Utilization patterns of eye care services among women in outreach camps: A retrospective study from Nepal.

Background: Vision impairment remains a major global public health concern, with persistent gender disparities in access to eye care services, particularly in low- and middle-income countries. Evidence from Nepal suggests inequities in service utilization despite expanded outreach programs. This study aimed to examine gender-specific patterns of eye care service utilization in outreach settings. Design and Methods: This retrospective cross-sectional study analyzed secondary data from 43,848 individuals screened at diagnostic, screening, and treatment (DST) and surgical outreach camps organized by 23 Nepal Netra Jyoti Sangh hospitals across all seven provinces of Nepal between 2020-2024. Demographic, clinical, and service-utilization data were summarized descriptively, and associations were tested using chi-square analysis (SPSS v23; p<0.05). Results: Women accounted for 53.1% (n=23,290) of service users, with slightly higher outreach participation than men (75.6% vs. 74.5%). However, women's participation declined with age, from 78.9% in those under 60 years to 60.5% in those aged ≥80 years. Cataract was the predominant diagnosis (n=42,239; 96.3%), more frequent among women (52.8%), while trauma-related surgeries were more common in men (78.6%). Follow-up rates were higher among patients treated by female surgeons (60.4%) compared to male surgeons (49.1%) (p<0.001). In multivariable analysis, patient gender showed a minimal association with follow up (AOR= 1.04, 95%CI: 1.00 -1.08). In contrast, patient treated by female surgeon was independently associated with higher odds of follow up (AOR:1.45, 95%CI: 1.39 -1.51). Significant provincial variation in follow-up attendance was observed, with significantly higher odds in most provinces compared to Sudurpaschim Province. Patient received service though surgical camp had the highest likelihood of follow up compared to walk-in patients (AOR=3.79). Conclusion: The finding highlights eye care service utilization varied by gender, age, patient residence, outreach modality in Nepal. Follow up was more influenced by surgeon gender and outreach modalities than by patient gender alone. Targeted, gender-responsive strategies are needed to improve equitable access and strengthen continuity of care, particularly for older women.