Prevalence and pattern of retinopathy of prematurity at two national referral hospitals in Uganda: a cross-sectional study.

BACKGROUND: Retinopathy of prematurity (ROP) is a leading cause of blindness in children and an ROP epidemic is predicted this decade in sub-Saharan Africa. With the increasing survival rate of preterm babies in Uganda, and no data on ROP prevalence, there is a need to assess the burden of ROP to inform preventive strategies and targeted screening. METHODS: We conducted a two-center cross-sectional study of preterm (< 37 weeks gestational age) infants from the neonatal units of Kawempe National Referral Hospital (KNRH) and Mulago Specialised Women and Neonatal Hospital (MSWNH) from August 2022 to October 2022. An ophthalmologist examined all participants using an indirect ophthalmoscope with a + 20D convex lens and captured digital images using a Volk iNview™ Fundus Camera. The collected data were entered into Epidata 4.2 and exported to Stata 14.0 for analysis. RESULTS: 331 preterm infants enrolled in this study. The oxygen received was unblended. The mean gestational age was 30.4 ± 2.7 weeks, and the mean birth weight was 1597 ± 509 g. 18/101 (17.8%) were found to have any ROP amongst the preterm infants recruited from MSWNH, 1/230 (0.4%) from KNRH [95% CI] had any stage of ROP (i.e. stage 5). Of these, 8 (42.1%) had stage 2 ROP. Infants with a birth weight below 1500 g were 10 times more likely to have ROP than those among infants with a birth weight more than 1500 g [AOR: 10.07 (2.71-37.44)]. Infants who were not fed exclusively on breast milk had higher odds of having ROP than those exclusively fed on breast milk [AOR: 7.82(1.92-31.82)]. CONCLUSION: 6% of preterm infants born in two tertiary hospitals in Uganda were found to have ROP. Lack of exclusive feeding on breast milk and birth weight of less than 1500 g were strong predictors of ROP. The higher prevalence of ROP in MSWNH calls for cautious use of oxygen among preterms. We recommend targeted ROP screening for those at risk.

Clinical presentation and outcomes in children with retinoblastoma managed at the Uganda Cancer Institute.

Background: The majority of patients with retinoblastoma, the most common intraocular cancer of childhood, are found in low-and middle-income countries (LMICs), with leukocoria being the most common initial presenting sign and indication for referral. Findings from the current study serve to augment earlier findings on the clinical presentation and outcomes of children with retinoblastoma in Uganda. Methods: This was a retrospective study in which we reviewed records of children admitted with a diagnosis of retinoblastoma at the Uganda Cancer Institute from January 2009 to February 2020. From the electronic database, using admission numbers, files were retrieved. Patient information was recorded in a data extraction tool. Results: A total of 90 retinoblastoma patients were studied, with a mean age at the first Uganda Cancer Institute (UCI) presentation of 36.7 months. There were more males (57.8%) than females, with a male to female ratio of 1.37 : 1. The majority (54.4%) had retinoblastoma treatment prior to UCI admission. The most common presenting symptoms were leukocoria (85.6%), eye reddening (64.4%), and eye swelling (63.3%). At 3 years of follow-up after index admission at UCI, 36.7% of the patients had died, 41.1% were alive, and 22.2% had been lost to follow-up. The median 3-year survival for children with retinoblastoma in our study was 2.18 years. Significant predictors of survival in the multivariate analysis were follow-up duration ( P ¯ < 0.001 ), features of metastatic spread (P = 0.001), history of eye swelling (P = 0.012), and bilateral enucleation (P = 0.011). Conclusions: The majority of children who presented to the Uganda Cancer Institute were referred with advanced retinoblastoma, and there was a high mortality rate. Retinoblastoma management requires a multidisciplinary team that should include paediatric ophthalmologists, paediatric oncologists, ocular oncologists, radiation oncologists, and nurses.

Prevalence and factors associated with ocular morbidity among prisoners of Luzira prison (Uganda).

BACKGROUND: Globally, ocular morbidity has emerged as a major public concern with at least 2.2 billion people having vision impairment or blindness. Prisoners (inmates) tend to have limited access to health care especially eye health, and as a result some conditions may go undiagnosed or mismanaged. With the increasing prison population in Uganda and in the face of limited facilities, little is known about the prevalence and factors associated with ocular morbidity amongst inmates of Luzira prison. METHOD: This was a descriptive cross-sectional study conducted on inmates of Luzira prison. The study included both male (334) and female (33) inmates using the proportionate stratified random sampling. Data on social demographic characteristics, medical, imprisonment factors and ocular assessment was collected using a questionnaire. All complete data was entered using an Epidata version 3.1 entry template, and logistic regression was used to determine associated factors. RESULTS: Overall, a total of 367 inmates were examined consisting of 334 (91%) males and 33(8.9%) females. The male-to-female ratio was 10:1 with ages ranging from 18 to 76 years. The mean age being 39 years (SD + 13.4) and the overall ocular morbidity was found to be 49%. The most common ocular morbidity included; presbyopia (27.4%), allergic conjunctivitis (19.6%) and cataracts (11.4%). Other disorders included; refractive errors, pterygia, optic atrophy and vitamin A deficiency. There was a statistically significant relationship between ocular morbidity and age (OR 11.96, CI 0.85-2.74), trauma (OR 5.21, CI 1.52-17.87), non-prison food (OR 0.45, CI 0.26-0.79). CONCLUSION: The prevalence of ocular morbidity among inmates was found to be high and significantly associated with age, trauma and having meals besides prison food. A fully functional eye unit established within the prison, and timely referral of complicated cases would help in offering quality eye services to the inmates.

Burden, etiology and predictors of visual impairment among children attending Mulago National Referral Hospital eye clinic, Uganda.

BACKGROUND: Childhood visual impairment (CVI) has not been given due attention. Knowledge of CVI is important in planning preventive measures. The aim of this study was determine the prevalence, etiology and the factors associated with childhood visual impairment among the children attending the eye clinic in Mulago National Referral Hospital. METHODS: This was a cross sectional hospital based study among 318 children attending the Mulago Hospital eye clinic between January 2015 to March 2015. Ocular and general history was taken and patient examination done. The data generated was entered by Epidata and analyzed by STATA 12. RESULTS: The prevalence of CVI was 42.14%, 134 patients with 49 patients (15.41%) having moderate visual impairment, 45 patients (14.15%) having severe visual impairment and 40 patients (12.58%) presenting with blindness. Significant predictors included; increasing age, delayed developmental milestones and having abnormal corneal, refractive and fundus findings. CONCLUSION: There is a high burden of visual impairment among children in Uganda. It is vital to screen all the children presenting to hospital for visual impairment. Majority of the causes of the visual impairment are preventable.