Impact of COVID-19 on ophthalmic surgical procedures in sub-Saharan Africa: a multicentre study
Authors: Ally Naseer , Ismail Sarah , Naidu Natasha , Makda Ismail , Mayet Ismail , Gyasi Michael E. , Makafui Peter , Nomo Arlette , Nanfack Chantal , Madikane Anesu T. , Pohl Walda D. , Mbambisa Bayanda N. , Oettle Jonathan T. , Adepoju Feyi , Tota-Bolarinwa Toibat B. , Buque Amelia , Khalau Sidonia J. N. , Zirima Douglas , Takayidza Brian , Eze Ugochukwu A. , Adedeji Akinyemi , Sandi Frank , Feksi Jacinta , Okonkwo Ogugua , Hassan Adekunle , du Toit Nagib , Petersen Shahlaa , Tsimi Caroline , Dovoma Viola , Bature Mustapha , Adamu Mohammed , Okeke Suhanyah , Asimadu Ifeoma N. , Kizor-Akaraiwe Nkiru N. , Ezisi Chinyelu N. , Nkumbe Henry E. , Olivier Tchoyou T. M. , Alli Hassan D. 
Published: March 2024

Abstract
Background
The COVID-19 pandemic had a profound impact on healthcare and ophthalmology services globally. Numerous studies amongst various medical and surgical specialties showed a reduction in patient attendance and surgical procedures performed. Prior published ophthalmic literature focused on specific types of procedures and were usually single centre. The current study attempts to quantify the impact on a larger scale, namely that of sub-Saharan Africa, and to include all ophthalmic subspecialties.

Methods
This is a retrospective analysis of the surgical records from 17 ophthalmology centres in seven countries located in East, Central, West and Southern Africa. The date of declaration of the first lockdown was used as the beginning of the pandemic and the pivot point to compare theatre records one year prior to the pandemic and the first year of the pandemic. We examined the total number of surgical procedures over the two year period and categorized them according to ophthalmic subspecialty and type of procedure performed. We then compared the pre-pandemic and pandemic surgical numbers over the two year period.

Results
There were 26,357 ophthalmic surgical procedures performed with a significant decrease in the first year of the pandemic (n = 8942) compared to the year prior to the pandemic (n = 17,415). The number of surgical procedures performed was lower in the first year of the pandemic compared to the year prior to the pandemic by 49% [Incidence rate ratio (IRR) 0.51, 95% CI 0.41–0.64), 27% (0.73, 0.55–0.99), 46% (0.54, 0.30–0.99), 40% (0.60, 0.39–0.92) and 59% (0.41, 0.29–0.57) in sub-Saharan Africa (4 regions combined), West, Central, East and Southern Africa, respectively]. The number of surgical procedures in the different sub-specialty categories in sub-Saharan Africa (4 regions combined) was significantly lower in the first year of the pandemic compared to the year prior to the pandemic, except for glaucoma (IRR 0.72, 95% CI 0.52–1.01), oncology (0.71, 0.48–1.05), trauma (0.90, 0.63–1.28) and vitreoretinal (0.67, 0.42–1.08) categories.

Conclusion
This study provides insight into the impact of the COVID-19 pandemic in multiple regions and countries on the African continent. The identification of which surgical subspecialty was most affected by the COVID-19 pandemic in each region allows for better planning and resource allocation to address these backlogs.