Sightsavers is an international non-governmental organisation that works with partners in developing countries to treat and prevent avoidable blindness, and promote equality for people with visual impairments and other disabilities. It is based in Haywards Heath in the United Kingdom, with branches in Sweden, Norway, India, Italy, Republic of Ireland, the United Arab Emirates, and the USA.The charity was founded in 1950 by Sir John Wilson and was originally called the British Empire Society for the Blind, then the Royal Commonwealth Society for the Blind. Its patron is Princess Alexandra. Between 1950 and 2018, Sightsavers had distributed over 1 billion treatments to prevent potentially debilitating diseases and supported 7.3 million sight-restoring cataract operations.
BACKGROUND:Cataract is the leading cause of blindness worldwide despite treatment being very cost-effective. To stimulate efforts to address the large unmet need for affordable, good-quality cataract services, member states at the 74th World Health Assembly endorsed a global target of a 30 percentage-point increase in effective cataract surgical coverage (eCSC) by 2030. In this Article, we report on progress towards that target. METHODS:We did a secondary analysis of 233 participant-level population-based survey datasets (Rapid Assessment of Avoidable Blindness [RAAB] surveys and other population-based cross-sectional surveys) from 68 countries (2003-24) to estimate eCSC with a cataract surgical threshold of worse than 6/18 pinhole visual acuity and a threshold of 6/18 or better for postoperative presenting visual acuity (eCSC6/18) for each country. Eligible studies included people aged 50 years and older, without any further age restrictions. eCSC was calculated as the number of people who had received surgery and had a good visual outcome as a proportion of all people who had received or were still to receive surgery. For countries with only one survey estimate available, we reported the survey as the country estimate; for each country with two or more surveys, we used more recent and nationally representative survey to generate estimates. We included 228 of 233 datasets (excluding five datasets from the European region) in a mixed-effects logistic regression to estimate global and WHO regional temporal trends in eCSC6/18 from 2000 to 2030. For global estimates, we used eCSC in the Americas region as a proxy for the European region. We used 120 RAAB surveys that measured visual acuity at the 6/12 threshold to analyse causes of non-good outcomes (postoperative presenting visual acuity worse than 6/12) and estimated potential gains in eCSC (with a cataract surgical threshold of worse than 6/12 pinhole visual acuity and a 6/12 or better threshold for postoperative presenting visual acuity [eCSC6/12]) from correcting residual postoperative refractive errors. Potential gains were estimated by comparing eCSC6/12 calculated using postoperative presenting visual acuity with eCSC6/12 calculated using pinhole visual acuity (a proxy for visual acuity with optical correction of refractive error). FINDINGS:We used 130 studies to report 68 country estimates of eCSC6/18. Country estimates for eCSC6/18 from surveys ranged from 2·1% (95% CI 0·9-3·4) in Burundi (2024) to 77·7% (72·9-82·5) in Qatar (2023). Globally, we predicted eCSC6/18 of 48·2% (39·7-57·2) in 2025, increasing by 8·4 percentage points (8·1-8·6) between 2020 and 2030 (from 43·9% [36·6-51·2] to 52·3% [41·4-62·7]). Uncorrected refractive error accounted for a median 26·4% of non-good outcomes per survey; we estimated that treating this condition could yield a median 3·7 percentage-point gain in eCSC6/12 globally. INTERPRETATION:Global efforts are not on track to meet the target of a 30 percentage-point increase in eCSC between 2020 and 2030-immediate and substantial investment in cataract services is, therefore, required. Survey data indicated which elements of the cataract care pathway could be targeted for quality-improvement initiatives. A suite of cataract surgery quality indicators should be collected to better inform service providers. FUNDING:Indigo Trust, The Fred Hollows Foundation, and Wellcome Trust.
