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.

Prevalence of Diabetes Mellitus and Diabetic Retinopathy in Persons 50 Years and Above in Katsina State Nigeria: A Population-based Cross-sectional Survey

PURPOSE

To estimate the prevalence and magnitude of diabetes mellitus and diabetic retinopathy among people with diabetes mellitus in Katsina State.

METHODS

A population-based cross-sectional study of persons aged 50 years and over in Katsina State Nigeria based on the rapid assessment of avoidable blindness survey plus diabetic retinopathy methodology. The study was conducted in November and December 2018.

RESULTS

A total of 2,653 of the 2,807 (94.5%) enrolled persons were examined. The unadjusted prevalence of diabetes was 3.3% (95% CI: 2.7-4.1) with females having higher risk of having diabetes than males (OR 1.04; (95% CI 1.00-1.07; P = .03). The age-sex adjusted magnitude of diabetes mellitus is 15,492 persons in the study population, but 60% of the people are unaware of their disease status. The proportion of people with diabetes mellitus and any retinopathy is 26.2% (95%CI: 14.4-31.6); 15.8% in males and 35.7% in females. The proportion of people with diabetes mellitus with any maculopathy is 12.5% (95% CI: 6.9 - 21.5). The proportion of people with diabetes mellitus having any retinopathy and/or maculopathy is 26.2% while that of a sight-threatening lesion is 7.5%.

CONCLUSION

The burden of diabetes and diabetic retinopathy in the population is lower than national average and elsewhere. However, there is still need to establish a simple cost-effective diabetic retinopathy service for the population as the burden of the problem will only increase with time.

Prevalence and causes of blindness and visual impairment; and cataract surgical services in Katsina state of Nigeria

Aim

To generate data on blindness and visual impairment for planning and monitoring a comprehensive eye care programme in Katsina state of Nigeria.

Method

A rapid assessment of avoidable blindness (RAAB) survey methodology was used to select 3120 persons aged 50 years and over. The sample was selected using a multistage cluster randomised sampling. Each participant had visual acuity and lens assessment. Persons with vision less than 6/12 in any eye were assessed for the cause of visual impairment. Persons with cataract were asked why they had not had surgery. Data were captured electronically with the mRAAB Android-based software and analysed with STATA V.14 software.

Results

A response rate of 90.1% was achieved. The age-sex adjusted blindness prevalence was 5.3% (95% CI 5.2% to 5.3%). Women were 30% more likely to be blind (OR 1.3, 95% CI 1.2 to 1.3). The principal causes of blindness were cataract (70%), other posterior segment (12%) and glaucoma (7%); 86.7% of blindness was avoidable. The prevalence of cataract blindness is 2.6% (95% CI 2.5% to 2.6%) with higher odds in women (OR 1.2, 95% CI 1.2 to 1.3, p<0.005). The cataract surgical coverage <6/60 for persons was 28.2% and women were 45% less likely to have had cataract surgery (OR 0.55, 95% CI 0.34 to 0.78, p<0.005). The major barriers to cataract surgery are lack of felt need and the cost of services.

Conclusion

Katsina state of Nigeria has high burden of avoidable blindness affecting more women. The state eye care programme should have cataract services that are more accessible, affordable and gender sensitive.

Corneal ulcers in a tertiary hospital in Northern Nigeria

BACKGROUND/OBJECTIVE

To highlight the pattern of corneal ulcers at the Guinness Ophthalmic Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria.

MATERIALS AND METHODS

A retrospective review of case notes of patients who presented with corneal ulcer at the Guinness Ophthalmic Unit, Ahmadu Bello University Teaching Hospital between January 1995 and December 2005. Information obtained include demographic data, presenting complaints, predisposing factors, microbiological diagnosis, use of orthodox or traditional medications before presentation, duration before presentation and, presenting and final visual acuity.

