AWARENESS AND SCREENING FOR RETINOPATHY OF PREMATURITY AMONG PAEDIATRICIANS IN NIGERIA SENSIBILISATION ET DEPISTAGE POUR LA RETINOPATHIE DES PREMATURES PARMI LES PEDIATRES AU NIGERIA 1
*UHUMWANGHO OM, ISRAEL-AINA YT
ABSTRACT Background: Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina which occurs in premature babies due to defective vasculogenesis. There are established screening guidelines to enhance its early identification and prompt treatment . The aim of the study was to determine the level of awareness of the screening protocols for retinopathy of prematurity (ROP) among paediatricians in Nigeria. Methods: A questionnaire was administered to paediatricians and residents in paediatrics attending a continuous professional development (CPD) course in Benin City, Nigeria. Information on their knowledge of risk factors, screening guidelines and treatment modalities for ROP was obtained. Results: There were a total of 48 participants. The mean age of the participants was 34.5 ± 4.5 years of which 25 (52.1%) were females. A majority, 46 (95.8%) knew some risk factors for ROP. Fourteen (29.2%) participants knew the ROP screening guidelines while 10 (20.8%) had partial knowledge of these guidelines. Knowledge on the use of laser as a treatment modality of ROP was shown by 18 (37.5%) participants. The major reason given for not screening for ROP was being unaware of a referral centre in Nigeria in 43 (89.6%) participants. Conclusion: The majority of paediatricians attending a CPD course in Nigeria though aware of retinopathy of prematurity, are currently poorly informed on the management of this condition and the need for screening. There is need to enlighten paediatricians in Nigeria on retinopathy of prematurity in order to prevent this treatable cause of blindness in children. Keywords: Retinopathy of prematurity, Paediatricians, Need for screening, Nigeria. ABSTRAIT Contexte: La Rétinopathiedeprématuré est un désordre vasoprolifératif de la rétinequi se produit dansdes bébésprématurés à cause devasculogènedéfectif. Ilexistedesconseilsde dépistage,établis dans le but d'améliorer l'identification précoce et le traitement rapide de cette condition. But: Le but de l'étude était la détermination,parmi des pédiatres nigérians, du niveau de connaissancedes protocoles de dépistagepour la Rétinopathie de prématuré. Méthode: Un questionnairea été administré aux pédiatres et internes qui fréquentaient un coursd'étude de développement professionnel continue (CDP) à Benin City au Nigéria. L'information de la connaissance des personnes interrogéessur les facteurs de risque,les conseils de dépistage et les modalités de traitement a étéobtenue. Au total, il y avait 48 participants.L'âgemoyen des participants été placé a 34.5 ± 4.5 ans, dans lequel 25 étaient des femmes. Une majoritéde 46 (95.8%) étaient conscientes des facteurs de risque pour le RDP. Quatorze participantsconnaissaient les conseils dedépistage de RDP alors que 10 participants avaient une connaissance partielledeces conseils. Une connaissance de l'utilisation de laser comme une modalité de traitement pour RDP a été montré par 18 participants (37.5)%. Le fait de ne pas êtreau courant d'un centre spécialiste pour le RDP au Nigeria a été donnécomme raison principale pour le non dépistage par 43 participants (89.6%). Conclusion: Bien que la majorité des pédiatres, fréquentantun cours CDP au Nigeria, connaisse l'idée de la rétinopathie de prématuré,ils sont actuellement mal informés sur la gestion de la condition et sur le besoin d'êtredépisté. C'est nécessaire d'éclairer les pédiatres au Nigeria sur la rétinopathie de prématuré afin d'éviter la cécité chez les enfants, une condition qui pourrait êtretraitée. Mots Cles: Rétinopathie de prématuré, les pédiatres, le besoin de dépistage, Nigeria.
