Afroja Yesmin, Lutful Husain, Iqbal Hossain and Dr Munir Ahmed

Bangladesh has made remarkable progress in improving child survival rates over the last two decades, but premature birth remains a significant challenge. With about 14 out of every 100 births being premature, the country now ranks among the top ten countries which have the highest numbers of preterm deliveries. Due to better neonatal care in urban hospitals, more preterm babies now survive, but many remain at risk of Retinopathy of Prematurity (ROP), an eye disorder that is developed because of abnormal growth of blood vessels in the retina.

Advances in screening and treatment have drastically reduced ROP blindness in high-income countries. However, in lower middle-income countries like ours, it is on the rise due to inequity in service coverage, limited trained personnel and lack of awareness among healthcare providers and parents. In Bangladesh, recent data shows that 35-40% of preterm and low birth weight neonates developed ROP. 

The disease is usually asymptomatic in early stages, underscoring the critical importance of timely screening in all at-risk preterm babies. If it is not detected timely, there is a risk of retinal detachment and potential blindness. Here, the most encouraging fact is that through early detection and treatment, ROP is largely preventable. Public health strategies that reduce preterm delivery rates directly help in decreasing the number of infants at risk of ROP. An integrated multi-disciplinary care approach with shared responsibility is, therefore, crucial for the effective management and prevention of avoidable ROP blindness. 
Primary prevention of ROP starts with safeguarding mother’s health and wellbeing and that often comes through the hands of obstetricians.

Delaying age at marriage, family planning and proper birth spacing ensure that women’s bodies are well prepared for a baby which reduces the risk of preterm delivery. During pregnancy, obstetricians can play a vital role in ensuring proper antenatal care, maternal nutrition, bedrest for mothers at risk of preterm delivery and by providing antenatal steroids for fetal development to reduce the risk of preterm birth. During the delivery, an obstetrician can further support the prevention of ROP in a preterm baby by delaying cord clamping, maintaining body temperature and through immediate transfer at facility where high quality special care newborn unit (SCANU)/ neonatal intensive care unit (NICU) are available. 

Community-based health care workers are vital in preventing premature births in Bangladesh, where over half of deliveries occur at home. By offering routine services, including couple registration, family planning, Antenatal Care (ANC) and pregnancy care, they have the opportunity to educate about maternal health, safe pregnancy, facility-based delivery and neonatal care.

Incorporating preterm birth awareness in these sessions allows them to counsel mothers and families on the importance of nutrition and ANC visits, ROP risks and the need for timely newborn eye screening particularly for premature and low birth weight babies. Trusted within their communities, these workers help raise awareness, establish referral systems, and link families to higher-level facilities for early ROP management, reducing childhood blindness risk.

Neonatologists, on the other hand, are instrumental in preventing ROP early by carefully monitoring oxygen therapy to significantly reduce the risk of developing ROP in preterm neonates. At SCANU/NICU, their skills are vital to maintain the optimum oxygen level, preventing developing other infections (sepsis) and avoiding blood and related product transfusion. They can also support maintaining good nutrition. Most importantly, neonatologists are crucial to ensure timely referral for eye screening and even can do the initial screening with proper training and equipment, while ophthalmologists must be integrated into neonatal care systems to perform this. 

We must not forget to include the families in this integrated approach as socio-psychological support would be needed to ensure that the parents are aware of the baby’s condition, knowing why it is important to bring premature babies for follow-up and where the treatments are available. As parents of preterm babies often experience anxiety and depression and lack clarity in seeking care, a strong social and medical support system can reduce their anxiety and prevent ROP on time. 

Despite having proper infrastructure and appropriate equipment on hand, success in ROP prevention depends on coordinated, multidisciplinary, unified teamwork among a wide range of experts and individuals. Their timely and coordinated involvement is essential for effective screening and treatment from start to finish.

This would require establishing protocols for screening and referral in all facilities that provide neonatal care following the National ROP Screening and Management Guideline. Creating awareness among healthcare providers and parents about ROP risk is also vital. There is a need to ensure routine communication between neonatal units and ophthalmology departments for collaboration in ROP detection and treatment. 

Streamlining the National ROP Screening and Management Guideline, establishing a national ROP prevention programme with support from the Ministry of Health, academia, professional associations, and NGOs could play a significant role in raising awareness, screening and treatment in Bangladesh. ROP cannot be a standalone condition for check; it needs to be an integral part of neonatal checkup for all preterm and low birth weight babies. By adopting a national ROP screening and prevention programme, like those in India and China, Bangladesh can significantly reduce the incidence of ROP blindness through a collaborative approach. 
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The writers are Project Manager, Director, Associate Director and Country Director of Orbis 
International, respectively