The Impact of Cataract on Time-use: Results from a Population Based Case-control Study in Kenya, the Philippines and Bangladesh

Purpose: Cataract is the leading cause of blindness in the world, and is particularly common in low-income countries. Cataract is asserted to increase poverty through reduced productivity; however there is a lack of empirical data supporting this claim. The aim of this study was to examine the relationship between visual impairment from cataract with time-use in adults (aged >or= 50 years) in Kenya, Bangladesh, and The Philippines.

Methods: A population-based case-control study was conducted in three countries. Detailed time-use data were collected through interview from 139, 216 and 238 cases with visually impairing cataract and 124, 280 and 163 controls with normal vision in Kenya, Bangladesh and Philippines, respectively during 2005-2006.

Results: Cases were substantially less likely than controls to participate in productive activities, including paid work and non-market activities (odds ratio [OR] across three countries is 0.2 95% confidence interval (CI): 0.1-0.3) and in leisure outside of the household (OR 0.7, 95% CI: 0.5, 0.9). Among cases, those with more severe visual impairment spent significantly less time on productive activities and leisure outside of the home, and more time on "no particular activity" (Kenya and Bangladesh) or leisure in the home (The Philippines). Cases were substantially more likely to require assistance in any activity than controls in Kenya (OR 9.8, 95% CI: 3.3, 29.8), Bangladesh (OR 8.6, 95% CI: 5.1-14.4) and the Philippines (OR 2.7, 95% CI: 1.4-5.1).

Conclusions: Cataract visual impairment restricts engagement in productive and leisure activities in this population of older adults in three different low income settings.