Prevalence and pattern of retinopathy of prematurity at two national referral hospitals in Uganda: a cross-sectional study

Iddi Ndyabawe; Flavia Namiiro; Anita Tumwebaze Muhumuza; Jesca Nakibuka; Juliet Otiti; Anne Ampaire; Moses Kasadhakawo; Fransisco Msonge; Siyad Mohamed; Mary Nyanzi; Victor Spector Tumukunde; Andrew Weil Semulimi; David Mukunya; Dan Bwonya; Primrose Magala; Clare Gilbert; Nancy Maria Douat Dietrich; Patricia Zanotelli Cagliari; Anna Hedstrom; Mike Blair; Becca Jones; James Nyonyintono; Aisha Muhamad Doka; Bariirah Bushirah Nakitende; Hamish R Graham; Susan Mary Carden; Rami Subhi; Grace Ssali Nsibirwa

doi:10.1186/s12886-023-03195-7

Prevalence and pattern of retinopathy of prematurity at two national referral hospitals in Uganda: a cross-sectional study

BMC Ophthalmol. 2023 Nov 22;23(1):478. doi: 10.1186/s12886-023-03195-7.

Authors

Iddi Ndyabawe¹, Flavia Namiiro², Anita Tumwebaze Muhumuza², Jesca Nakibuka², Juliet Otiti^{3

4}, Anne Ampaire³, Moses Kasadhakawo⁵, Fransisco Msonge³, Siyad Mohamed³, Mary Nyanzi⁶, Victor Spector Tumukunde⁶, Andrew Weil Semulimi⁷, David Mukunya⁸, Dan Bwonya⁹, Primrose Magala¹⁰, Clare Gilbert¹¹, Nancy Maria Douat Dietrich¹², Patricia Zanotelli Cagliari¹³, Anna Hedstrom¹⁴, Mike Blair¹⁵, Becca Jones¹⁶, James Nyonyintono¹⁶, Aisha Muhamad Doka¹⁷, Bariirah Bushirah Nakitende¹⁸, Hamish R Graham^#¹⁹, Susan Mary Carden^#¹⁹, Rami Subhi^#¹⁹, Grace Ssali Nsibirwa⁵

Affiliations

¹ Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda. iddi3000@gmail.com.
² Department of Paediatrics and Child Health, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda.
³ Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
⁴ Department of Ophthalmology, University of Antwerp, Antwerp, Belgium.
⁵ Department of Ophthalmology, Mulago National Referral Hospital, Kampala, Uganda.
⁶ Department of Paediatrics and Child Health, Kawempe National Referral Hospital, Kampala, Uganda.
⁷ Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
⁸ Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Tororo, Uganda.
⁹ Department of Ophthalmology, Mengo Hospital, Kampala, Uganda.
¹⁰ Moorfields Eye Hospital, London, UK.
¹¹ Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
¹² Instituto de Oftalmologia de Joinville, Paulo, Brazil.
¹³ Department of Ophthalmology, School of Medicine, University of the Region of Joinville, Paulo, Brazil.
¹⁴ Department of Neonatology, University of Washington, Seattle, United States of America.
¹⁵ Department of Ophthalmology, Pritzker School of Medicine, University of Chicago, Hyde Park, United States of America.
¹⁶ Department of Paediatrics, Kiwoko Hospital, Luwero, Uganda.
¹⁷ Department of Special Needs Education, Entebbe Parents Senior Secondary School, Entebbe, Uganda.
¹⁸ School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
¹⁹ Department of Pediatrics, Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia.

^# Contributed equally.

Abstract

Background: Retinopathy of prematurity (ROP) is a leading cause of blindness in children and an ROP epidemic is predicted this decade in sub-Saharan Africa. With the increasing survival rate of preterm babies in Uganda, and no data on ROP prevalence, there is a need to assess the burden of ROP to inform preventive strategies and targeted screening.

Methods: We conducted a two-center cross-sectional study of preterm (< 37 weeks gestational age) infants from the neonatal units of Kawempe National Referral Hospital (KNRH) and Mulago Specialised Women and Neonatal Hospital (MSWNH) from August 2022 to October 2022. An ophthalmologist examined all participants using an indirect ophthalmoscope with a + 20D convex lens and captured digital images using a Volk iNview™ Fundus Camera. The collected data were entered into Epidata 4.2 and exported to Stata 14.0 for analysis.

Results: 331 preterm infants enrolled in this study. The oxygen received was unblended. The mean gestational age was 30.4 ± 2.7 weeks, and the mean birth weight was 1597 ± 509 g. 18/101 (17.8%) were found to have any ROP amongst the preterm infants recruited from MSWNH, 1/230 (0.4%) from KNRH [95% CI] had any stage of ROP (i.e. stage 5). Of these, 8 (42.1%) had stage 2 ROP. Infants with a birth weight below 1500 g were 10 times more likely to have ROP than those among infants with a birth weight more than 1500 g [AOR: 10.07 (2.71-37.44)]. Infants who were not fed exclusively on breast milk had higher odds of having ROP than those exclusively fed on breast milk [AOR: 7.82(1.92-31.82)].

Conclusion: 6% of preterm infants born in two tertiary hospitals in Uganda were found to have ROP. Lack of exclusive feeding on breast milk and birth weight of less than 1500 g were strong predictors of ROP. The higher prevalence of ROP in MSWNH calls for cautious use of oxygen among preterms. We recommend targeted ROP screening for those at risk.

Keywords: Birth weight; Breast milk; Gestational age; Oxygen therapy; Retinopathy of prematurity; Sub-Saharan Africa; Uganda.

MeSH terms

Birth Weight
Child
Cross-Sectional Studies
Female
Gestational Age
Humans
Infant
Infant, Newborn
Infant, Premature*
Infant, Very Low Birth Weight
Oxygen
Prevalence
Referral and Consultation
Retinopathy of Prematurity* / diagnosis
Retinopathy of Prematurity* / epidemiology
Retinopathy of Prematurity* / etiology
Risk Factors
Tertiary Care Centers
Uganda / epidemiology

Substances

Oxygen

Grants and funding

R25 TW011213/TW/FIC NIH HHS/United States