Abstract:

Background: Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness, globally and in low and middle-income countries like Tanzania, where healthcare resources are limited. The relatively high prevalence of preterm births, attributed to improved neonatal services, further exacerbates the risk of retinopathy of prematurity. Despite efforts to integrate ROP screening into the management of neonatal and childhood illness, challenges persist, resulting in an increased incidence of ROP cases in Tanzania.

Objective: The aim of this study was to determine the availability of ROP screening programs, health workers' knowledge of ROP case identification and referral practices, and their influencing factors in health facilities equipped with Kangaroo Mother Care (KMC) units in Mwanza, Tanzania.

Methods: This was a cross-sectional study design utilizing a standardized structured questionnaire for data collection among health workers working in health facilities with KMC services in Mwanza, Tanzania. 110 health practitioners were enrolled in the study. Data was entered, cleaned, and analyzed using SPSS Version 25.0. Continuous variables were summarized as means and standard deviations, while skewed continuous variables were represented by medians and interquartile ranges. Categorical variables were described using frequencies, percentages, and proportions. Bivariate logistic regression was initially performed to assess independent variables for potential inclusion in a multivariate logistic regression. The results were analyzed with a 95% confidence interval, using a significance level of less than 0.05.

Results: A total of 110 health practitioners were enrolled in the study. Their median age was 32 years, and 57.3% were aware of Retinopathy of Prematurity (ROP). Of the 30 health facilities with KMC services studied, only 4 (12.7%) had ROP screening programs. The availability of ROP screening was overall low at 12.7%, with 37.3% of facilities having written clinical practice
guidelines for ROP screening, but only 9.8% using these guidelines in practice. Knowledge levels varied, with 22.7% having high knowledge of ROP case identification and referral, 37.3% having average knowledge, and 40.0% having low knowledge. Key challenges of ROP case identification and referral practices included challenges such as a lack of resources and time constraints were common, and health practitioners with higher knowledge and confidence in identifying ROP cases were more likely to perform referrals. Collaboration with colleagues and availability of ROP screening programs also positively influenced ROP case identification and referrals.

Conclusion: The study highlights significant gaps in ROP screening programs, training, and resource availability in Mwanza, Tanzania. Despite some awareness among health practitioners, limited confidence and insufficient resources hinder effective ROP identification and referral. Addressing these issues through enhanced training and resource allocation is crucial for improving neonatal care.

Keywords: Retinopathy of prematurity, case identification, referral practices, knowledge, experience