{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T12:30:51Z","timestamp":1789129851077,"version":"build-2803163510"},"reference-count":26,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background: Continuity of retinopathy of prematurity (ROP) screening follow-up is essential, as the disease progression can occur after the initial examination. Evidence on factors associated with loss to follow-up (LTFU) in South African ROP services is limited.\nMethods: This retrospective cohort study reviewed 1698 infants referred for ROP screening at Inkosi Albert Luthuli Central Hospital from 2016 to 2021. Demographic and clinical data were extracted from referral records and the electronic medical records. Loss to follow-up was defined as failure to attend any scheduled follow-up after the initial visit. Baseline (first-visit) characteristics were analysed separately from post-baseline follow-up descriptors. Univariable and multivariable logistic regression identified factors associated with LTFU.\nResults: Among the infants, 457 (26.9%) were LTFU. LTFU was more common among infants with lower birth weight, lower gestational age, anaemia, transfusion history, maternal HIV exposure and documented ROP. In multivariable analysis, documented ROP remained strongly associated with LTFU (adjusted odds ratio [aOR] 2.06; 95% confidence interval [CI] 1.60\u20132.67; p &lt; 0.001). Maternal HIV exposure was also independently associated with LTFU in a sensitivity model (aOR 1.58; 95% CI 1.13\u20132.22; p = 0.008).\nConclusion: More than one in four referred infants did not complete scheduled ROP screening follow-up, with those most in need of surveillance being most vulnerable to interrupted care. Strengthened counselling, clearer inter-facility handover and active reminder or tracing systems may improve continuity of care.\nContribution: This study provides local evidence on factors associated with incomplete ROP follow-up in a South African tertiary referral pathway and identifies practical targets for service improvement.<\/jats:p>","DOI":"10.4102\/jcmsa.v4i1.430","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T11:46:51Z","timestamp":1789127211000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with loss to follow-up in retinopathy of prematurity screening referrals at a South African tertiary hospital: A retrospective cohort study"],"prefix":"10.4102","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7448-2865","authenticated-orcid":false,"given":"Masego","family":"Madibane","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8805-8383","authenticated-orcid":false,"given":"Carl-Heinz","family":"Kruse","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0709-7836","authenticated-orcid":false,"given":"Jerusha S.","family":"John","sequence":"additional","affiliation":[{"name":"Westville Eye Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Koc E, Bas AY. Retinopathy of prematurity (ROP): From the perspective of the neonatologist. Glob Pediatr. 2024;8:100159. https:\/\/doi.org\/10.1016\/j.gpeds.2024.100159","DOI":"10.1016\/j.gpeds.2024.100159"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Berrocal AM, Fan KC, Al-Khersan H, Negron CI, Murray T. Retinopathy of prematurity: Advances in the screening and treatment of retinopathy of prematurity using a single center approach. Am J Ophthalmol. 2022;233:189\u2013215. https:\/\/doi.org\/10.1016\/j.ajo.2021.07.016","DOI":"10.1016\/j.ajo.2021.07.016"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Zhang X, Wan C, Zhang CR, Liu XL. Incidence and treatment outcomes of retinopathy of prematurity in preterm infants assessed through wide-field fundus imaging: a retrospective cohort study. TTransl Pediatr. 2025;14(9):2150\u20132166. https:\/\/doi.org\/10.21037\/tp-2025-224","DOI":"10.21037\/tp-2025-224"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Dammann O, Hartnett ME, Stahl A. Retinopathy of prematurity. Dev Med Child Neurol. 