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Retinopathy of prematurity in South Africa: an assessment of needs, resources and requirements for screening
S Varughese1, C Gilbert, C Pieper
1South Asia Regional Office (North), Bangalore, India. sara.varughese@gmail.com
Insights
Preventing blindness from retinopathy of prematurity (ROP) in premature infants requires better neonatal care and screening. South Africa
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of childhood blindness in middle-income nations.
- In South Africa, ROP contributed to 10.6% of childhood blindness in 1995.
Purpose of the Study:
- To estimate the number of premature infants at risk of ROP in South Africa.
- To investigate current policies, practices, and screening programs for ROP.
Main Methods:
- Surveyed 17 neonatal units across four South African provinces.
- Reviewed published literature and interviewed healthcare staff.
Main Results:
- An estimated 13,000-15,000 premature infants are at risk of ROP annually.
- Public neonatal units faced equipment shortages for oxygen monitoring and insufficient nursing staff awareness of target oxygen saturations.
- Screening was limited, with ophthalmologists visiting only four units regularly, primarily using birth weight (<1500g) as a criterion. Treatment rates for ROP were low (1.6-2.9%).
Conclusions:
- Effective ROP prevention necessitates high-quality neonatal care, well-equipped facilities, and adequate staffing.
- Efficient screening and treatment programs are crucial for secondary prevention.
- Limited resources and competing priorities in South Africa's public sector have hindered ROP prevention efforts, necessitating a re-evaluation.
Aims:
Retinopathy of prematurity (ROP) is a major cause of blindness in children in middle-income countries. In 1995, it accounted for 10.6% of blindness in children in schools for the blind in South Africa. This study was undertaken to estimate the number of premature babies at risk and to investigate policies, practices and screening programmes.
Materials And Methods:
17 level 1-3 neonatal units were visited in four provinces. Published literature reports were reviewed and staff interviewed.
Results:
13,000-15,000 surviving premature babies are at risk of ROP each year. Shortage of equipment precluded continuous oxygen monitoring in public units. Nursing levels were often below recommendations, and most nurses were unaware of target oxygen saturations. Private units were well staffed and adequately equipped. Ophthalmologists were only visiting four units on a regular basis for screening, using the birth weight criterion of <1500 g for ROP screening. ROP needing treatment rates were low (1.6-2.9%), as were rates of follow-up.
Conclusions:
Primary prevention of ROP requires meticulous neonatal care and adequately equipped and staffed units. Secondary prevention requires efficient screening and treatment programmes. Competing demands and limited resources in the public sector in South Africa have precluded prioritizing the prevention of ROP. This should be re-evaluated.
