Screening for Retinopathy of Prematurity in a Provincial Hospital in Port Elizabeth; South Africa

ABSTRACT

Background. Retinopathy of prematurity (ROP) is an emerging public health problem in many middle-income countries where improved neonatal survival rates coupled with inadequate health resources have created a new epidemic. There are limited available data on the magnitude of the problem; and screening in South African (SA) hospitals has not been uniformly practised.OBJECTIVE:To describe the results of various interventions implemented over a 6-year period while developing a new ROP screening service in a provincial hospital in Port Elizabeth; SA.METHOD: A retrospective case folder review of ROP screening at Dora Nginza Hospital; Port Elizabeth; SA; over the 6-year period 2009 - 2014 was conducted.RESULTS:A total of 919 new cases were seen. Fifteen patients received treatment for type 1 ROP (T1ROP); 223 had type 2 (T2) or earlier ROP; 1 had stage 4 ROP and 6 had stage 5 ROP. The combination of healthcare worker education; improved equipment and human resources and the introduction of dual responsibility for case referrals resulted in an increase in the number of new infants screened from 33 in year 1 to 292 in year 6. The number of infants who were screened late decreased from 33/33 (100%) in year 1; prior to the interventions; to 23/292 in the final year (7.9%). Improved oxygen delivery and adequate oxygen saturation monitoring contributed to a decrease in the incidence of T1ROP from 1.5% to 1% over 1 year and in the incidence of T2 or earlier ROP from 30.3% to 24%.CONCLUSIONS:Better management of ROP can be achieved through adequate provision of healthcare professionals and material resources coupled with education and a well-supported referral system. A close working relationship between paediatricians and ophthalmologists results in a more efficient screening programme