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

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

Ocular axial length measurement among normal adults using magnetic resonance imaging

Background/Introduction: Macrophthalmia and microphthalmia are cardinal signs of many orbito-ocular and systemic diseases which are seen in northern Nigeria. Some cases of refractive error may also be directly related to the ocular axial length (AL). The need for an imaging parameter that will aid their early diagnosis is necessary, as visual compromise is a major consequence if they are not diagnosed and managed appropriately.Aim and Objectives: To use magnetic resonance imaging, to determine the normal AL of the eyeball and to establish the association, if any, between AL and inter-zygomatic line (IZL), age and sex.Materials and Methods: The study was conducted over a 6- month period (29th November 2011 to 28th May 2012) at the Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria. The anterio-posterior dimension of the globes (AL) and the length of IZL were measured at the level of the lens for 340 normal ocular globes of 170 patients on T1-weighted MR images.Results: The normal ranges for ocular measurements were as follows (mean ± SD): AL of the right globe, 23.32 ± 1.34mm (range 22.0–24.7) and AL of the left globe, 23.29 ± 1.22mm (range 22.10–24.51). The length of the IZL was 103 ± 4.78mm (range 98.2–107.78). All measurements in male patients were significantly higher than those in female patients (P &lt; 0.001).Conclusion: The results obtained from this study may help ophthalmologists, radiologists and other clinicians to quantitatively evaluate patients with macrophthalmia, microphthalmia and/or refractive errors.Keywords: Inter-zygomatic line, magnetic resonance imaging, normal adults, ocular axial lengt