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Awareness And Screening For Retinopathy of Prematurity Among Paediatricians in Nigeria Sensibilisation et Depistage Pour la Retinopathie Des Prematures Parmi Les Pediatres au Nigeria
INTRODUCTION Retinopathy of prematurity (ROP), previously c a l l e d re t ro l e n ta l f i b ro p l a s i a s , i s a vasoproliferative disorder of the retina which occurs principally in premature children due to defective vasculogenesis1. The survival of premature and low birth weight babies with modern and effective neonatal care increases the incidence of retinopathy of prematurity. Retinopathy of prematurity is one of the causes of avoidable blindness targeted by the World Health Organization in the Vision 2020-Right to Sight initiative2. There is a wide variation in the incidence of ROP in various countries which is 3-6 closely linked to their level of development . Reports indicate a steady decline in industrialized countries, an upsurge in middle income countries and low incidence in low 5,6 income countries . The low incidence in low income countries has been attributed to high infant mortality rates and poorly equipped 7 neonatal intensive care units . In order to reduce the prevalence of retinopathy of prematurity, screening guidelines of at risk babies have been recommended in order to institute appropriate interventions to reduce the incidence of blindness form this treatable condition8,9. Pediatricians who are responsible for the care of these neonates ought to be well informed and implement the recommended protocol to achieve a complete win-win situation in the saving of both lives and sight of these babies for a more productive life. This is important as the number of blind years in a child increases the burden of care to the families affected and society at large10,11. The study was performed to determine the level of awareness and retinopathy of prematurity *Uhumwangho OM, Israel-Aina YT1 Department of Ophthalmology & 1Department of Child Health, University of Benin Teaching Hospital, P.M.B. 1111, Benin City, Nigeria. E-mail: [email protected] *Correspondence Grant support: None Subvention: Aucun Conflict of interest: None Conflit d'intérêts: Aucun
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INTRODUCTION N o m m é a u t refo i s co m m e ret ro l e nta l fibroplasias, la Rétinopathie de prématuréest un désordre vasoprolifératifde rétine qui se produit principalement aux enfants prématuréàcause de vasculogène défectif. La survie des prématurés et des bébés, ayant un poids bas à la naissance augment l'incidence de la rétinopathie de prématuré,suite aux soins néonatals moderneset éffective.La Rétinopathie de prématuré est l'un des causes majeures de la cécité qui pourrait être évité et qui a été ciblée par L'Organisation Mondiale de la Santé dans la vision 20-20, l'initiative Pour le droit de la vue. Il ya une grande variation d'incidence de RDP de pays en pays qui sont liés à leur niveau de développement. Selon les rapports, il ya une chute progressive aux pays développé, unemontéedans les pays aux revenus moyens et une incidence basse aux pays à faible revenu. L'incidence basse aux pays des bas salaires ont étéattribué au taux élevé de la mortalité infantile et ainsi que le service de soins intensifs qui sont mal équipée. Afin de réduire la prédominance de la Rétinopathie de prématuré, les conseils de dépistage ont étérecommandés pour les bébés menacés de la maladie ; ceci dans le but d'établir des interventions destinéesà réduire l'incidence de cette condition de la cécité qui pourrait êtretraité. Les pédiatresresponsables pour les soins de ces néonatalsauraient dûêtrebien informéet de s'appliquer le protocolerecommandés pour obtenir une situation Win Win visé à sauver la vie et la vue de ces enfants pour qu'ils mènent une vie plus productive. L'importance de bien former les pédiatresest vue du fait que le nombre des annéesdont l'enfant subi a la cécité pèsent lourdement sur les familles affecteéset la société en général. L'étude a été actualisée, en conformité avec la norme internationale de dépistage pour le RDP, pour déterminer le niveau de conscience ainsi que le protocole et les conseils de dépistage pour laRétinopathie de prématuré parmi les pédiatres au Nigeria. Cela est pertinent vue l'augmentation dans la naissance assisté, la fécondation in vitro dans le pays et une amélioration aux soins néonatals :