RESULTS

A total of 228 cases presented within the 10 years study period. There were 129 (56.6%) males and 99 (43.4%) females. The age range was 15 months to 66 years. The commonest presenting complaints was poor vision 109 (47.8%) followed by lacrimation 97 (42.5%) and ocular pains 96 (42.1%). The common predisposing factors were trauma 117 (51.3%), use of traditional eye medications 39 (17.1%), self medication with topical steroids 13 (5.7%) and measles 9 (4.0%). The presenting visual acuity was <6/60 in 49.8% of the patients, <6/18-6/60 in 23.4%, and 6/6-6/18 in 25.5% of the patients. At discharge, 45.6% had a visual acuity of 6/6-6/18, 27.2% had borderline vision (<6/18-6/60), 18.0% had severe visual impairment (<6/60), while 6.6% had no light perception. The commonest organisms isolated were Staphylococcus aureus in 19.7%, fungal hyphae in 15.8% and Streptococcus pneumoniae in 4.8%.

CONCLUSION

In this study most patients with corneal ulcer presented with poor vision and excessive lacrimation. Trauma was the commonest predisposing factor with bacterial organisms as the commonest isolate.

Efficacy of Garcinia kola 0.5% Aqueous Eye Drops in Patients with Primary Open-Angle Glaucoma or Ocular Hypertension

Purpose:

To evaluate the intraocular pressure (IOP) lowering efficacy of Garcinia kola 0.5% aqueous solution eye drops in patients with newly diagnosed primary open-angle glaucoma or ocular hypertension (POAG/OH).

Materials and Methods:

A randomized, double-masked, multicenter, active-controlled prospective study. Patients who met the inclusion criteria were randomly assigned in equal numbers to receive Timolol 0.5% eye drops as a control medication (A = Group 1 eyes) or Garcinia kola 0.5% eye drops as the study medication (B = Group 2 eyes). All drops were instilled at 6 am and 6 pm daily. Goldman applanation tonometry was performed at 9 am, 12 pm and 3 pm at baseline, week-6, week-12 and week-24 visits. Voluntary and actively elicited reports of adverse events were documented. The mean change in IOP over 24 weeks was the primary outcome measure. Both groups were compared for statistically significant differences at all visits. A P < 0.05 was considered statistically significant.

Results:

A total of 178 patients were randomly assigned to G. kola and Timolol groups. At baseline there were no differences in mean IOP between groups, based on age, sex, or diagnosis. At the end of the study period (24^th week), the mean (± SD) reduction in IOP was 12.93 ± 2.3 mmHg (47.8% ± 0.8% reduction) in G. Kola group and 13.09 ± 2.8 mm Hg (48.2% ± 1.03% reduction) in the Timolol group (P > 0.05). Adverse events were mild in nature with no statistically significant differences between groups (P > 0.05).

Conclusions:

Garcinia kola ophthalmic solution significantly reduces IOP as compared to baseline. The IOP lowering effect of both treatments was equivalent.

Pupillary changes among Nigerian adults following the instillation of Garcinia kola nut extracts: multicentric studies

BACKGROUND

A multi-centre, open, within-patient controlled study was performed on 106 adult volunteers to investigate the effects of Garcinia kolanut extracts on the pupillary sizes.

STUDY DESIGN

106 participants in three Nigerian Ophthalmic Centres with no pupillary defects and associated ocular or systemic co-morbidities had their pupillary diameters measured at 0, 15, 30 and 45 minutes respectively with a pupillometer (Neuroptics model # 586009). Using the left eyes as control, Garcinia kolanut extract was instilled into the right eyes at 15 minutes intervals.

RESULTS

There were 63 females and 43 males ranging in age from 18 to 58 years with the mean age of 34.9 years. Average pupillary diameter measured among participants was 4.1 - 8.4 mm with the mean value of 6.0 mm prior to garcinia kola nut extract instillation. There was a gradual reduction in the baseline pupillary size with age in years at 0.2mm per decade without garcinia extract instillation. There was a significant higher baseline pupillary diameter in males than females with males and females mean values of 6.29mm (6.00 - 6.56mm) and 5.85mm (5.60 - 6.11mm) in the right eye (p=0.026) and mean pupillary diameters 6.16mm (5.90 - 6.42mm) and 5.80mm (5.56 - 6.04mm) in the left eyes (p=0.05) respectively. There were consistent significant miosis in the right eyes with instilled Garcinia kola nut extract compared to the left eyes at 15, 30 and 45 minutes (p=0.0000).

CONCLUSION

4% Garcinia kola nut extract drop has a transient miotic effect on human pupils not sustainable for more than 45 minutes.