Changes in the prevalence, causes of visual impairment, and cataract service coverage in Karamoja, Uganda, between 2015 and 2023: Findings from two cross-sectional surveys.

Two rapid assessments of avoidable blindness (RAAB) surveys were conducted in the Karamoja subregion, Uganda, in 2015 and 2023. This paper reports the observed changes in prevalence, causes of visual impairment and coverage of cataract services and examines how the trends differ for males and females. Standard RAAB methodology was used in both studies. Two-stage cluster sampling was used to generate random samples of adults aged over 50 years. Participants underwent a simplified visual acuity (VA) exam, a lens exam, and a posterior segment exam using a direct ophthalmoscope for all participants with presenting VA < 6/18. Data was analyzed using an inbuilt command prtesti, and the regression models were developed using Stata v15 statistical software. In 2015, 3,833 participants were enrolled, and 96.8% (3,727) examined. In 2023, 3,450 were enrolled and 91.6% (3,159) examined. The prevalence of all-cause blindness was 6.0% in 2015 and 4.9% in 2023 (p-value = 0.05). The Cataract Surgical Coverage (CSC) for persons with visual acuity threshold of <3/60, < 6/60, and <6/18 was 41.6%, 34.2% and 20.5% in 2015 and 71.6%, 56.6% and 41.5% respectively, in 2023. The effective Cataract Surgical Coverage (eCSC) for the same vision category was 20.0%, 16.2%, and 9.2% in 2015 and 22.5%, 17.1% and 12.4% in 2023 The eCSC was consistently lower among females than males with the gap widening over the years: 15.9%, 12.1%, and 9.1% in females vs 28.4%, 21.6%, and 15.7% in males respectively. The CSC levels differed across assessments while eCSC values remained low. Targeted interventions are needed to improve post-surgical visual outcomes and ensure equity in access for women and individuals with moderate visual impairment.