In the present study, more elderly females than males Accessed care at the eye hospital similar to the pattern observed in Ghana [9]. Conversely, other studies [13] have found that more males attended eye care services than females. The greater number of female patients in our study can be attributed to the fact that in general women use more healthcare services than men [14]. In part, it could also be because women spend a lot of time at the hospital for other reasons or health concerns than men [15] hence they could be preoccupied with other routine healthcare programs. On the other hand, it also could be due to the fact that men are nonchalant about their health [16]. Therefore, the results of our study call for the integration of eye services within the national health system and outreach programs targeting elderly men. Equity in access to eye health should be addressed if we are to attain Universal health coverage by preventing the systematic exclusion of vulnerable individuals [17].
Our study also found that cataract is the most common ocular disorder among the elderly population in Malawi, similar to previous studies [18]. However, the prevalence of cataracts was lower than reported in India [19]. However, it was higher compared to findings by other authors [20]. The variation could be due to different geographical settings and sample composition since the cataract differs with ethnicity [11]. The relatively higher prevalence of cataracts in our study is not surprising considering that in developing countries it is widely known as the commonest cause of blindness [4]. In Malawi, Cataract is the main cause of blindness among people aged 40 and above [6]. Consequently, cataract is regarded as an independent marker of mortality and several studies have linked the presence of cataract to a higher risk of death [11]. Considering that only about 5 % of the cataract patients self-refer in Malawi, [21] our study highlights the need for cataract case-finding strategies among senior citizens.
Not surprisingly, our study found lower proportions of Age-related Macular degeneration. Previous studies have confirmed that ARMD is more prevalent among Europeans unlike Africans [11].
In the present study, the prevalence of cataracts was significantly associated with the male sex than with females. On the contrary, other authors [11,25] found that cataract was more among females than males. Furthermore, others reported that there was no significant association between the prevalence of cataracts and sex [4]. We attribute the results of our study to the fact that more men than women smoke in Malawi [22]. Our study did not explore the association between behavioral risk factors and eye diseases, however, previous studies have found a strong association between smoking and cataract formation. [23]. More males being affected may in turn affect their families because these people may be active breadwinners despite their geriatric age [24].
In the current review, the prevalence of Glaucoma was lower compared to previous studies in India [25,26]. We attribute the low prevalence of glaucoma in our study to differences in the study population. The present study found that the prevalence of glaucoma was significantly associated with age. Similarly, a study by Pisudde and colleagues reported a significantly associated with increasing age [25]. Glaucoma is known to increase with growing populations [27].
According to the time of the year, the least number of patients were attended to in August while the highest number was recorded in March which is the start of the dry season in Malawi hence people can easily access hospitals either because they have leveraged their livelihoods crop harvests or roads are passable [28]. Although eye care services are free at the point of access, patients still incur out-of-pocket expenditures when accessing health care due to transport [29]. In general, 50 % of Malawians live within 5 kilometers of a health facility. Nevertheless, Terrible terrain and pitiable road infrastructure make it challenging for Malawians to access health care, especially during the rainy season [30].
Limitations
Our study is not without drawbacks. First, the design of our study may be prone to selection bias since retrospective records were used. In addition, we were unable to find the association of ocular conditions with possible risk factors. Furthermore, due to the nature of our study, we could not estimate the prevalence of blindness and visual impairment among this high-risk population group. Nevertheless, this study provides baseline data for planning and resource allocation for eye health services in Malawi.