Gendered disparities in quality of cataract surgery in a marginalised population in Pakistan: The Karachi marine fishing communities eye and general health survey

Abstract BACKGROUND: Marine fishing communities are among the most marginalised and hard-to-reach groups and have been largely neglected in health research. We examined the quality of cataract surgery and its determinants, with an emphasis on gender, in marine fishing communities in Karachi, Pakistan, using multiple indicators of performance. METHODS AND FINDINGS: The Karachi Marine Fishing Communities Eye and General Health Survey was a door-to-door, cross-sectional study conducted between March 2009 and April 2010 in fishing communities living on 7 islands and in coastal areas in Keamari, Karachi, located on the Arabian Sea. A population-based sample of 638 adults, aged ≥ 50 years, was studied. A total of 145 eyes (of 97 persons) had undergone cataract surgery in this sample. Cataract surgical outcomes assessed included vision (presenting and best-corrected with a reduced logMAR chart), satisfaction with surgery, astigmatism, and pupil shape. Overall, 65.5% of the operated eyes had some form of visual loss (presenting visual acuity [PVA] \u3c 6/12). 55.2%, 29.0%, and 15.9% of these had good, borderline, and poor visual outcomes based on presenting vision; with best correction, these values were: 68.3 %, 18.6%, and 13.1%, respectively. Of 7 covariates evaluated in the multivariable generalized estimating equations (GEE) analyses, gender was the only significant independent predictor of visual outcome. Women\u27s eyes were nearly 4.38 times more likely to have suboptimal visual outcome (PVA\u3c6/18) compared with men\u27s eyes (adjusted odds ratio 4.38, 95% CI 1.96-9.79; P\u3c0.001) after adjusting for the effect of household financial status. A higher proportion of women\u27s than men\u27s eyes had an irregular pupil (26.5% vs. 14.8%) or severe/very severe astigmatism (27.5% vs. 18.2%). However, these differences did not reach statistical significance. Overall, more than one fourth (44/144) of cataract surgeries resulted in dissatisfaction. The only significant predictor of satisfaction was visual outcome (P \u3c0.001). CONCLUSIONS: The quality of cataract surgery in this marginalised population, especially among women, falls well below the WHO recommended standards. Gender disparities, in particular, deserve proactive attention in policy, service delivery, research and evaluation

Practitioner perspectives of legacy: insights from the 2015 Pan Am Games

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Although legacy frameworks exist in academia and legacies are oft discussed in relation to publicly- and privately funded events, there remains a dearth of knowledge on practitioner conceptualisations of the concept. A case study of the Toronto 2014 Pan Am and Parapan Am Games was conducted using semi-structured interviews with event organisers and city officials to understand how practitioners conceptualise legacies, and what their goals are in relation to legacies. The findings show that organisers conceptualise legacies as solely positive, and include Games-time impacts and outcomes as part of the legacy. The positive frame supports the three central legacy goals: justifying public spending on events, boosting public support for event hosting, and advancing city development goals through event hosting. This research contributes to the discourse on event legacy and takes an important step in expanding understandings of practitioner conceptualisations of legacy

KarachiFishing_PlosOne

Quality of Cataract Surgery in The Karachi Marine Fishing Communities Eye and General Health Surve

Data from: Gendered disparities in quality of cataract surgery in a marginalised population in Pakistan: the Karachi marine fishing communities eye and general health survey

Background: Marine fishing communities are among the most marginalised and hard-to-reach groups and have been largely neglected in health research. We examined the quality of cataract surgery and its determinants, with an emphasis on gender, in marine fishing communities in Karachi, Pakistan, using multiple indicators of performance. Methods and Findings: The Karachi Marine Fishing Communities Eye and General Health Survey was a door-to-door, cross-sectional study conducted between March 2009 and April 2010 in fishing communities living on 7 islands and in coastal areas in Keamari, Karachi, located on the Arabian Sea. A population-based sample of 638 adults, aged ≥ 50 years, was studied. A total of 145 eyes (of 97 persons) had undergone cataract surgery in this sample. Cataract surgical outcomes assessed included vision (presenting and best-corrected with a reduced logMAR chart), satisfaction with surgery, astigmatism, and pupil shape. Overall, 65.5% of the operated eyes had some form of visual loss (presenting visual acuity [PVA] < 6/12). 55.2%, 29.0%, and 15.9% of these had good, borderline, and poor visual outcomes based on presenting vision; with best correction, these values were: 68.3 %, 18.6%, and 13.1%, respectively. Of 7 covariates evaluated in the multivariable generalized estimating equations (GEE) analyses, gender was the only significant independent predictor of visual outcome. Women’s eyes were nearly 4.38 times more likely to have suboptimal visual outcome (PVA<6/18) compared with men’s eyes (adjusted odds ratio 4.38, 95% CI 1.96-9.79; P<0.001) after adjusting for the effect of household financial status. A higher proportion of women’s than men’s eyes had an irregular pupil (26.5% vs. 14.8%) or severe/very severe astigmatism (27.5% vs. 18.2%). However, these differences did not reach statistical significance. Overall, more than one fourth (44/144) of cataract surgeries resulted in dissatisfaction. The only significant predictor of satisfaction was visual outcome (P <0.001). Conclusions: The quality of cataract surgery in this marginalised population, especially among women, falls well below the WHO recommended standards. Gender disparities, in particular, deserve proactive attention in policy, service delivery, research and evaluation