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Try out PMC Labs and tell us what you think. Learn More. Women suffer disproportionately more from cataract blindness compared to males in low- and middle-income countries. Two large population-based surveys have been undertaken in India at an interval of 7 years and data from these surveys provided an opportunity to assess the trends in gender differentials in cataract blindness.

Data were extracted from the surveys to discern sex differences in cataract blindness. Multivariate analysis was performed to adjust for confounders and their impact on gender differences in cataract blindness. Prevalence of cataract blindness was higher in females compared to males in both surveys. The odds of cataract blindness for females did not change over time as observed in the surveys — and — Adjusted odds ratio from logistic regression analysis revealed that females continued to be at a higher risk of cataract blindness.

Sex differences continued in India in relation to cataract blindness despite the gains made by the national program. Women bear a disproportionate burden of health inequity across the globe and face unique barriers in accessing health care. Several studies have documented such disparities. Evidence on prevalence of blindness, disaggregated by sex, has been collected at periodic intervals on large population denominators in India.

This allows a comparison on the gender dimension of blindness, with special reference to cataract blindness, in the Indian context. The present study describes the sex differentials in cataract blindness in India using data from the two large surveys conducted during — and — Detailed methodology used in the two surveys in India has been described earlier. Twenty-five clusters were randomly selected in each district and all individuals aged 50 years and above in these clusters were eligible for examination.

In —, a rapid assessment of avoidable blindness RAAB survey was undertaken in 16 districts in 15 states of India. Presenting vision was recorded for all individuals in both surveys. Individuals were dilated if the posterior segment needed to be examined in detail to identify the cause of visual loss. Vision was recorded by trained ophthalmic assistants while the basic and detailed eye examinations were performed by a trained ophthalmologist. A systematic approach of exploring the sex disparity was undertaken.

In the first step, the existence of sex difference among cataract blind was documented. Test of proportion and adjusted odds ratios from logistic regression were used for this purpose. The surveys were conducted nationwide covering a large of districts which naturally have a different demographic and economic distribution. The could be biased due to the fact that there are some districts where the sex difference is comparatively more Lady looking sex Cataract other districts, thus inflating the overall gender difference. To investigate the district-wise sex differentials, the district-wise odds ratios were also calculated.

The entire computation was performed using R statistical software R foundation for statistical computing, Vienna, Austria. A total ofindividuals were examined in the two surveys in India 63, in — and 45, in — The proportion of males examined were marginally higher in — The mean age of respondents was Comparison of sociodemographic characteristics of population examined in two large surveys in India. The difference Lady looking sex Cataract the prevalence of cataract blindness was ificant between the two surveys as there is no overlap in the CIs. Similarly, statistically ificant differences were observed between males and females in the surveys and also when the data from the two surveys was pooled [ Table 2 ].

It was observed that the prevalence of cataract blindness decreased by The decrease was steeper in males The odds of cataract blindness were ificantly higher in females compared to males in both rounds of surveys [ Table 3 ]. Gender differences in cataract blindness in the two large population-based surveys in India. Age-specific cataract blindness rates were also compared between males and females in both surveys [ Fig. It was observed that prevalence of cataract blindness increased ificantly with increasing age in both males and females in both surveys.

It was also observed that at the younger ages, the prevalence of cataract Lady looking sex Cataract was similar in males and females in both surveys, but at the older ages, there was a ificant differential in the cataract blindness curves between males and females. Age-specific gender differences in prevalence of cataract blindness in India over a period of 7 years.

In nine districts, the survey was undertaken both in and When the data from these nine districts were compared, it was observed that in all districts, except one Vaishalithe odds of blindness were ificantly lower in compared to [ Fig. These indicate that there has been a ificant decline in the magnitude of blindness in most states of India over the period — Forest plot depicting inter-district variation in districts included in surveys both in and Evidence from India clearly shows that there is a sex differential in the prevalence of cataract blindness with females in a disadvantaged position compared to males.

We were only able to adjust for place of residence and age. We were unable to adjust for socioeconomic status, education, and other risk factors as no data were available in comparable format in the two studies. These unadjusted factors might potentially confound the result. However, since this information was not collected for the RAAB, we were unable to include in the analysis. Another general limitation, as with any rapid assessment, was that there is a higher female participation.

Based on our analysis, it is also evident that the trend has remained constant over the last decade. It is of great concern that females at older ages are ificantly worse off compared to their male counterparts. This is despite the observation that at the age of 50—54 years, males and females have the same risk of cataract blindness. This dimension is of public health concern as females outlive males, and the differential in life expectancy is around 3 years in low- and middle-income countries.

As observed in the two large population surveys reported here, evidence available from most of the low- and middle-income countries including India shows that the prevalence of cataract blindness is ificantly higher in females compared to males. The findings from the present analysis, for the first time, corroborate anecdotal evidence about a ificant decrease in the prevalence of cataract blindness in India in the first decade of this century.

All the districts baring Vaishali had reduced odds of blindness. The reason for lower prevalence in Vaishali was not very clear. However, similar trends were reported from an earlier National Programme for Control of Blindness survey — In a country like India where the overall status of women in society is poor, a gender focus is essential if gender equity is to be ensured, especially when access to services is poor. Policymakers should consider innovative options to target the elderly female cataract blind in poor settings to improve coverage.

Additional incentives for operating on poor elderly females, providing transportation for women, and counseling the males in the household who have the economic clout could be specific measures in this direction. This will help in enhancing coverage of needy women.

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These measures would generally be applicable in the short term as evidence also shows that when coverage rates peak and reach a saturation point, gender differentials disappear even in countries where women have a poorer social standing, as is seen from a survey in India from a region with high cataract surgical coverage. National Center for Biotechnology InformationU. Journal List Indian J Ophthalmol v. Indian J Ophthalmol.

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Author information Article notes Copyright and information Disclaimer. Correspondence to: Dr. E-mail: gro.

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Received Jan 8; Accepted Jan This article has been cited by other articles in PMC. Abstract Aims: Women suffer disproportionately more from cataract blindness compared to males in low- and middle-income countries. Materials and Methods: Data were extracted from the surveys to discern sex differences in cataract blindness. : Prevalence of cataract blindness was higher in females compared to males in both surveys. Conclusions: Sex differences continued in India in relation to cataract blindness despite the gains made by the national program. Key words: Blindness, cataract, gender, India, prevalence.

Materials and Methods Detailed methodology used in the two surveys in India has been described earlier. Table 1 Comparison of sociodemographic characteristics of population examined in two large surveys in India. Open in a separate window. Table 2 Prevalence of cataract blindness in two large population surveys in India. Table 3 Gender differences in cataract blindness in the two large population-based surveys in India. Figure 1.

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Figure 2. Discussion Evidence from India clearly shows that there is a sex differential in the prevalence of cataract blindness with females in a disadvantaged position compared to males. Conflicts of interest There are no conflicts of interest. References 1. Monitoring gender equity in health using gender-sensitive indicators: A cross-national study.

J Womens Health Larchmt ; 20 — Sociodemographic characteristics associated with blindness in a Nile Delta governorate of Egypt. Br J Ophthalmol. Courtright P, Lewallen S. Why are we addressing gender issues in vision loss? Community Eye Health. Woldeyes A, Adamu Y. Gender differences in adult blindness and low vision, Central Ethiopia. Ethiop Med J. Sex inequalities in cataract blindness burden and surgical services in South India.

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Gender and blindness: A meta-analysis of population-based prevalence surveys. Ophthalmic Epidemiol. Current estimates of blindness in India. Rapid assessment of avoidable blindness in India. PLoS One. R Core Team.

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