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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 8  |  Issue : 2  |  Page : 106-109

Knowledge, attitude, and practice study on awareness of retinopathy of prematurity among pediatricians in Goa


1 Department of Ophthalmology, Goa Medical College and Hospital, Bambolim, Goa, India
2 Department of Preventive and Social Medicine, Goa Medical College and Hospital, Bambolim, Goa, India
3 Department of Pediatrics, Goa Medical College and Hospital, Bambolim, Goa, India

Date of Web Publication25-Apr-2019

Correspondence Address:
Dr. Tanvi Poy Raiturcar
House No. 992, St. Joaquim Road, Near Peter Pan Day Care, Borda Margao - 403 602, Goa
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.JCN_13_19

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  Abstract 


Context: The improvement in neonatal care has led to more number of premature infants surviving. This has led to more number of babies requiring screening for retinopathy of prematurity (ROP). Thus, there is a need to bridge the knowledge gap between pediatricians and ophthalmologists for ROP management. Limited studies done among pediatricians across India had shown that there is a need for greater awareness and timely screening of pre-terms for ROP. No such study was carried out in Goa and adjoining Western India. Hence, the present study was undertaken. Aims: The aim of the study is to assess the knowledge, attitude, and practices about ROP among practicing pediatricians in Goa. Settings and Design: This is a cross-sectional study. Materials and Methods: A pretested pro forma was given to 58 pediatricians, which contained 19 questions related to their educational and practice profile, about the risk factors for ROP, screening protocol, referral criteria, facilities for referral, treatment options, and problems faced by them for referral of babies requiring treatment for sight-threatening ROP. Statistical Analysis Used: Percentages and proportions are used for analysis. Results: Among the 58 pediatricians, 75.86% were practicing in government hospitals including Goa Medical College and Hospital, whereas 14 (24.13%) were private practitioners. 50% had been practicing for 5–10 years. All participants had heard about ROP and were aware of the most common risk factors for ROP. 87.93% were aware of the timing of first screening of preterm infants for ROP; 84.48%were aware of referral to an ophthalmologist for screening and management of ROP. 77.58% had knowledge about the treatment modalities. 56.89% reported that they faced barriers to referral. Conclusions: There is a very high level of awareness among pediatricians in Goa about the risk factors and screening of ROP.

Keywords: Knowledge-attitude-practice, pediatricians, retinopathy of prematurity


How to cite this article:
Raiturcar TP, Cacodcar JA, Dubhashi A, Aguiar M. Knowledge, attitude, and practice study on awareness of retinopathy of prematurity among pediatricians in Goa. J Clin Neonatol 2019;8:106-9

How to cite this URL:
Raiturcar TP, Cacodcar JA, Dubhashi A, Aguiar M. Knowledge, attitude, and practice study on awareness of retinopathy of prematurity among pediatricians in Goa. J Clin Neonatol [serial online] 2019 [cited 2019 May 22];8:106-9. Available from: http://www.jcnonweb.com/text.asp?2019/8/2/106/257136




  Introduction Top


Retinopathy of prematurity (ROP) is a proliferative peripheral retinopathy affecting preterm infants exposed to high oxygen pressures.[1],[2] It is a very important cause of preventable blindness among infants, the risk factors for which are prematurity, low birth weight, prolonged exposure to supplemental oxygen, sepsis, cyanosis, respiratory distress, and multiple blood transfusions.[3]

The incidence of ROP in India is between 38% and 51.9% among preterm infants exposed to high oxygen tension.[4],[5],[6]

The American Academy of Pediatrics and American Association for Pediatrics and Strabismus guidelines 2006 for ROP screening includes birth weight <1500 g, or gestational age of 32 weeks or less, to be screened after pupillary dilatation using binocular indirect ophthalmoscopy.[7]

The improvements in neonatal care have led to more premature infants surviving[8],[9] and hence more babies requiring ROP screening. Thus, there is a need to bridge the knowledge gap between pediatricians and ophthalmologists for ROP management.

Limited studies done among pediatricians across India had shown that there is a need for greater awareness and timely screening of preterms for ROP. No such study was carried out in Goa and adjoining Western India. Hence, the present study was undertaken.

Objectives

  1. To study the knowledge, attitudes, and practices about ROP among pediatricians in Goa
  2. To study the barriers faced for screening of ROP and referral of preterms.



  Materials and Methods Top


Study design

This is a cross-sectional study.

Simple random sampling was followed by selecting every alternate pediatrician practicing in Goa as per the Membership Enrolment List of the Indian Academy of Pediatrics, Goa chapter.

Study setting

The study was conducted at private pediatrician clinics, pediatric hospitals, nursing homes, and government hospitals.

