Fourteen years of retinopathy of prematurity in KwaZulu-Natal, South Africa.

Abstract

This thesis addresses a critical need in neonatal healthcare: preventing blindness and severe vision impairment caused by retinopathy of prematurity (ROP) among preterm infants in KwaZulu-Natal, South Africa. With advances in neonatal care enabling the survival of smaller, more vulnerable infants, ROP has become a pressing public health issue. This project aimed to evaluate the impact of the South African ROP screening guidelines introduced nearly a decade ago and to assess the current state of ROP detection and screening in KwaZulu-Natal. By analysing referral patterns, patient demographics, and screening outcomes, the study aimed to understand the effects of the guidelines and identify areas where care could be further improved. To achieve these objectives, the study followed an approach that involved analysing clinical data on ROP referrals from neonatal intensive care units (NICUs) across eastern KwaZulu-Natal. This included examining ROP referral rates, patient demographics, screening compliance, and treatment numbers to capture trends before and after implementing the guidelines, the identification of trends and areas requiring intervention. The project’s outputs include an evaluation of the effectiveness of the ROP screening guidelines, revealing notable reductions in treatable ROP cases and improvements in neonatal eye health overall. However, it also uncovered persistent challenges, such as inconsistent referral practices across facilities, large variability in guideline adherence, and a concerning rate of missed follow-up appointments. These insights have implications for healthcare policy and practice, suggesting that while the guidelines are largely beneficial, targeted efforts are needed to address gaps in referral practices and patient follow-up. The impact of this project is important for both clinical practice and public health policy. The project advocates for focused education and monitoring efforts, especially in facilities with high inappropriate referral rates, to enhance ROP screening efficacy. In doing so, the study supports ongoing improvements to neonatal care, aiming to safeguard vision health among the most vulnerable infant populations in South Africa and beyond.