An Eight-Year Review of Paediatric Ophthalmic Surgical Services at a Tertiary Eye Centre in Malawi

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Abstract Background Childhood visual impairment is a significant public health challenge, with prevalence rates in sub-Saharan Africa exceeding those in high-income countries. While surgical intervention is the mainstay of treatment for many blinding paediatric conditions, access to these services is constrained in low-resource settings. We report a comprehensive analysis of demographic and geographic patterns of paediatric ophthalmic surgical services at a tertiary eye centre in Malawi. Methods A retrospective analysis of paediatric patients who underwent ophthalmic surgeries at Lions Sight First Eye Unit, Queen Elizabeth Central Hospital (QECH) in Southern Malawi, between January 2015 and December 2022 was undertaken. Demographic variables included age group, sex and distance travelled to reach the facility. Descriptive statistics summarised trends, and a chi-square test assessed the association between sex and distance travelled. Results Of 3,807 identified patient files, 3,263 (85.7%) were eligible for analysis. A male predominance was observed (61.0% male vs 39.0% female), with a mean age of 5.7 (±4.4) years. The majority of children (n = 2783, 85.3%) were from the Southern region. More than half of the patients (52.6%, n = 1717) travelled over 50 km to reach QECH. A statistically significant association was found between sex and distance travelled (χ2 = 14.46, p = 0.013). Annual surgical volumes plateaued during the study period. Conclusion Paediatric ophthalmic surgical services in Malawi are concentrated at a single tertiary facility, creating geographic disparities in access. The male predominance in the number of children accessing the surgical services across different paediatric eye diseases highlights the need for gender-sensitive community awareness initiatives to ensure equitable access to surgical eye care for all children. Furthermore, the surgical numbers failing to increase in line with the national population growth can be an indicator of an overwhelmed system. These findings emphasise the urgent need to establish additional specialised centres to overcome these barriers.

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