ORIGINAL PAPER Uptake of cataract surgery in Sava Region, Madagascar: role of cataract case finders in acceptance of cataract surgery Narivony Razafinimpanana • Henry Nkumbe • Paul Courtright • Susan Lewallen Received: 6 June 2011 / Accepted: 17 January 2012 / Published online: 20 March 2012 Ó Springer Science+Business Media B.V. 2012 Abstract The number of people coming for cataract surgery in Madagascar remains low and most ophthal- mologists could do many more surgeries than currently done. Knowing why people identified with cataract do not accept surgery will help to design programs that use existing resources more effectively. The study was carried out in Sava Region of Madagascar. People with blinding ( \ 6/60) cataract were identified by cataract case finders in the community, interviewed, and given a referral card for surgery at the hospital. We then monitored uptake of surgery at the hospital. Overall, 142 people were identified, interviewed and referred. Among the referrals, 35 (24.6%) presented at the hospital for surgery. The most important factors associated with acceptance were proximity to hospital (people from Sambava district were twice as likely to present as people from more distant districts) and perceived price of transport and food (being higher for people not accepting). The actual price of surgery was not the main barrier to acceptance of surgery; instead it appears that distance to the hospital and the willingness to pay are important predictors. Strategies to improve uptake need to be revised in order to ensure that people have access to and use cataract surgical services. Keywords Barriers Á Cataract surgery Á Uptake Á Madagascar Introduction Cataract is the leading cause of blindness in Africa [1]; it is estimated that there are over 3.8 million people in Africa blind from this condition. In Africa the barriers that prevent people with cataract from receiving sight restoring surgery are various and are often complex. For example, in Nigeria, reported barriers to cataract surgery were non-availability or inaccessibility and high cost of eye care services [2]. In Tanzania, factors related to willingness to pay have included perceived need and social support from relatives [3]. Differences between the people who accept and who refuse surgery also included self-perceived mental well-being, sense of shame, dependency and social functioning [4]. Rumours N. Razafinimpanana SALFA Eye Clinic Sambava, Sambava, Madagascar N. Razafinimpanana (&) Á H. Nkumbe SALFA Eye Project Antananarivo, P.O. Box 3825, Ambohibao, Madagascar e-mail: narivonyraza@yahoo.fr H. Nkumbe e-mail: nkumbe@gmx.net H. Nkumbe CBM, Antananarivo, Madagascar P. Courtright Á S. Lewallen Kilimanjaro Centre for Community Ophthalmology, Moshi, Tanzania e-mail: pcourtright@kcco.net S. Lewallen e-mail: slewallen@kcco.net 123 Int Ophthalmol (2012) 32:107–111 DOI 10.1007/s10792-012-9523-7