2023;65(5):625\u2013631. https:\/\/doi.org\/10.1111\/dmcn.15468","DOI":"10.1111\/dmcn.15468"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Tan Z, Isaacs M, Zhu Z, Simkin S, He M, Dai S. Retinopathy of prematurity screening: A narrative review of current programs, teleophthalmology, and diagnostic support systems. Saudi J Ophthalmol Off J Saudi Ophthalmol Soc. 2022;36(3):283\u2013295. https:\/\/doi.org\/10.4103\/sjopt.sjopt_220_21","DOI":"10.4103\/sjopt.sjopt_220_21"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Garc\u00eda H, Villasis-Keever MA, Zavala-Vargas G, Bravo-Ortiz JC, P\u00e9rez-M\u00e9ndez A, Escamilla-N\u00fa\u00f1ez A. Global prevalence and severity of retinopathy of prematurity over the last four decades (1985\u20132021): A systematic review and meta-analysis. Arch Med Res. 2024;55(2):102967. https:\/\/doi.org\/10.1016\/j.arcmed.2024.102967","DOI":"10.1016\/j.arcmed.2024.102967"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Senjam SS, Chandra P. Retinopathy of prematurity: Addressing the emerging burden in developing countries. J Fam Med Prim Care. 2020;9(6):2600\u20132605. https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_110_20","DOI":"10.4103\/jfmpc.jfmpc_110_20"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Wong ES, Choy RW, Zhang Y, et al. Global and regional trends in retinopathy of prematurity. JAMA Ophthalmol. 2026;144(2):139\u2013147. https:\/\/doi.org\/10.1001\/jamaophthalmol.2025.5103","DOI":"10.1001\/jamaophthalmol.2025.5103"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Ismail MF, Khalafalla I, Sheck ZO, et al. Prevalence and associated factors of retinopathy of prematurity in sub-Saharan Africa: A systematic review and meta-analysis. BMC Ophthalmol. 2025;25(1):699. https:\/\/doi.org\/10.1186\/s12886-025-04572-0","DOI":"10.1186\/s12886-025-04572-0"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Van der Lecq T, Rhoda N, Jordaan E, et al. Screening for retinopathy of prematurity (ROP) in South Africa: Data from a newly established prospective regional register. BMJ Open Ophthalmol. 2025;10(1):e002036. https:\/\/doi.org\/10.1136\/bmjophth-2024-002036","DOI":"10.1136\/bmjophth-2024-002036"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Van der Lecq T, Rhoda N, Jordaan E, et al. Screening for retinopathy of prematurity in South Africa: Are those developing severe ROP screened on time? Data from a prospective register. BMJ Open Ophthalmol. 2025;10(1):e002239. https:\/\/doi.org\/10.1136\/bmjophth-2025-002239","DOI":"10.1136\/bmjophth-2025-002239"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics Section on Ophthalmology, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, et al. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2013;131(1):189\u2013195. https:\/\/doi.org\/10.1542\/peds.2012-2996","DOI":"10.1542\/peds.2012-2996"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Sabri K, Ells AL, Lee EY, Dutta S, Vinekar A. Retinopathy of prematurity: A global perspective and recent developments. Pediatrics. 2022;150(3):e2021053924. https:\/\/doi.org\/10.1542\/peds.2021-053924","DOI":"10.1542\/peds.2021-053924"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Visser L, Singh R, Young M, Lewis H, McKerrow N. 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Operationalization of retinopathy of prematurity screening by the application of the essential public health services framework. Int Ophthalmol Clin. 2023;63(1):39\u201363. https:\/\/doi.org\/10.1097\/IIO.0000000000000448","DOI":"10.1097\/IIO.0000000000000448"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Santineau K, Abikoye TM, Guerin CM. Determinants of compliance with outpatient examinations for infants at risk for retinopathy of prematurity. J AAPOS Off Publ Am Assoc Pediatr Ophthalmol Strabismus. 2024;28(1):103813. https:\/\/doi.org\/10.1016\/j.jaapos.2023.11.015","DOI":"10.1016\/j.jaapos.2023.11.015"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Vinekar A, Dogra M, Azad RV, Gilbert C, Gopal L, Trese M. The changing scenario of retinopathy of prematurity in middle and low income countries: Unique solutions for unique problems. 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