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screening protocol/guidelines among pediatricians in Nigeria in compliance with international screening guidelines for ROP. This is relevant with an upsurge in the number of assisted births and in-vitro fertilization in the country and improved neonatal care in a bid to ensure survival of the babies, thus assessing how prepared paediatricians are to tackle the sequel of improved neonatal care12. MATERIALS AND METHODS A questionnaire modified from previous 10,13 studies was administered to paediatricians and residents in paediatrics drawn from across the country attending a continuous professional development (CPD) course in Benin City, Nigeria. Information on demographics, education and practice profile, knowledge of risk factors, dilatation drops, screening guidelines and treatment options, risks of screening and treating preterm babies with retinopathy of prematurity (ROP) was obtained. Also obtained were responses on the number of premature babies seen per month, a w a r e n e s s a n d r e fe r ra l s c h e m e t o ophthalmologist and barriers for referring babies for ROP screening. Responses obtained were analyzed using Graphpad Instat Software V2.05a and P value 0.05).Ce phénomènesuggère l'existence d'un niveau bas sur l'importance accordé au RDP lors de la formation des internes au service de pédiatrie. L'implication de tous ces faits se montre dans la préparation des pédiatres à s'attaquer au défi lancé par le RDP, qui pourrait se produit suite aux soins néonatales améliorées.
There are currently no established guidelines or screening protocol for ROP in Nigeria. A blind school study performed about two decades ago in Northeastern Nigeria recorded an incidence of 0.5%21. An isolated pilot study carried out in a tertiary health centre in South West Nigeria, also about two decades ago reported an incidence of 5.5% in babies weighing about 1,500g or less than 31 weeks gestational age22. This figure may have been higher if majority of the preterm babies had not died. However, a more recent study performed in South-south Nigeria with
A l'heure actuel, au Nigeria, il n'existe pas de conseils ni de protocole de dépistage établi pour le RDP. Selon une étude menée dans une école de cécité au nord-est du Nigeria, il a vingt ans, une incidence de 0.5% a été enregistré. Une étude pilote isolé et effectué dans un centre tertiaire de la sante au sud-est du Nigeria, aussi dans l'environ de vingt ans, a rapporté une incidence de 5.5% dans les bébés qui pesaient d'un environ de 1,500 ou moins que 31 semaines d'âges de gestation. Ce nombre aurait du être plus élevé si la plupart des bébés née avant terme n'étaient pas mortes. Néanmoins, uneétude plus récemmentmenée au sud-sud du Nigeria,
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improving neonatal care reported an incidence of 47.2% and babies requiring treatment 23 referred to a center about 800 miles away . This rise in incidence carries the risk of another 'epidemic' of the disease if appropriate measures for screening, detection, prompt treatment and prevention are not instituted. Retinopathy of prematurity is an important and emerging disease in Nigeria. Paediatricians and other caregivers should be educated to improve their awareness of ROP. Its prevalence should be documented, national guidelines for screening and prompt treatment of babies at risk developed, and facilities for screening and treatment made readily available. Acknowledgement: Special thanks go to Drs Subhadra Jalali, Padmaja Rani Kumari, at the LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India for their professional assistance.
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remarquant des soins néonatalesaméliores, a rapporté une incidence de 47.2% aussi que des bébés, qui ont besoin de traitement, envoyé a un centre spécialiste a l'environ de 1334km. Ce taux d'incidence élevéporte le risque d'une autre épidémie de la maladie si des mesures suffisant n'ont pas prises sur le dépistage, la détection, le traitement précoce et la prévention. La rétinopathie des prématurés est une maladie important et qui se fait jour au Nigeria. Les Pédiatres et les autres personnes qui prennent soins des malades devraient être instruit pour améliorer leur niveau de conscience. La prédominance RDP, faudrait êtredécrite, les conseils nationales pour le dépistage et un traitement rapide des bébés au risque développé et des installations pour le dépistage et traitement soient plus facilement disponible. Les Remerciements: Tous mes remerciements aux Drs. Subhadra Jalali, Padmaja Rani Kumari, et LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, pour leur soutien professionnel.
