Retinopathy of prematurity in South Africa: an assessment of needs, resources and requirements for screening programmes

Abstract

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.