Objective: Adolescent mental health in the UK is an urgent public health concern, with rising prevalence and persistent inequities in access to care. This systematic review synthesises qualitative evidence on barriers and disparities affecting adolescents in engaging with mental health services across the UK, and interprets findings using the Social-Ecological Model (SEM). Methods: The review followed PRISMA 2020 guidance and was registered in PROSPERO (CRD42025652782). Peer-reviewed qualitative studies (UK; ages 10 - 19) published between 2014 and 2024 were searched across multiple databases using predefined terms and eligibility criteria. Two reviewers undertook screening with discrepancy resolution procedures, studies were critically appraised, and findings were thematically synthesised. Results: Eight qualitative studies (published 2014 - 2024) were included, comprising 97 adolescent participants across UK settings. Five key barriers were identified: (1) limited mental health literacy, (2) stigma and fear of judgement, (3) lack of culturally competent care, (4) economic deprivation and long waiting times, and (5) gendered norms surrounding help-seeking. Three intersecting disparities (ethnic and cultural, socio-economic, and geographic) further constrained access. Interpreted through the SEM, barriers operated across individual, interpersonal, community/school, and system levels. Conclusion: This UK-specific synthesis highlights multi-level barriers and intersecting disparities that delay or prevent adolescents' access to mental health support. With over 109,000 young people reportedly on mental health waiting lists in England alone, findings underscore the need for targeted reforms to improve timely, inclusive access, strengthening mental health literacy, embedding culturally adapted care, improving geographic accessibility, and integrating support within educational settings.
BACKGROUND:Aerial larviciding of Simulium breeding sites in Niger was conducted from 1976 to 1989, as onchocerciasis was a serious public health problem. In 2002, onchocerciasis was declared no longer of public health importance. Surveys to determine whether transmission of infection was still occurring began in 2014, including onchocerciasis elimination mapping in 2019-2020. METHODS:The endemic area encompassed 1575 communities across the basins of the Niger, Tapoa, Goroubi, Diamangou, Sirba and Mekrou rivers. From 2014 to 2018, flies caught from 55 sites were processed to detect infection using a polymerase chain reaction protocol. In 2018, Ov16 antibody levels were assessed in children, following World Health Organization guidelines, in areas suspected of ongoing transmission. Confirmatory testing of blackflies and Ov16 serology and parasite loads in residents was also performed. RESULTS:Between 2014 and 2016, 161 641 blackflies from 17 sites, in the six river basins were examined (with 7 surveyed twice), and an additional 126 283 flies from 13 sites processed in 2018; no Onchocerca volvulus infective larvae were found. Thus, the official elimination threshold (<1/2000 infective flies) was met. In 2018-2019, blood tests in 16 406 children ages 5-9 years were negative, and an additional 11 372 flies tested in 2024 were also negative. CONCLUSION:Niger has eliminated the transmission of human onchocerciasis, the first country in Africa to achieve this success.
An estimated 1.3 billion people worldwide experience disability and are a part of human diversity. People with disabilities remain underrepresented in development programmes and research. People with disabilities must be included in development initiatives to ensure that no one is left behind. This article serves as an introduction to this issue of the IDS Bulletin, which presents a collection of articles written by researchers and practitioners involved in the UK aid-funded Disability Inclusive Development (DID) programme. The articles explore a range of topics relating to disability and development such as health, education, safeguarding, transport, stigma, including the most marginalised groups, the imperative role of Organisations of Persons with Disabilities, and disability-inclusive approaches to research and evaluations. This IDS Bulletin presents robust evidence produced under the DID programme to show what is known, makes practical suggestions for what needs to be done to achieve inclusion going forward, and highlights persisting evidence and funding gaps.
BACKGROUND:Despite over two decades of Community-Directed Treatment with Ivermectin (CDTI), onchocerciasis transmission persists in localized pockets in Ghana, particularly in the Kwanware-Ottou community within the Wenchi Health District. This study trialled a scalable approach to identifying context-specific barriers and solutions for improving CDTI effectiveness. METHODOLOGY/PRINCIPAL FINDINGS:A mixed-methods approach was employed, including Geographical Information System mapping, community consultation, census and treatment coverage evaluation, and qualitative assessments. These informed the participatory development of an Action Plan, which was implemented and evaluated across three sub-districts. Key challenges identified and addressed included poor data quality, high population mobility, remote settlements with accessibility issues, limited awareness, and inadequate number and deployment of community drug distributors. As a result, therapeutic coverage increased from 70.8% to 88.2. Seven out of eight communities with pre-intervention coverage below the recommended 65% threshold not only achieved but exceeded this target. Ultimately, all communities met the coverage goal. The intervention also improved data accuracy and quality, community engagement, and adherence to directly observed treatment, while addressing systemic gaps in CDTI delivery. CONCLUSIONS/SIGNIFICANCE:This study demonstrates that a coordinated, locally adapted stimulus package can significantly enhance CDTI performance in areas of persistent onchocerciasis transmission. The approach presents a scalable model for similar endemic settings and aligns with the World Health Organization's 2021-2030 Roadmap for the elimination of Neglected Tropical Diseases.
