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

doi:10.1136/bmjophth-2020-000645

. 2021 Aug 23;6(1):e000645.

doi: 10.1136/bmjophth-2020-000645. eCollection 2021.

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

Dupe S Ademola-Popoola^{1

2}, Iretiola B Fajolu³, Clare Gilbert⁴, Bolutife A Olusanya⁵, Oluwatoyin H Onakpoya⁶, Chinyelu N Ezisi⁷, Kareem O Musa⁸, Robison Vernon Paul Chan⁹, Valentina W Okeigbemen¹⁰, Rilwan C Muhammad¹¹, Aeesha N J Malik¹², Adedayo O Adio¹³, Olubunmi T Bodunde¹⁴, Abdulkadir L Rafindadi¹⁵, Tunji S Oluleye¹⁶, Olukemi O Tongo¹⁷, Sarat A Badmus¹⁸, Olufunmilayo V Adebara¹⁹, Tapas Ranjan Padhi²⁰, Beatrice N Ezenwa³, Tokunbo S Obajolowo², Lateefat B Olokoba²¹, Victoria A Olatunji²¹, Yewande Olubunmi Babalola¹⁶, Mary O Ugalahi⁵, Adetunji Adenekan²², Omotayo O Adesiyun²³, Jagdish Sahoo²⁴, Marilyn T Miller²⁵, Odarosa M Uhumwangho²⁶, Adeduntan S Olagbenro¹⁴, Ebunoluwa A Adejuyigbe²⁷, Chinyere V C Ezeaka³, Olugbenga Mokuolu²⁸, Tinuade A Ogunlesi²⁹, Olusoga B Ogunfowora²⁹, Isa Abdulkadir³⁰, Fatima L Abdullahi³⁰, Abosede T Fabiyi³¹, Laila H L Hassan³⁰, Aderonke M Baiyeroju⁵, Peace I Opara³², Kehinde Oladigbolu¹⁵, Augusta U Eneh³², Bassey E Fiebai³³, Fatima A Mahmud-Ajeigbe¹⁵, Elijah N Peter¹⁵, Hawwa S Abdullahi¹⁵

Affiliations

¹ Department of Ophthalmology, University of Ilorin, Ilorin, Kwara, Nigeria.
² Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria.
³ Department of Neonatology/Perinatology, Paediatrics, University of Lagos College of Medicine/ Lagos University Teaching Hospital, Lagos, Nigeria.
⁴ Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
⁵ Paediatric Ophthalmology & Strabismus Unit, Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria.
⁶ Retinal Unit, Department of Ophthalmology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun, Nigeria.
⁷ Pediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria.
⁸ Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria.
⁹ Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA.
¹⁰ Paediatric Ophthalmology Unit, Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Edo, Nigeria.
¹¹ Department of Ophthalmology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.
¹² London School of Hygiene and Tropical Medicine, London, UK.
¹³ Paediatric Ophthalmology Unit, Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria.
¹⁴ Department of Ophthalmology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria.
¹⁵ Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria.
¹⁶ Vitreoretinal Unit, Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria.
¹⁷ Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria.
¹⁸ Paediatric Ophthalmology Unit, Department of Ophthalmology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria.
¹⁹ Neonatal Unit, Department of Paediatrics, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria.
²⁰ Vitreoretinal Services, LV Prasad Eye Institute Bhubaneswar Campus, Bhubaneswar, India.
²¹ Vitreoretinal Unit, Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria.
²² Vitreoretinal Unit, Department of Ophthalmology, University of Lagos, Lagos, Nigeria.
²³ Department of Paediatrics, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria.
²⁴ Neonatology, IMS and SUM Hospital, Kalinga Nagar, Bhubaneswar, Odisha, India, Bhubaneswar, Odisha, India.
²⁵ Department of Ophthalmology, University of Illinois College of Medicine, Chicago, Illinois, USA.
²⁶ Vitreoretinal Unit, Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Edo, Nigeria.
²⁷ Peadiatrics and Child Health, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria.
²⁸ Neonatal Unit, Department of Paediatrics, University of Ilorin, Ilorin, Kwara, Nigeria.
²⁹ Department of Paediatrics, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria.
³⁰ Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria.
³¹ Special Care Baby Unit, Nursing Service, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria.
³² Department of Paediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria.
³³ Vitreoretinal Unit, Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria.

PMID: 34514173
PMCID: PMC8383855
DOI: 10.1136/bmjophth-2020-000645

Free PMC article

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

Dupe S Ademola-Popoola et al. BMJ Open Ophthalmol. 2021.

