Strengthening retinopathy of prematurity screening and treatment services in Nigeria: a case study of activities, challenges and outcomes 2017-2020

Abstract

Objectives Retinopathy of prematurity (R0P) will become a major cause of blindness in Nigerian children unless screening and treatment services expand. This article aims to describe the collaborative activities undertaken to improve services for R0P between 2017 and 2020 as well as the outcome of these activities in Nigeria. Design Descriptive case study. Setting Neonatal intensive care units in Nigeria. Participants Staff providing services for R0P, and 723 preterm infants screened for R0P who fulfilled screening criteria (gestational age <34 weeks or birth weight <2000 g, or sickness criteria). Methods and analysis A WhatsApp group was initiated for Nigerian ophthalmologists and neonatologists in 2018. Members participated in a range of capacity building, national and international collaborative activities between 2017 and 2018. A national protocol for R0P was developed for Nigeria and adopted in 2018; 1 year screening outcome data were collected and analysed. In 2019, an esurvey was used to collect service data from WhatsApp group members for 2017-2018 and to assess challenges in service provision. Results In 2017 only six of the 84 public neonatal units in Nigeria provided R0P services; this number had increased to 20 by 2018. Of the 723 babies screened in 10 units over a year, 127 (17.6%) developed any R0P; and 29 (22.8%) developed type 1 R0P. Only 13 (44.8%) babies were treated, most by intravitreal bevacizumab. The screening criteria were revised in 2020. Challengesincluded lack of equipment to regulate oxygen and to document and treat R0P, and lack of data systems. Conclusion R0P screening coverage and quality improved after national and international collaborative efforts. To scale up and improve services, equipment for neonatal care and R0P treatment is urgently needed, as well as systems to monitor data. Ongoing advocacy is also essential.