [AOR: 1.23, 95% CI (1.01, 1.50) P =0.042].

For subjects with bilateral operable cataract in Sarawak, the factors that influenced them to have “no surgery” were “knowledge on surgery” [AOR: 0.35, 95% CI (0.25, 0.50) P <0.001], “perception to own sight” [AOR: 1.48, 95% CI (1.15, 1.89) P =0.002], ethnicity (Chinese compared to Malays) [AOR: 0.19, 95% CI (0.04, 0.88) P =0.033] and level of education (primary school compared to secondary school or above) [AOR: 5.54, 95% CI (1.49, 20.69) P =0.011]. Additionally, for Eastern region, the factors identified were “knowledge on surgery” [AOR: 0.35, 95% CI (0.26, 0.48) P <0.001] and “practice on surgery” [AOR: 0.72, 95% CI (0.62, 0.84) P <0.001].

Conclusion

The common factors influencing the cataract surgical uptake for both Sarawak and Eastern Region include “perception to own sight”, “attitude towards treatment”, and “knowledge on surgery”. Ethnicity and level of education factors were specific to Sarawak. “Practice towards information” and “practice on surgery” were specific to the Eastern Region.