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*UHUMWANGHO OM, ISRAEL-AINA YT
ABSTRACT Background: Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina which occurs in premature babies due to defective vasculogenesis. There are established screening guidelines to enhance its early identification and prompt treatment . The aim of the study was to determine the level of awareness of the screening protocols for retinopathy of prematurity (ROP) among paediatricians in Nigeria. Methods: A questionnaire was administered to paediatricians and residents in paediatrics attending a continuous professional development (CPD) course in Benin City, Nigeria. Information on their knowledge of risk factors, screening guidelines and treatment modalities for ROP was obtained. Results: There were a total of 48 participants. The mean age of the participants was 34.5 ± 4.5 years of which 25 (52.1%) were females. A majority, 46 (95.8%) knew some risk factors for ROP. Fourteen (29.2%) participants knew the ROP screening guidelines while 10 (20.8%) had partial knowledge of these guidelines. Knowledge on the use of laser as a treatment modality of ROP was shown by 18 (37.5%) participants. The major reason given for not screening for ROP was being unaware of a referral centre in Nigeria in 43 (89.6%) participants. Conclusion: The majority of paediatricians attending a CPD course in Nigeria though aware of retinopathy of prematurity, are currently poorly informed on the management of this condition and the need for screening. There is need to enlighten paediatricians in Nigeria on retinopathy of prematurity in order to prevent this treatable cause of blindness in children. Keywords: Retinopathy of prematurity, Paediatricians, Need for screening, Nigeria. ABSTRAIT Contexte: La Rétinopathiedeprématuré est un désordre vasoprolifératif de la rétinequi se produit dansdes bébésprématurés à cause devasculogènedéfectif. Ilexistedesconseilsde dépistage,établis dans le but d'améliorer l'identification précoce et le traitement rapide de cette condition. But: Le but de l'étude était la détermination,parmi des pédiatres nigérians, du niveau de connaissancedes protocoles de dépistagepour la Rétinopathie de prématuré. Méthode: Un questionnairea été administré aux pédiatres et internes qui fréquentaient un coursd'étude de développement professionnel continue (CDP) à Benin City au Nigéria. L'information de la connaissance des personnes interrogéessur les facteurs de risque,les conseils de dépistage et les modalités de traitement a étéobtenue. Au total, il y avait 48 participants.L'âgemoyen des participants été placé a 34.5 ± 4.5 ans, dans lequel 25 étaient des femmes. Une majoritéde 46 (95.8%) étaient conscientes des facteurs de risque pour le RDP. Quatorze participantsconnaissaient les conseils dedépistage de RDP alors que 10 participants avaient une connaissance partielledeces conseils. Une connaissance de l'utilisation de laser comme une modalité de traitement pour RDP a été montré par 18 participants (37.5)%. Le fait de ne pas êtreau courant d'un centre spécialiste pour le RDP au Nigeria a été donnécomme raison principale pour le non dépistage par 43 participants (89.6%). Conclusion: Bien que la majorité des pédiatres, fréquentantun cours CDP au Nigeria, connaisse l'idée de la rétinopathie de prématuré,ils sont actuellement mal informés sur la gestion de la condition et sur le besoin d'êtredépisté. C'est nécessaire d'éclairer les pédiatres au Nigeria sur la rétinopathie de prématuré afin d'éviter la cécité chez les enfants, une condition qui pourrait êtretraitée. Mots Cles: Rétinopathie de prématuré, les pédiatres, le besoin de dépistage, Nigeria.
