Cataract Surgical Quality Assurance in State Eye Care Programmes: Lessons from Niger State

Quality assurance in cataract surgery is essential to achieving the dual objectives of increasing surgical volume and maintaining acceptable visual outcomes in Nigerian state eye care programmes. This study evaluates cataract surgical quality assurance practices within the Niger State Eye Care Programme, North Central Nigeria. A retrospective programme audit will be conducted, reviewing data from all cataract surgeries performed at five programme sites from 2021 to 2023. Variables assessed will include surgeon grading, surgical technique employed, percentage of patients achieving visual acuity of 6 over 18 or better post-operatively with available correction (WHO acceptable outcome threshold), complication rates including posterior capsule rupture and endophthalmitis, and follow-up compliance. Key informant interviews with ophthalmologists and programme managers will supplement clinical data. The WHO recommends that no more than 5 percent of cataract surgical patients should have poor outcomes attributable to surgical error. Findings from Nigeria suggest this standard is not consistently met, with outcome variations influenced by surgeon experience, equipment availability, and patient follow-up. This study identifies specific quality gaps in the Niger State programme and proposes targeted corrective measures. Recommendations will include mandatory surgical outcome monitoring, structured mentorship for lower-volume surgeons, equipment maintenance protocols, and standardised post-operative care pathways. Embedding quality assurance as a core function of state eye care programme management is non-negotiable for building public trust and long-term sustainability of surgical eye care in Niger State. Keywords: cataract surgery, quality assurance, surgical outcomes, Niger State, WHO threshold