Iddi Ndyabawe and Hamish Graham
My journey into retinopathy of prematurity (ROP) screening began with a pivotal encounter in September 2019, when Hamish Graham – a consultant pediatrician and research fellow at the University of Melbourne – visited the Makerere University Ophthalmology Department. As a first-year resident and coordinator of other residents, I was called on to discuss the prevalence of ROP in Uganda. Driven by the lack of ROP statistics in our country, I seized the opportunity to champion this cause.
To illustrate what we were facing, I took Graham to the pediatric acute care unit of Mulago Hospital – the largest state-owned hospital in Uganda – and connected him with pediatrician Namiro Flavia. Flavia emphasized the urgent need for active ROP screening in public hospitals.
Research implementation
Subsequently, I integrated ROP into my academic pursuits. My research proposal – “The Prevalence, Pattern and Associated Factors of ROP in Kawempe National Referral Hospital and Mulago Specialized Women and Neonatal Hospital” – was approved by the Department of Epidemiology and Research at Makerere University, and this led me further into this previously uncharted territory.
My research journey, which ran from August to October 2022, fueled the first ROP study in Uganda. We examined the prevalence and pattern of ROP at neonatal intensive care units (NICUs) in Kawempe National Referral Hospital (KNRH) and Mulago Specialized Women and Neonatal Hospital (MSWNH), revealing a combined 6 percent prevalence in both facilities. Site-specific prevalence further delineated the disparities, with 0.4 percent at KNRH and a staggering 18 percent at MSWNH.
When we presented our findings at the Annual Congress of the Ophthalmology Society of Uganda (OSU) in December 2022, the study was named the best paper in the Makerere University Ophthalmology Department – and earned me the award for best surgical resident.
Technological advancements and international collaborations
February 2023 heralded a new phase, with the Moorfields Eye Hospital team visiting from the UK, bringing with them the Eyer Fundus camera by Phelcom. This visit laid the groundwork for innovative approaches to ROP screening in Uganda – demonstrating the capabilities of the Volk iNview fundus camera that I had been using and comparing it with the Eyer device marked a significant leap in enhancing our screening process.
A generous donation from Jose Agusto, founder of the Phelcom company, allowed us to expand our international collaborations; Phelcom also provided me with an Eyer fundus camera in June 2023. This technology elevated the precision and efficiency of my ROP screening programs.
Iddi Ndyabawe and Hamish Graham
ROP screening expansions and initiatives
The first ROP screening took place at Kiwoko Hospital NICU on April 10, 2023, and was conducted by me. The prevalence of ROP was 50 percent – with 13 percent of patients requiring treatment – highlighting the urgent need for interventions. This screening was not an isolated event, but rather part of a broader initiative as ROP screening programs extended to KNRH, showing an incidence of 29 percent, with 9 percent requiring treatment. In addition, a week earlier I identified a total of 12 preterm babies with treatment-requiring ROP, among the 70 preterm babies I had screened at Kawempe, Kiwoko and Mulago in preparation for the SIBA (Stop Infant Blindness in Africa) ROP workshop.
Using the Volk iNview fundus camera
In October 2023, I journeyed to India for a short-term fellowship in ROP at Aravind Eye Hospital, Coimbatore, and became the first Ugandan to receive certification in the Management of ROP and Paediatric Retinal Diseases. The publication of our manuscript by BMC Ophthalmology in November 2023 further underscored the international recognition of our research. That same month, however, when floods hit Kiwoko Hospital, my ROP screening duties had to move beyond the academic realm.
Screening for ROP at Kiwoko Hospital
The future of ROP screening
As the ROP journey continues, the commitment to screening in Uganda is having a tangible impact on the lives of preterm infants. Technological advancements, international collaborations, and expanding initiatives are setting the stage for ROP screening to be an integral part of neonatal care across the country. Our team’s dedication to this cause – rooted in a passion for preserving sight and preventing blindness – is propelling us toward a future where every preterm infant has the opportunity for a healthy and unimpaired visual journey.
Navigating the floods in Kiwoko, November 2023