Study participants

All pediatricians working in private as well as government sector, including those under the Goa Medical College and Hospital and the Directorate of Health Services, were included as study participants.

A total of 58 of 120 pediatricians were covered; 22 of those who could not be interviewed were working overseas or unavailable despite three visits. Thus, 60% of the pediatricians practicing in the state of Goa were covered.

Variables

Educational qualifications, practice settings, awareness of the risk factors for ROP, its screening protocol, referral criteria, facilities, and problems faced during referral of at-risk babies were the variables.

Data measurement

A pretested semi-structured questionnaire was used by the research investigators, which was self-administered to the participating pediatricians on their consent.

Statistical methods

The data obtained in the study questionnaire were entered into Microsoft Excel sheet, and simple percentages and proportions were calculated.

Bias

Adequate efforts were made to ensure that all the pediatricians practicing in the government sector as well as the private sector were covered. They were not informed previously about the objectives of the study or its title before being approached personally by the study investigators. Informed consent was obtained. Confidentiality of their responses was ensured. Ethics committee approval was obtained before the commencement of the study, from the Institutional Ethics Committee at the Goa Medical College and Hospital.


  Results Top


Among the 58 pediatricians included in the study, 44 (75.86%) were practicing in the government sector including Goa Medical College and Hospital and the Directorate of Health Services, whereas 14 (24.13%) were from the private sector. 34 (58.62%) participants were male and 24 (41.37%) female pediatricians. Majority of the participants, i.e., 29 (50%), had been in pediatric practice for 5–10 years, 17 (29.31%) had a work experience of >10 years, and only 12 (20.68%) had <5 years of experience in pediatric practice.

Overall, it was observed that there was a very high level of awareness on ROP, its risk factors, the importance of timely screening, and prompt referral.

All participants had heard about ROP and were aware of the most common risk factors for ROP.

Majority, i.e., 51 participants (87.93%), were aware of the timing of first screening of preterm infants for ROP and 49 (84.48%) were aware of referral to an ophthalmologist for screening and management of ROP.

Over three-fourths of the study participants, i.e., 45 (77.58%), had knowledge about the available treatment modalities [Table 1].
Table 1: Knowledge, attitude, and practices on awareness about retinopathy of prematurity among pediatricians

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Over half, i.e., 33 (56.89%), of the participants reported that they faced barriers to referral. Which in most of the cases i.e. 24 (72.72%) was the unavailability of an Ophthalmologist, 7 (21.21%) stated that the treatment was too expensive, and 2 (6.06%) said that the parents refused treatment after the infant was diagnosed to have sight-threatening ROP.


  Discussion Top


In our study, we observed that the awareness of ROP was universal, i.e., all the pediatricians were aware of various risk factors including gestational age <34 weeks, low birth weight (<1500 g), and supplemental oxygen therapy. Some participants mentioned additional risk factors such as respiratory distress, neonatal apnea, cyanosis, and multiple blood transfusions.[3] Similar results (100%) were found by Rani PK, Jalali S et al[10] in a study conducted among pediatricians who were attending a neonatal ventilation workshop in South India.

In another study by Sathiamohanraj et al.[11] in Coimbatore, only 57.8% were aware of the risk factors for ROP.

Majority, i.e., 51 participants (87.93%), were aware of the correct timing of first screening. This is similar to the study by Rani PK and Jalali S et al.,[10] who found that 97.8% of pediatricians were aware of the correct timing of first screening. However, in another study by Sathiamohanraj et al.,[11] only 54.2% pediatricians were aware of the correct timing.

A standardized screening protocol for ROP will help pediatricians detect ROP at the earliest and prevent avoidable blindness among preterm neonates.[12]

The current guideline is of a 20th-day screening strategy for neonates <30 weeks of gestation and the 30th-day screening for preterms between 30 and 35 weeks.[13]

A total of 49 (84.48%) were aware of referral to an ophthalmologist for ROP. Pediatricians practicing in government or teaching institute were regularly referring preterm babies to ophthalmologists for screening and treatment because of easy availability of the ophthalmologist, while few private practitioners were unaware of the referral facilities for screening of and management of ROP.

Majority, i.e., 45 (77.58%), of pediatricians in our study had knowledge about the available treatment modalities, as compared to low levels of awareness of 51.8% and 68% in studies by Sathiamohanraj et al,[11] Rani PK and Jalali S et al,[10] respectively. This suggests that pediatricians in Goa are better aware of the treatment modalities such as laser photocoagulation, cryotherapy, intravitreal anti-vascular endothelial growth factor injections, and vitreoretinal surgery.

