rop en brazil dra andrea zin
DESCRIPTION
La Dra Zin y su aporte en la 10ma Jornada de Prevencion de ROP en Bs As el 5 de Julio de 2001. La Dra Zin es pionera en su extenso país y artícife de la prevención en su ciudad, Rio de Janeiro.TRANSCRIPT
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