Barriers and enablers to uptake of cataract surgery services at the Siaya County Referral Hospital, Kenya

Abstract

Introduction: Cataracts are the leading cause of blindness globally, affecting approximately 94 million people, predominantly the elderly. Despite effective surgical interventions, disparities in access to cataract surgery persist in Kenya, with surgical coverage below 35% in rural areas. This study identified barriers and facilitators to the uptake of cataract surgical services at Siaya County Referral Hospital.

Methods: A descriptive cross-sectional study with a mixed-methods approach was conducted. A survey questionnaire was administered to patients with cataracts, complemented by key informant interviews with four healthcare providers and focus group discussions with patients. 

Findings: A total of 239 cataract patients participated in the study. Majority of the respondents (84.3%) were over 60 years old (median age: 79, age range of 35–93 years), with 53.1% male. Cataract was correctly identified as an eye disease by 59.8%. Barriers included lack of awareness (30.4%), fear (30.1%) and geographical distance (33.7%), while facilitators were counselling (69.5%), proximity to facilities (39.3%), and financial support (32.2%, NHIF). Religious factors significantly influenced surgical willingness (p = 0.01, χ² = 11.234). No significant associations were found with education, marital status, or occupation.

Conclusion: Lack of awareness, fear, and distance are major barriers to cataract surgery uptake, while counselling, facility proximity, and financial aid are key enablers. Recommendations include enhanced community education, strengthened counselling, and additional surgical facilities to improve access in underserved areas.