Factors Affecting Delay in Presentation and Management of Pediatric Cataract: A Cross-sectional Study at a Tertiary Philippine hospital

Background. Pediatric cataract is a major cause of childhood visual impairment, and delays in detection, presentation, and surgical management can result in stimulus deprivation amblyopia and poor visual outcomes. In the Philippines, local data on factors contributing to these delays, including sociodemographic, sociocultural, socioeconomic, and pandemic-related barriers, remain limited.

Objective. This study aimed to determine the factors affecting the delay in presentation and management of patients with pediatric cataract in a tertiary Philippine hospital.

Methods. This was a single-center, cross-sectional study that conducted a questionnaire-based interview with guardians of patients who were diagnosed with pediatric cataract from January 2018 until June 2023. The questionnaire covered the basic sociodemographic and socioeconomic information, and asked questions on healthseeking behavior and possible causes of delay before seeking consult and before surgical management.

Results. A total of 93 guardians of patients with pediatric cataract/s were interviewed. There was a delay in presentation for the first consult in 59.1% and in presentation to the Pediatric Ophthalmology and Strabismus (POS) Clinic in 90.3%. Delay in surgical management affected 35.5% of patients. The main reasons for the delay in presentation  were unawareness, the COVID-19 pandemic, and financial issues, while the main reasons for delay in surgical management were due to economic issues, the COVID-19 pandemic, and the presence of other ophthalmologic problems that needed to be treated first. The parent being the first person who noticed the problem, having their own means of transport, and a higher loss of income on admission were significant factors contributing to the delay in presentation. A younger age of the mother during the child’s birth, the patient being initially seen prior to the COVID-19 pandemic, a lower education level of the father, use of public transport to and from the hospital, and a lower travel cost per visit were factors associated with delay in management. There was a decreasing trend in the delay during and after the COVID-19 pandemic compared to prior to the pandemic. 

Conclusion. Unawareness of the problem led the causes of delay in presentation, signifying how high a barrier this was at the household and community level rather than at the provider level. Economic issues contributing to the delay represented how citizens in developing countries struggled when it came to preparing for the financial needs for healthcare. The COVID-19 pandemic was shown to be a delaying factor at the individual and community level, but it lessened the delay at the provider level. Health education, cataract screening in the pediatric population, and financial support are recommended to overcome barriers in the prompt management of pediatric cataract.