The prevention of blindness in children in Colombia: The assessment of the service requirement for an ROP programmes in Manizales-Pereira-Armenia cities, and plan for a future screening programme
BackgroundRetinopathy of prematurity is the major cause of blindness in children in Colombia. This cause of childhood blindness is irreversible when stablished, but 100% preventable with the adequate strategies put in place. This raises important questions concerning strategies to reduce the incidence of blindness as a result of ROP, which should ensure that all infants who are at risk of blinding ROP are examined in screening programmes.AimThe aim was to collect data in the neonatal intensive care units. This was used to evaluate the existing human and material resources for preventing, screening and treating ROP and rehabilitation of children suffering from ROP. The data helped to do an analysis of gaps in the service and allowed to present a proposal for a programme to prevent blindness due to ROP in the cities of Manizales, Pereira and Armenia, Colombia.Methods7 NICUs were visited in the three cities. The study collected quantitative data on neonatal intensive care units, admission and survival of premature babies during 2010, human resources and infrastructure and data on knowledge of the Colombian guidelines on ROP.ResultsThe survival rates vary according to the provider. They are higher in the private sector, and lower in the public sector. Overall, the available data allowed us to estimate that there are approximately 45,000 births per year (2010) in the region (95% occur in hospital) and 1.8% of all the births are less than 2,000g. Therefore, in the region, 810 babies per year weighing less than 2,000g are at risk of developing any type of ROP.The number of places, ventilators and monitors is sufficient. Staffing is adequate in the private NICUs, with a shortage of neonatologists in the public NICUs. The number of nurses monitoring babies is universally adequate, but the lack of knowledge in controlling risk factors of developing ROP such as monitoring oxygen in a constraint.An ROP screening programme is not available in public NICUs and in some of the mixed providers. The Kangaroo Mother programme lack of screening for ROP.ConclusionsThe unstable health system has allowed (i) unsustainable NICUs and programmes for ROP (ii) If available, programmes running without being monitored or evaluated, and, (iii) no screening in public and some mixed NICUs in Manizales, Pereira and Armenia. (iv) no screening for ROP in the Kangaroo Mother ProgrameAs access and survival rates improve in the NICUS of these cities, ROP is likely to continue to be a significant cause of blindness in the region, despite the progress that has been achieved with the 2010 Colombian guidelines for screening and treating ROP.RecommendationsThe results suggest that the prevention of blinding ROP is a complex task in Colombia that requires concomitant strategies to be put in place:Firstly, national policies in screening for ROP and oxygen delivery for the babies in the NICUs are needed.Secondly, as a primary preventive strategy, training nurses in the NICUs to control and monitor the delivery of oxygen; as a secondary preventive strategy, ROP programmes offered to the public, mixed, private NICUs and to the Kangaro Mother Programme; as a tertiary strategy, rehabilitation providing a low vision centre for these childrenThirdly, running ROP programmes need to be monitored and evaluated.
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Biblioteca Virtual Banco de la República
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