33 (56.89%) participants stated that they faced barriers to referral. Which in most of the cases i.e. 24. (72.72%) was the unavailability of an Ophthalmologist, 7 (21.21%) stated that the treatment was too expensive, and only 2 (6.06%) said that the parents refused treatment [Figure 1].
Figure 1: Barriers to referral

Click here to view


In a similar study conducted by Jalali et al,[10] 18.4% Paediatricians reported that the parents of newborns with ROP often refused to go to higher centres for referral for the treatment of ROP. 13% of the Paediatricians reported that parents found the treatment of ROP very expensive and 13.1% Paediatricians were unaware of the higher centres for referral for ROP treatment.

Kemper et al.[13] in a similar study found that the most important barrier to referral was lack of ophthalmologist.

From these study findings, it becomes clear that there is a need to bridge the knowledge and communication gap between pediatricians and ophthalmologists in the management of ROP. They should together develop a protocol for screening and management of ROP. Increasing awareness about the screening protocol, available treatment options, and referral facilities through seminars and presentations will help pediatricians to manage ROP better, prevent the development of ROP, and also prevent blindness in cases which develop ROP.

The referral facilities also need to be strengthened. There should be easy accessibility to ophthalmologists for screening as well as treatment of ROP.


  Conclusion Top


There is a very high level of awareness among pediatricians in Goa about ROP, its risk factors, and screening of ROP. However, there is a need to increase the awareness about management and treatment of ROP, and there is a need to reduce the barriers for referral to an ophthalmologist so that blindness due to ROP can be prevented.

Acknowledgment

We would like to thank all the pediatricians for spending their valuable time to help us complete this study, and also our medical interns Dr. Nadine D'silva and Dr. Arpita Sirsikar for helping us with our data collection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chen J, Smith LE. Retinopathy of prematurity. Angiogenesis 2007;10:133-40.  Back to cited text no. 1
    
2.
Kinsey VE. Retrolental fibroplasia; cooperative study of retrolental fibroplasia and the use of oxygen. AMA Arch Ophthalmol 1956;56:481-543.  Back to cited text no. 2
    
3.
Palmer EA, Flynn JT, Hardy RJ, Phelps DL, Phillips CL, Schaffer DB, et al. Incidence and early course of retinopathy of prematurity. The cryotherapy for retinopathy of prematurity cooperative group. Ophthalmology 1991;98:1628-40.  Back to cited text no. 3
    
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Gopal L, Sharma T, Ramchandran S, Shanmugasundaram R, Asha V. Retinopathy of prematurity. A study. Indian J Ophthalmol 1995;43:50-61.  Back to cited text no. 4
    
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Charan R, Dogra MR, Gupta A, Narang A. The incidence of retinopathy of prematurity in a neonatal care unit. Indian J Ophthalmol 1995;43:123-6.  Back to cited text no. 5
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6.
Varughese S, Jain S, Gupta N, Singh S, Tyagi V, Puliyel JM. Magnitude of the problem of retinopathy of prematurity. Experience in a large maternity unit with a medium size level-3 nursery. Indian J Ophthalmol 2001;49:187-8.  Back to cited text no. 6
[PUBMED]  [Full text]  
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Kemper AR, Freedman SF, Wallace DK. Retinopathy of prematurity care: Patterns of care and workforce analysis. J AAPOS 2008;12:344-8.  Back to cited text no. 7
    
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Gilbert C. Retinopathy of prematurity: A global perspective of the epidemics, population of babies at risk and implications for control. Early Hum Dev 2008;84:77-82.  Back to cited text no. 8
    
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Gibson DL, Sheps SB, Schechter MT, Wiggins S, McCormick AQ. Retinopathy of prematurity: A new epidemic? Pediatrics 1989;83:486-92.  Back to cited text no. 9
    
10.
Rani PK, Jalali S. Knowledge, attitude, practice study of retinopathy of prematurity amongst pediatricians attending a neonatal ventilation workshop in South India. World J Retina Vitreous 2011;1:9-13.  Back to cited text no. 10
    
11.
Sathiamohanraj SR, Shah PK, Senthilkumar D, Narendran V, Kalpana N. Awareness of retinopathy of prematurity among pediatricians in a tier two city of South India. Oman J Ophthalmol 2011;4:77-80.  Back to cited text no. 11
[PUBMED]  [Full text]  
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Chow LC, Wright KW, Sola A; CSMC Oxygen Administration Study Group. Can changes in clinical practice decrease the incidence of severe retinopathy of prematurity in very low birth weight infants? Pediatrics 2003;111:339-45.  Back to cited text no. 12
    
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Kemper AR, Wallace DK. Neonatologists' practices and experiences in arranging retinopathy of prematurity screening services. Pediatrics 2007;120:527-31.  Back to cited text no. 13
    


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