Interventions to improve gender equity in eye care in low-middle income countries: A systematic review

Purpose: Women bear an inequitable burden of blinding conditions compared to men primarily because they have more limited access to eye care services. This systematic review sought evidence regarding interventions to increase gender equity in eye care.
Methods: We searched MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and EBSCO CINAHL, and contacted experts to identify studies in low- and middle-income countries of health services interventions for age-related cataract, childhood cataract, and trachoma. Eligible studies could be clinical trials or observational studies, but had to present sufficient data for intervention effects to be estimated separately for women and men.
Results: We included four cluster RCTs and nine observational studies. All were judged to have serious risk of bias. Six studies examined interventions involving training rural community volunteers to identify, educate and assist individuals with unmet eye care needs. Interventions were associated with reduced gender inequities in all-cause blindness, clinic attendance, cataract surgery coverage and trachoma treatment coverage (low-to-very low quality evidence). Studies in Nepal and Tanzania examining a multicomponent intervention to improve follow-up after pediatric cataract surgery found reduced gender inequities in follow-up rates at 10 weeks (low quality evidence).
Conclusion: Limited evidence exists to inform health service planners regarding interventions to reduce gender inequity in visual impairment and blindness. Training community volunteers to identify and counsel affected individuals, and empower them to circumvent or challenge socioeconomic barriers to accessing care holds promise. Future interventions ought to explicitly consider gender in their design and implementation, and incorporate high-quality evaluation efforts.

研究背景：相较于男性，女性在致盲性眼病方面承担着更为不公的疾病负担，这主要源于她们获得眼科医疗服务的机会更为有限。本系统综述旨在探寻能够提升眼科医疗服务领域性别公平性的干预措施相关证据。
研究方法：本研究检索了MEDLINE、Cochrane对照试验中心注册库（Cochrane Central Register of Controlled Trials）、EMBASE以及EBSCO CINAHL数据库，并联系了相关专家，以筛选低收入和中等收入国家中针对年龄相关性白内障、儿童白内障以及沙眼的医疗服务干预措施相关研究。纳入的研究可为临床试验或观察性研究，但需提供足够数据，以便分别估算干预措施对女性和男性的影响效果。
研究结果：本综述共纳入4项整群随机对照试验（cluster RCT）与9项观察性研究，所有研究均被判定存在较高偏倚风险。其中6项研究针对培训乡村社区志愿者识别、宣教并协助存在未被满足的眼科医疗需求的人群这一干预措施展开了评估。结果显示，该类干预可降低全因失明、门诊就诊率、白内障手术覆盖率以及沙眼治疗覆盖率方面的性别不公平性（证据质量为低至极低）。针对尼泊尔与坦桑尼亚的研究评估了改善儿童白内障术后随访情况的多组分干预措施，结果发现该干预可降低术后10周随访率方面的性别不公平性（证据质量为低）。
研究结论：目前仅有有限的证据可用于指导医疗服务规划者制定可降低视力损害与致盲性眼病领域性别不公平性的干预措施。培训社区志愿者识别并告知患者相关信息，同时赋予其克服或挑战就医过程中社会经济障碍的能力，这类干预措施展现出良好前景。未来的干预措施应在设计与实施阶段明确考量性别因素，并纳入高质量的评估工作。