Local experts have sounded the alarm after their recent study showed a spike in premature infant blindness, detracting from the progress made in the field of newborn care, they noted.
In a remarkable achievement, South Africa has aligned its newborn survival rates with the Sustainable Development Goal (SDG) 2030 target of 12 neonatal deaths per 1 000 births, reports IOL.
But this latest troubling study by researchers from the University of the Western Cape (UWC), the South African Medical Research Council, the University of Cape Town, and Stellenbosch University, highlights a growing concern: as more premature infants survive, the incidence of retinopathy of prematurity (ROP), a preventable cause of childhood blindness, may be on the rise.
The findings highlight the need for robust preventive strategies to combat newborn blindness, particularly in light of the increasing survival rates of premature infants.
The population-based study, involving 378 premature babies in Cape Town – the first of its kind to investigate ROP risk factors in sub-Saharan Africa – has established that extremely low birth weight is the most significant predictor of this debilitating eye disease.
The odds for developing ROP increase incrementally with every 100g reduction in birth weight; those born weighing under 1kg are more than twice as likely as their heavier peers to suffer from ROP.
Additionally, surgical necrotising enterocolitis (NEC), a severe intestinal condition affecting premature infants, has emerged as another risk factor. This life-threatening disease can lead to urgent surgical interventions if it escalates, causing further concern among medical professionals.
Advocates have amplified their calls for enhanced investment in care for small and sick newborns.
The study, published in the peer-reviewed journal Acta Paediatrica, revealed that 44.6% of infants weighing under 1kg were diagnosed with ROP, compared with just 23% among their heavier counterparts.
Out of the 378 premature babies screened between May 2022 and January 2023 at five public sector neonatal units, 34.4% fell into the extremely low birth weight category, with an average weight of merely 883g.
Alarmingly, ROP was diagnosed in 30% of these infants, mirroring findings from recent studies across other African nations.
Lead researcher Dr Tshilidzi van der Lecq highlighted the significance of the study in South Africa, which has the highest rate of infants weighing under 1kg needing screening.
“These babies face the highest risk of developing ROP and ensuing blindness,” she said.
Van der Lecq, a consultant at UCT with expertise in glaucoma and ROP, noted that while the prevalence of ROP is around 22% in high-income countries, it skyrockets to more than a third – about 40% – in sub-Saharan Africa.
Importantly, Van der Lecq said that high-income nations have managed to lower their ROP incidence through enhanced neonatal care, signalling a pathway forward for South Africa.
“Maintaining a ROP screening register in Cape Town and beyond is crucial for timely monitoring and treatment for those infants who develop ROP,” she said.
Study details
Surviving Extremely Low Birth Weight Infants Have a Higher Risk of ROP in Sub-Saharan Africa
Tshilidzi van der Lecq, Gerd Holmström, Esmè Jordaan, Gugulabatembunamahlubi Kali, Rudzani Muloiwa, Natasha Rhoda; ROPSA Collaborative Group
Published in Acta Paediatrica in November 2025
Abstract
Aim
Retinopathy of prematurity (ROP) risk factors have been investigated in population-based studies from most global regions. No such studies are available from Sub-Saharan Africa (SSA), where improved neonatal care is increasing the survival of preterm infants at risk of ROP.
Methods
A population-based study was conducted in infants born in Cape Town, South Africa, from 1 May 2022 to 31 January 2023. The screening criteria were birth weight < 1250 g or gestational age < 32 weeks. The data were extracted from the Retinopathy of Prematurity South African register.
Results
The study included 378 screened infants, 115 (30.4%) of whom developed ROP. In the multiple regression analyses, lower birth weight was an independent ROP risk factor, OR 1.3 95% CI 1.2-1.5, p < 0.001. Surgical necrotising enterocolitis (NEC) was the only other independent ROP risk factor, OR 5.8 95% CI 1.6-21.0, p = 0.007. Infants with birth weight < 1000 g were 39.4% (130/378) of those screened and more likely to develop ROP compared to larger infants, OR 2.4 95% CI 1.5-3.9, p < 0.001.
Conclusion
Birth weight remained a significant ROP risk factor, especially for those born weighing less than 1000 g. These infants represented a larger proportion of screened infants compared to previous Sub-Saharan African studies.
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