An evaluation of referral system for retinopathy of prematurity in leading health centers across Karachi, Pakistan

Objective: Retinopathy of prematurity (ROP) is emerging as a significant avoidable cause of childhood blindness in developing countries. This study was conducted to assess the referral system for ROP in the leading health care centers involved in the provision of services to newborns in Karachi, and to assess the awareness of this condition among health care workers in these centers. Methods: A purposeful sampling technique was employed to select ten health care centers in Karachi, Pakistan, which had the highest number of deliveries per year. Key informants interviews were held with the health care providers involved in the decision-making at these centers. A content analysis was performed on their responses. Results: A total of 20 physicians (5 neonatologists and 15 pediatricians) were interviewed. Most of the surveyed centers did not have any referral system for ROP. The two centers that did have a referral system were not following standard protocol for such referrals. Most interviewees had inadequate knowledge of ROP. Only 2 out of 20 physicians were aware that ROP can lead to blindness. Conclusion: There was no referral system for ROP screening at most of the surveyed centers. The few centers that did have a referral system were not following international screening guidelines for such referrals. There is lack of recognition of ROP as a sight-threatening condition as shown by the inadequate knowledge of ROP among the concerned staff.