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Retinopathy of prematurity screening and treatment practice patterns: an African multi-country survey
Jonathan Malcolm1, David Ngabo2,3, Elie Nziyomaze2,3
1Hull Royal Infirmary, Hull, UK.
Insights
Retinopathy of prematurity (ROP) screening and treatment in Africa show significant variation. Limited resources and training gaps hinder effective ROP care, with a need for improved neonatal-ophthalmology integration.
Area of Science:
- Ophthalmology
- Public Health
- Neonatal Care
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Effective screening and treatment are crucial to prevent vision loss.
Purpose of the Study:
- To evaluate current retinopathy of prematurity (ROP) screening and treatment practices among African healthcare professionals.
- To identify challenges and barriers in ROP care delivery across the continent.
Main Methods:
- An online survey was distributed to ophthalmologists and ROP care providers in Africa.
- The survey utilized multiple-choice questions to gather data on screening, treatment, and available resources.
Main Results:
- Respondents from 16 countries highlighted ROP as a public health concern.
- Despite available neonatal intensive care units, formal referral pathways were often lacking.
- Treatment modalities like anti-VEGF and laser photocoagulation showed varied availability and usage patterns.
- Key barriers included cost, personnel shortages, and poor service integration.
Conclusions:
- ROP care in Africa is characterized by heterogeneity and resource limitations, including access to laser photocoagulation and integrated services.
- The prevalent use of anti-VEGF as a first-line treatment across all ROP stages is concerning due to high rates of patient loss to follow-up.
- There is a strong interest in further training and participation in regional ROP networks to improve care standards.
Purpose:
This study aimed to assess current retinopathy of prematurity (ROP) screening and treatment practices among healthcare professionals across Africa.
Methods:
An online in-depth survey consisting primarily of multiple-choice questions was sent to ophthalmologists and healthcare professionals involved in ROP care across Africa via professional networks, social media and word-of-mouth recommendations.
Results:
A total of 62 respondents from 16 countries were included. ROP was considered a current or emerging public health problem by 95.2% of respondents. Although 91.9% of respondents reported having a neonatal intensive care unit in their facility or nearby, 51.6% indicated the absence of a formal referral pathway between neonatal and ophthalmology services. Anti-VEGF and laser photocoagulation were available for 90.3% and 56.5% of respondents, respectively. ROP screening criteria and treatment approaches were heterogeneous, with anti-VEGF therapy frequently being used as a first-line across all disease stages. Vitreoretinal services were located more than 200 km away or outside the country for 31.6% of respondents. The most frequently reported barriers to care were cost, lack of trained personnel, and limited integration between neonatal and ophthalmic services. Notably, 95.2% expressed interest in further training or participation in a regional ROP network.
Conclusion:
ROP practice patterns across Africa remain heterogeneous and are constrained, in many settings, by limited access to laser photocoagulation, inadequate integration with neonatal services, and gaps in formal training. The widespread use of anti-VEGF as first-line therapy across all stages of disease raises concern in settings where loss to follow-up is common.