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Awareness And Screening For Retinopathy of Prematurity Among Paediatricians in Nigeria Sensibilisation et Depistage Pour la Retinopathie Des Prematures Parmi Les Pediatres au Nigeria
INTRODUCTION Retinopathy of prematurity (ROP), previously c a l l e d re t ro l e n ta l f i b ro p l a s i a s , i s a vasoproliferative disorder of the retina which occurs principally in premature children due to defective vasculogenesis1. The survival of premature and low birth weight babies with modern and effective neonatal care increases the incidence of retinopathy of prematurity. Retinopathy of prematurity is one of the causes of avoidable blindness targeted by the World Health Organization in the Vision 2020-Right to Sight initiative2. There is a wide variation in the incidence of ROP in various countries which is 3-6 closely linked to their level of development . Reports indicate a steady decline in industrialized countries, an upsurge in middle income countries and low incidence in low 5,6 income countries . The low incidence in low income countries has been attributed to high infant mortality rates and poorly equipped 7 neonatal intensive care units . In order to reduce the prevalence of retinopathy of prematurity, screening guidelines of at risk babies have been recommended in order to institute appropriate interventions to reduce the incidence of blindness form this treatable condition8,9. Pediatricians who are responsible for the care of these neonates ought to be well informed and implement the recommended protocol to achieve a complete win-win situation in the saving of both lives and sight of these babies for a more productive life. This is important as the number of blind years in a child increases the burden of care to the families affected and society at large10,11. The study was performed to determine the level of awareness and retinopathy of prematurity *Uhumwangho OM, Israel-Aina YT1 Department of Ophthalmology & 1Department of Child Health, University of Benin Teaching Hospital, P.M.B. 1111, Benin City, Nigeria. E-mail: [email protected] *Correspondence Grant support: None Subvention: Aucun Conflict of interest: None Conflit d'intérêts: Aucun
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INTRODUCTION N o m m é a u t refo i s co m m e ret ro l e nta l fibroplasias, la Rétinopathie de prématuréest un désordre vasoprolifératifde rétine qui se produit principalement aux enfants prématuréàcause de vasculogène défectif. La survie des prématurés et des bébés, ayant un poids bas à la naissance augment l'incidence de la rétinopathie de prématuré,suite aux soins néonatals moderneset éffective.La Rétinopathie de prématuré est l'un des causes majeures de la cécité qui pourrait être évité et qui a été ciblée par L'Organisation Mondiale de la Santé dans la vision 20-20, l'initiative Pour le droit de la vue. Il ya une grande variation d'incidence de RDP de pays en pays qui sont liés à leur niveau de développement. Selon les rapports, il ya une chute progressive aux pays développé, unemontéedans les pays aux revenus moyens et une incidence basse aux pays à faible revenu. L'incidence basse aux pays des bas salaires ont étéattribué au taux élevé de la mortalité infantile et ainsi que le service de soins intensifs qui sont mal équipée. Afin de réduire la prédominance de la Rétinopathie de prématuré, les conseils de dépistage ont étérecommandés pour les bébés menacés de la maladie ; ceci dans le but d'établir des interventions destinéesà réduire l'incidence de cette condition de la cécité qui pourrait êtretraité. Les pédiatresresponsables pour les soins de ces néonatalsauraient dûêtrebien informéet de s'appliquer le protocolerecommandés pour obtenir une situation Win Win visé à sauver la vie et la vue de ces enfants pour qu'ils mènent une vie plus productive. L'importance de bien former les pédiatresest vue du fait que le nombre des annéesdont l'enfant subi a la cécité pèsent lourdement sur les familles affecteéset la société en général. L'étude a été actualisée, en conformité avec la norme internationale de dépistage pour le RDP, pour déterminer le niveau de conscience ainsi que le protocole et les conseils de dépistage pour laRétinopathie de prématuré parmi les pédiatres au Nigeria. Cela est pertinent vue l'augmentation dans la naissance assisté, la fécondation in vitro dans le pays et une amélioration aux soins néonatals :
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screening protocol/guidelines among pediatricians in Nigeria in compliance with international screening guidelines for ROP. This is relevant with an upsurge in the number of assisted births and in-vitro fertilization in the country and improved neonatal care in a bid to ensure survival of the babies, thus assessing how prepared paediatricians are to tackle the sequel of improved neonatal care12. MATERIALS AND METHODS A questionnaire modified from previous 10,13 studies was administered to paediatricians and residents in paediatrics drawn from across the country attending a continuous professional development (CPD) course in Benin City, Nigeria. Information on demographics, education and practice profile, knowledge of risk factors, dilatation drops, screening guidelines and treatment options, risks of screening and treating preterm babies with retinopathy of prematurity (ROP) was obtained. Also obtained were responses on the number of premature babies seen per month, a w a r e n e s s a n d r e fe r ra l s c h e m e t o ophthalmologist and barriers for referring babies for ROP screening. Responses obtained were analyzed using Graphpad Instat Software V2.05a and P value 0.05).Ce phénomènesuggère l'existence d'un niveau bas sur l'importance accordé au RDP lors de la formation des internes au service de pédiatrie. L'implication de tous ces faits se montre dans la préparation des pédiatres à s'attaquer au défi lancé par le RDP, qui pourrait se produit suite aux soins néonatales améliorées.