Free PMC article

. 2021 Aug 23;6(1):e000645.

doi: 10.1136/bmjophth-2020-000645. eCollection 2021.

Authors

Affiliations

¹ Department of Ophthalmology, University of Ilorin, Ilorin, Kwara, Nigeria.
² Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria.
³ Department of Neonatology/Perinatology, Paediatrics, University of Lagos College of Medicine/ Lagos University Teaching Hospital, Lagos, Nigeria.
⁴ Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
⁵ Paediatric Ophthalmology & Strabismus Unit, Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria.
⁶ Retinal Unit, Department of Ophthalmology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun, Nigeria.
⁷ Pediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria.
⁸ Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria.
⁹ Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA.
¹⁰ Paediatric Ophthalmology Unit, Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Edo, Nigeria.
¹¹ Department of Ophthalmology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.
¹² London School of Hygiene and Tropical Medicine, London, UK.
¹³ Paediatric Ophthalmology Unit, Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria.
¹⁴ Department of Ophthalmology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria.
¹⁵ Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria.
¹⁶ Vitreoretinal Unit, Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria.
¹⁷ Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria.
¹⁸ Paediatric Ophthalmology Unit, Department of Ophthalmology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria.
¹⁹ Neonatal Unit, Department of Paediatrics, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria.
²⁰ Vitreoretinal Services, LV Prasad Eye Institute Bhubaneswar Campus, Bhubaneswar, India.
²¹ Vitreoretinal Unit, Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria.
²² Vitreoretinal Unit, Department of Ophthalmology, University of Lagos, Lagos, Nigeria.
²³ Department of Paediatrics, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria.
²⁴ Neonatology, IMS and SUM Hospital, Kalinga Nagar, Bhubaneswar, Odisha, India, Bhubaneswar, Odisha, India.
²⁵ Department of Ophthalmology, University of Illinois College of Medicine, Chicago, Illinois, USA.
²⁶ Vitreoretinal Unit, Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Edo, Nigeria.
²⁷ Peadiatrics and Child Health, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria.
²⁸ Neonatal Unit, Department of Paediatrics, University of Ilorin, Ilorin, Kwara, Nigeria.
²⁹ Department of Paediatrics, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria.
³⁰ Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria.
³¹ Special Care Baby Unit, Nursing Service, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria.
³² Department of Paediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria.
³³ Vitreoretinal Unit, Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria.

PMID: 34514173
PMCID: PMC8383855
DOI: 10.1136/bmjophth-2020-000645

Abstract

Objectives: Retinopathy of prematurity (ROP) 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 ROP 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 ROP, and 723 preterm infants screened for ROP 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 ROP 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 ROP 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 ROP; and 29 (22.8%) developed type 1 ROP. Only 13 (44.8%) babies were treated, most by intravitreal bevacizumab. The screening criteria were revised in 2020. Challenges included lack of equipment to regulate oxygen and to document and treat ROP, and lack of data systems.

Conclusion: ROP screening coverage and quality improved after national and international collaborative efforts. To scale up and improve services, equipment for neonatal care and ROP treatment is urgently needed, as well as systems to monitor data. Ongoing advocacy is also essential.

Keywords: angiogenesis; epidemiology; retina; treatment lasers; treatment medical.

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Activities for retinopathy of prematurity (ROP) in Nigeria 2016–2020. IPOSC, International Pediatric Ophthalmology and Strabismus Council.

**Figure 2**
Status of retinopathy of prematurity (ROP) programme in Nigeria in 2017 and 2018.

**Figure 3**
Birth weight and gestational ages of babies developing type 1 retinopathy of prematurity (ROP).

See this image and copyright information in PMC

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LinkOut - more resources

Full Text Sources

[1] March of Dimes . Save the Children, WHO. In: Howson CP, Kinney MV, Lawn JE, eds. Born too soon: the global action report on preterm birth born too soon. World Health Organization, 2012.

[2] March of Dimes . Save the Children, WHO. In: Howson CP, Kinney MV, Lawn JE, eds. Born too soon: the global action report on preterm birth born too soon. World Health Organization, 2012.

[3] Nigeria profile of preterm and low birth weight prevention and care. Available: https://www.everypreemie.org/wp-content/uploads/2019/07/Nigeria_7.5.19.pdf [Accessed 17th Apr 2020].

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[9] WHO . Born too soon: the global action report on preterm birth, 2016.

[10] WHO . Born too soon: the global action report on preterm birth, 2016.

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