Retinopathy of prematurity: Prevalence and risk factors among infants in rural Kenya

Abstract

Background: Retinopathy of Prematurity (ROP) is a potentially blinding eye disorder that is seen in premature infants. Data is scanty on prevalence rates in Africa. This study was done to determine the prevalence and risk factors for ROP in a rural hospital in Kenya.
Design: A prospective cohort study.
Methods: The study was carried out at the Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya between March 2015 and April 2016 in the neonatal unit and outpatient eye clinic. Infants less than 32 weeks gestation and/or weighing less than 1500 grams at birth, plus those with an unstable clinical course had a dilated fundoscopic examination starting at 28 days of life. Exam findings were recorded using standard IC-ROP classification. Examinations were repeated every 1-2 weeks until mature vasculature in zone III was confirmed. Infants were excluded if they died before the ROP outcome or if they did not show up for the first outpatient exam.
Results: One hundred and thirty one neonates were included in the study, with a male to female ratio of 1:0.95 (64/67). Mean gestational age was 30.64 ± 3.6 weeks and mean birth weight was 1478 ± 414.08 grams. Of these, 91 (69.5%) had been on oxygen, with a mean of 4.6 ± 5.9 days on oxygen. Four babies developed ROP (a prevalence of 3.05%). Three (75%) had zone II, stage 1 ROP and one (25%) had zone II, stage 2 ROP; all regressed without treatment. No infant developed vision-threatening ROP. Peri-natal risks identified in this group included respiratory distress syndrome, prolonged oxygen administration, intra-ventricular haemorrhage and seizures.
Conclusion: ROP prevalence was much lower than that reported in other studies, with all cases of ROP regressing without treatment. The presence of ROP in this setting however, makes a case for screening in hospitals in rural areas.