with an estimated 1,600 ophthalmologists and an inadequate from being born too soon means that organ systems
at organ systems are
ophthalmologist-population ratio (estimated at 9.7 per million
compared with 56.8 per million population in the USA).
2.2. Problem Analysis and Root
Causes of ROP
A systematic analysis of the causes and underlying risk factors
for blindness due to ROP has been conducted based on the
available evidence. A hierarchical diagram shows the primary
and secondary and tertiary causes of visual loss from ROP
(Figure 2).
Primary Root Cause
Prematurity is defined by the World Health Organization
(WHO) as an infant born at less than 37 weeks’ gestation
and severe if less than 28 weeks. Low birth weight (LBW) is
defined as than 2,500 grams and extremely LBW as <1000g.
Globally, over one million deaths occur each year due to
the complications of prematurity. This is largely because
Figure 2: Problem Tree: Causes of ROP in Bangladesh
Main Problem: Preterm infants are becoming
blind from ROP unnecessarily in Bangladesh
1. Primary Root Cause:
High rates of preterm birth
2. Secondary Root Cause:
Inadequate neonatal care from
immediatley after birth which increases
the risk of sight-threatening ROP
3. Tertiary Root Cause:
Inadequate coverage of ROP screening,
treatment and follow up services
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immature, such as the brain, lungs, immune system, kidneys,
skin, eyes and gastrointestinal system.13 This means that
support is needed for them to survive in the extra-uterine
environment. The more severe the prematurity, the more
life support is required, and many survivors may endure a
lifetime of disability.
Secondary Root Cause
Due to greater advances in technology, infants born
prematurely are surviving. There is still great disparity
between high and low-income countries where a baby born
at 24 weeks can survive in a high-income country whereas
infants born at 32 weeks continue to die in low-income
countries (Born Too Soon: The Global Action Report on
Preterm Birth, 2012).
A study conducted in Bangladesh highlighted risk factors
for ROP in premature and LBW infants, which included
prolonged, poorly monitored oxygen therapy, jaundice,
phototherapy, anemia and blood transfusion and sepsis.14
Other risk factors include early cord clamping, failure to gain
weight and thrombocytopenia.
Young maternal age, inadequate
antenatal care, intrauterine
infection
Lack of equipment, human
resources and poor infection
control, lack of awareness of ROP
and how it can be prevented
Lack of policies, leadership and
governance, human resources and
equipment, national HMIS and
guidelines