There are currently no established guidelines or screening protocol for ROP in Nigeria. A blind school study performed about two decades ago in Northeastern Nigeria recorded an incidence of 0.5%21. An isolated pilot study carried out in a tertiary health centre in South West Nigeria, also about two decades ago reported an incidence of 5.5% in babies weighing about 1,500g or less than 31 weeks gestational age22. This figure may have been higher if majority of the preterm babies had not died. However, a more recent study performed in South-south Nigeria with
A l'heure actuel, au Nigeria, il n'existe pas de conseils ni de protocole de dépistage établi pour le RDP. Selon une étude menée dans une école de cécité au nord-est du Nigeria, il a vingt ans, une incidence de 0.5% a été enregistré. Une étude pilote isolé et effectué dans un centre tertiaire de la sante au sud-est du Nigeria, aussi dans l'environ de vingt ans, a rapporté une incidence de 5.5% dans les bébés qui pesaient d'un environ de 1,500 ou moins que 31 semaines d'âges de gestation. Ce nombre aurait du être plus élevé si la plupart des bébés née avant terme n'étaient pas mortes. Néanmoins, uneétude plus récemmentmenée au sud-sud du Nigeria,
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Awareness And Screening For Retinopathy of Prematurity Among Paediatricians in Nigeria Sensibilisation et Depistage Pour la Retinopathie Des Prematures Parmi Les Pediatres au Nigeria
improving neonatal care reported an incidence of 47.2% and babies requiring treatment 23 referred to a center about 800 miles away . This rise in incidence carries the risk of another 'epidemic' of the disease if appropriate measures for screening, detection, prompt treatment and prevention are not instituted. Retinopathy of prematurity is an important and emerging disease in Nigeria. Paediatricians and other caregivers should be educated to improve their awareness of ROP. Its prevalence should be documented, national guidelines for screening and prompt treatment of babies at risk developed, and facilities for screening and treatment made readily available. Acknowledgement: Special thanks go to Drs Subhadra Jalali, Padmaja Rani Kumari, at the LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India for their professional assistance.
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remarquant des soins néonatalesaméliores, a rapporté une incidence de 47.2% aussi que des bébés, qui ont besoin de traitement, envoyé a un centre spécialiste a l'environ de 1334km. Ce taux d'incidence élevéporte le risque d'une autre épidémie de la maladie si des mesures suffisant n'ont pas prises sur le dépistage, la détection, le traitement précoce et la prévention. La rétinopathie des prématurés est une maladie important et qui se fait jour au Nigeria. Les Pédiatres et les autres personnes qui prennent soins des malades devraient être instruit pour améliorer leur niveau de conscience. La prédominance RDP, faudrait êtredécrite, les conseils nationales pour le dépistage et un traitement rapide des bébés au risque développé et des installations pour le dépistage et traitement soient plus facilement disponible. Les Remerciements: Tous mes remerciements aux Drs. Subhadra Jalali, Padmaja Rani Kumari, et LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, pour leur soutien professionnel.
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