South Africa has made significant progress in improving the survival rates of newborns, with its neonatal mortality now in line with the Sustainable Development Goal (SDG) 2030 target of 12 per 1 000 births. But a new study by researchers from the University of the Western Cape (UWC), the South African Medical Research Council, the University of Cape Town, and Stellenbosch University shows that as more premature babies survive in South Africa and across the continent, cases of retinopathy of prematurity (ROP) – a potentially preventable cause of childhood blindness – may be on the rise.
The authors said this makes it urgent for countries to strengthen strategies to prevent newborn blindness. The population-based study conducted among 378 premature babies in Cape Town, the first to examine risk factors for ROP in Sub-Saharan Africa, has found that extremely low birth weight – babies under one kilogram – is the strongest predictor of the blinding eye disease in premature babies in Cape Town. The odds of developing ROP increased for every 100g drop, and these low-birth-weight babies are more than twice as likely to develop ROP compared to their larger counterparts, weighing above 1kg.
Another independent risk factor identified is surgical necrotising enterocolitis (NEC), a life-threatening intestinal disease in premature babies that causes severe inflammation and tissue death. In the most serious cases, NEC can perforate the intestine, requiring urgent, life-saving surgery. Researchers warn that as neonatal survival rates improve across the continent, screening and treatment services must scale up to prevent this avoidable childhood blindness through early detection and treatment.
November is Prematurity Awareness Month, which highlights the challenges faced by babies born too soon, a condition that affects 1 in 10 infants worldwide. According to the World Health Organisation (WHO), a premature birth is defined as the birth of a baby before 37 weeks of pregnancy. Because they have less time to develop in the womb, these babies are at higher risk of health complications and often need specialised medical care. This year’s theme, “Give preterm babies a strong start for a hopeful future,” calls for greater investment in care for small and sick newborns to ensure they not only survive, but thrive.
Titled “Surviving Extremely Low Birth Weight Infants Have a Higher Risk of ROP in Sub-Saharan Africa”, the study, which has been published in a peer-reviewed paediatric journal, Acta Paediatrica, found nearly half (44.6%) of infants weighing under 1 kg developed ROP, compared to 23% of babies who weighed above 1kg.
More than a third, or 34.4% of the 378 premature babies from five public sector neonatal units who were screened between May 2022 and January 2023, were classified as extremely low birth weight with an average birth weight of just 883g. ROP was diagnosed in 30% of the infants. The new study’s findings align with recent research in other parts of Africa. An Ethiopian study of 202 infants found that babies weighing 1 500 g or less were 53% more likely to develop ROP, while a Ugandan study reported a 90% higher risk in infants under 1 500g. In Botswana, more than half (54.5%) of these babies developed ROP.
Lead researcher, Dr Tshilidzi van der Lecq, said the study, which was based on data from the first regional ROP screening register in Sub-Saharan Africa, is crucial for South Africa, which has the highest number of infants weighing under 1kg who require screening.
“Because they are less mature, these infants are the ones known to have the highest risk of developing ROP and blindness due to ROP,” she said.
According to Dr van der Lecq, a consultant at UCT with a special interest in Glaucoma and ROP, while only 22% of babies in high-income countries develop ROP, in Sub-Saharan Africa, ROP affects more than a third of babies at approximately 40%.
“High-income countries have managed to reduce the incidence by improving the level of neonatal care for their babies,” she said, noting that maintaining a ROP screening register in Cape Town and the rest of South Africa is important as it “will allow doctors to continue to monitor whether infants who develop ROP are treated in time”, she said.
By Sipokazi Fokazi, Institutional Advancement
