Factors associated with loss to follow-up in retinopathy of prematurity screening referrals at a South African tertiary hospital: A retrospective cohort study.

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. Methods: 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. Results: 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] 1.60-2.67; Conclusion: 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. Contribution: 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.