What are the priorities for improving cataract surgical outcomes in Africa? Results of a Delphi exercise.
PURPOSE
The quality of cataract surgery delivered in sub-Saharan Africa (SSA) is a significant constraint to achieving the elimination of avoidable blindness. No published reports from routine SSA cataract services attain the WHO benchmarks for visual outcomes; poor outcomes (<6/60) often comprise 20% in published case series. This Delphi exercise aimed to identify and prioritise potential interventions for improving the quality of cataract surgery in SSA to guide research and eye health programme development.


METHODS
An initial email open-question survey created a ranked list of priorities for improving quality of surgical services. A second-round face-to-face discussion facilitated at a Vision 2020 Research Mentorship Workshop in Tanzania created a refined list for repeated ranking.


RESULTS
Seventeen factors were agreed that might form target interventions to promote quality of cataract services. Improved training of surgeons was the top-ranked item, followed by utilisation of biometry, surgical equipment availability, effective monitoring of outcomes of cataract surgery by the surgeon, and well-trained support staff for the cataract pathway (including nurses seeing post-operative cases).


CONCLUSION
Improving the quality of cataract surgery in SSA is a clinical, programmatic and public health priority. In the absence of other evidence, the collective expert opinion of those involved in ophthalmic services regarding the ranking of factors to promote quality improvement, refined through this Delphi exercise, provides us with candidate intervention areas to be evaluated.
['Buchan|J C|JC|http://orcid.org/0000-0003-1005-7011', 'Dean|W H|WH|', 'Foster|A|A|', 'Burton|M J|MJ|']
D001766:Blindness D002386:Cataract D002387:Cataract Extraction D003697:Delphi Technique D005260:Female D006301:Health Services Needs and Demand D006801:Humans D015994:Incidence D008297:Male D009885:Ophthalmology D011795:Surveys and Questionnaires D013636:Tanzania
Cataract Sub-Saharan Africa Quality improvement Delphi technique