Prevalence and risk factors of retinopathy of prematurity in Africa: A systematic review and meta-analysis

Abstract

Background: Improvement in neonatal services across Africa has led to increased survival of preterm and low birth weight neonates with  consequent rising incidence of ROP. We review the reported prevalence and risk factors associated with ROP in Africa.
Methods: Databases were searched systematically between December 2018 and February 2019, using relevant search terms. Primary studies done  between 1948 and February2019 in Africa reporting prevalence and/or risk factors for ROP were included. Eligible articles were reviewed and  discrepancies resolved by consensus. We conducted random -effects meta-analyses to estimate the overall ROP prevalence. Interstudy  heterogeneity, potential confounding variables, publication bias, and small-study bias were explored using Galbriath plot, sensitivity analysis,  metaregression, and Egger’s regression tests while temporal trends from accumulating studies were explored using cumulative metaanalysis.
Results: Twenty-four studies from six African countries were included. To address heterogeneity, we grouped the studies by prevalence: High (> 45%)  – four; Medium (20% to 44%) - twelve; Low (< 20%) – eight studies. The commonest risk factors were very low birth weight and lower  gestational ages. The combined prevalence of ROP in Africa was 30%. Cumulative meta-analysis indicated an increasing ROP prevalence in the last 2 decades.
Conclusion: The prevalence of ROP in Africa is 30% with commonest risk factors being lower gestational age and very low birth weight. Increasing  prevalence is possibly related to better survival of preterm neonates while risk management remains static.