Andrea ZinDepartamento de Neonatologia/Unidade de Pesquisa Clinica

Instituto Fernandes Figueira/FIOCRUZCentro Colaborador OPS/OMS para Ceguera Infantil - ROP

Rio de Janeiro, BrasilAsesora Medica CBM

Subcomite Ceguera Infantil/IAPB

Current situation analysis in: Brazil

Brazil

BRAZIL

8.5 millions Km

IBGE estimates – pop.

2010 – 192,304,735

27 STATES

43% Southeast

28% Northeast

15% South

7% North

7% Middle-Westwww.datasus.gov.br

Under 5 mortality rates (U5MR) and estimates of blindness prevalence

Courtesy C Gilbert

U5MRPrevalence

estimate

0-19 0.3 per 1,000

20-39 0.4 per 1,000

40-59 0.5 per 1,000

60-79 0.6 per 1,000

80-99 0.7 per 1,000

100-119 0.8 per 1,000

120-139 0.9 per 1,000

140-159 1.0 per 1,000

160-179 1.1 per 1,000

180-199 1.2 per 1,000

200-219 1.3 per 1,000

220-239 1.4 per 1,000

240+ 1.5 per 1,000

Brazil

• 98% births are hospital based

• U5MR 20.6/1000 (World Bank)

• Prevalence of Blindness estimate: 0.4/1,000

Childhood Blindness

Population 192 million

% < 15 yo 28%

No of children 54 million

Prevalence 0.4/1,000

Number of blind 22,000

Blind/million 110

Childhood Blindness

• No precise data available

• Lack of epidemiological studies and/or accurate registers

of the blind

• Isolated reports from school for the blind and low vision

services

• Isolated reports from screening programs

• Different criteria for blindness and low vision

• Data based on WHO and NGO reports

Childhood Blindness

• Toxoplasmosis – 21 to 31%• Congenital glaucoma – 11 to 18%• Congenital cataract – 7 to 19%• ROP – 3 to 21%

Brazil - ROP

• Population

192,304,735

• Live births 2,934,

828

• BW < 1500 g 36,

995

• 70% access to NICU

25,896

• 60% Survival rate < 1,500

15,538

• 10% severe ROP

1,554

Source: CBO 2010

2010- 15,000 ophthalmologists

WHO – 1/20,000

Brazil - 1/13,000

2010- 15,000 ophthalmologists

WHO – 1/20,000

Brazil - 1/13,000

Human Resources

One of the biggest health care systems in the world

Guarantee free and comprehensive health care.

• 25% population have private health care

• 75% depends on SUS

Brazilian Health Care System (SUS)

Brazilian Ministry of HealthNational Health Confederation

Ministry of Health – Federal government

State Government

Municipal Government

Communities

Federal Law: 8080/90 - 8142/90 - Ministry of Health

• No Vision 2020 plan/policy• May 15 2008: Policy number 957/GM, National Policy of “Ophthalmology” Política Nacional de Atenção em Oftalmologia (not eye care) Does not include primary eye care, just secondary and tertiary levels

• Cataract (adult and infantile), Glaucoma, Retinal detachment, DR, ROP, ARMD

• Consultations, diagnostic exams and surgery

Brazil - Eye Care Policy

• National Societies:• Conselho Brasileiro de Oftalmologia• Sociedade Brasileira de Pediatria

• # NICUS ?? Approx 300

• RBPN: 32 NICUs

• Grupo ROP: 2002

Brazil

Brazil

• Grupo ROP: 2007• Brazilian Screening and Treatment Guidelines

• ≤ 1,500 g and/or GA ≤ 32 weeks• Sickness criteria• 1st exam 4th week of life

Arq Bras Oftalmol 2007; 70(5): 875-83

Brazil-ROP

17

Results

Rates of any ROP and ROP needing treatment, by unit

Unit Examined Any stage of ROP (N) Treatable ROP 1(N)

N % N %

1 287 45 15.7 10 3.5

2 327# 39 11.9 7 2.1

3 166 58 34.9 13 7.8

4 813# 159 19.6 37 4.6

5 516# 93 18.0 16 3.1

6 888# 123 13.9 25 2.8

7 440# 63 14.3 16 3.6

Total 3,437 580 16.9 124 3.6

# Examined by AZ1 Babies with either threshold or type 1

Retinopathy of prematurity in 7 NICUs in Rio de Janeiro: screening criteria

2004-2006

Zin et al, Pediatrics, 2010

18

Results Plot of birth weight against gestational age of babies treated for ROP

Survival ≤ 1,500 g ≥ 80% Survival ≤ 1,500 g < 80%

Units 1 and 2 Units 3,4, 5, 6 and 7

Retinopathy of prematurity in 7 NICUs in Rio de Janeiro: screening criteria

2004-2006

Zin et al, Pediatrics, 2010

• RBPN

• Descriptive study• Questionnaire to NICUs: Screening criteria, available

resources, work processes

• All access to ROP exam and treatment• Screening and treatment criteria not standardized• No agenda, register book etc• Neonatal team does not have access to ROP data• Not all examined patients are in the database

Brazil-ROP

LOGIN - BANCO DE DADOS ROP

GUIA DO USUÁRIO – FICHAS ROP

Follow-up

23