Evidence-based interventions implemented in low-and middle-income countries for sickle cell disease management: A systematic review of randomized controlled trials

Gyamfi, Joyce; Ojo, Temitope; Epou, Sabrina; Diawara, Amy; Dike, Lotanna; Adenikinju, Deborah; Enechukwu, Scholastica; Vieira, Dorice; Nnodu, Obiageli; Ogedegbe, Gbenga; Peprah, Emmanuel

doi:10.1371/journal.pone.0246700

Cited by 11 publications

(9 citation statements)

References 72 publications

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“…Search outputs from research databases suggest that this REA is the first to evaluate the impact of educational interventions relating to improving HCPs' knowledge and attitude towards SCD patients and acute SCD pain management. The results and inferences presented in this review align with two previous systematic reviews (Gyamfi et al, 2021;Häggman-Laitila et al, 2017).…”

Section: Discussionsupporting

confidence: 89%

A rapid evidence assessment of sickle cell disease educational interventions

Oti

Heyes

Bruce

et al. 2022

Journal of Clinical Nursing

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Aims and objectives To assess the impact of educational interventions on the knowledge and attitude of healthcare professionals (HCPs) regarding sickle cell disease (SCD) pain management in the UK. Background Variations and inadequate pain management due toHCPs’ lack of knowledge and negative attitude is still an ongoing global concern for SCD patients despite availability of effective treatment and evidence‐based guidelines. Several international studies have implemented interventions aimed at improving knowledge, attitude, and pain management. No review on the effectiveness of these interventions was found. Also, no previous intervention done in the UK was found from the thorough search of research databases. However, there are estimated 240,000 genetic carriers with about 12,500–15,000 estimated people living with SCD in the UK. Design Rapid Evidence Assessment of existing evidence. Methods A rapid evidence assessment was conducted between March 2021–January 2022 following the PRISMA 2020 guidelines. Included papers must have an educational intervention about SCD or related symptom management where the learners were HCPs. Excluded papers were those not published in English or before 2010. The following databases were searched: CINAHL, MEDLINE, PubMed America and Europe, Scopus, PsycINFO and Web of Science. Data quality was assessed using the Mixed Methods Assessment Tool (MMAT) and analysed using a narrative approach. Results Ten studies were included in the final review. Overall, they reported improved outcomes in six main themes: knowledge, attitude, perception, adoption, satisfaction and efficiency. Five studies reported statistically significant improvement in at least one outcome, four studies reported positive improvement, and two studies reported no significant improvement in knowledge and attitude. These heterogeneous studies were implemented once, and all designs were prone to bias; this makes it difficult to state how effective interventions are for SCD. Conclusion Current evidence of positive improvement in HCPs’ knowledge and attitude is insufficient for generalisation and recommendation for adoption. However, we believe that implementing validated educational interventions remains essential for effective acute SCD pain management and patient‐centred care. Further research is needed to find a suitable educational intervention that can be replicated. Relevance to clinical practice Quality SCD education, timely crisis management and reduced patient stigma are crucial in reducing the risk of rapid clinical decompensation to avoid developing life‐threatening complications. Understanding SCD can also support the building of therapeutic relationships between the patient and practitioner. Trial registration This review was not registered.

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Section: Discussionsupporting

confidence: 89%

A rapid evidence assessment of sickle cell disease educational interventions

Oti

Heyes

Bruce

et al. 2022

Journal of Clinical Nursing

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“…These ameliorating effects have translated into improved patient outcomes, including reduced rate of vaso-occlusive crisis, blood transfusions, hospitalizations, and incidence of acute chest syndrome, as well as improved organ function and overall survival (S. Charache et al, 1995 ; Youssry et al, 2017 ; Ofakunrin et al, 2020 ). Although hydroxyurea was approved for SCD management in adult patients by the US FDA in 1998 ( Ault, 1998 ), for pediatric patients in 2017, and specifically for children within low and middle income countries (LMICs) in 2018, ( Tshilolo et al, 2019 ) challenges to its routine use in LMICs persist ( Gyamfi et al, 2021a ; Gyamfi et al, 2021b ).…”

Section: Introductionmentioning

confidence: 99%

Barriers to Therapeutic Use of Hydroxyurea for Sickle Cell Disease in Nigeria: A Cross-Sectional Survey

Okocha

Gyamfi²,

Ryan³

et al. 2022

Front. Genet.

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Background: Sickle cell disease, the inherited blood disorder characterized by anemia, severe pain and other vaso-occlusive complications, acute chest syndrome, disproportionate hospitalization, and early mortality, has significant financial, social, and psychosocial impacts and drains individuals, families, and health systems globally. Hydroxyurea could improve the health of the 300,000 individuals born each year with sickle cell disease in sub-Saharan Africa; however, challenges to adoption and adherence persist. This study assessed the barriers to therapeutic use of hydroxyurea for sickle cell disease within the Nigerian healthcare system, specifically from the level of the patient, provider, and health system.Methods: We used purposive sampling to recruit participants from 13 regions in Nigeria. A cross-sectional survey was administered to physicians (n = 70), nurses or counselors (n = 17), and patients or their caregivers (n = 33) at 13 health centers. Findings were mapped onto the appropriate Consolidated Framework for Implementation Research (CFIR) domains.Results: This study was able to identify factors that mapped onto the inner setting, outer setting, and characteristics of individuals domains of CFIR. The majority of physicians (74.3%) prescribe hydroxyurea, and half stated hydroxyurea is the standard of care. Among clinicians, barriers included limited knowledge of the drug, as well as low self-efficacy to prescribe among physicians and to counsel among nurses; perceived side effects; perceived patient preference for traditional medicine; cost for patient and expense of accompanying laboratory monitoring; and limited availability of the drug and equipment for laboratory monitoring. Among patients and caregivers, barriers included lack of knowledge; perceived side effects; cost; religious beliefs of disease causation; and lack of pediatric formulation.Conclusions: Findings suggest that patient, provider, and health systems-level interventions are needed to improve hydroxyurea uptake among providers and adherence among patients with sickle cell disease in Nigeria. Interventions such as patient education, provider training, and policy change could address the disproportionate burden of sickle cell disease in sub-Saharan Africa and thus improve health equity.

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“…It is estimated that between 60,000 to 100,000 individuals live with SCD in Brazil today [ 3 , 15 ]. In other LMICs the SCD population is also showing improvements in survival, [ 16 ] highlighting the need for better understanding of the costs and resources needed to support continued survival improvements. Clinical guidelines outlining healthcare management of the SCD population specifies early diagnosis, ongoing monitoring, and disease-specific therapies.…”

Section: Discussionmentioning

confidence: 99%

Cost analysis of acute care resource utilization among individuals with sickle cell disease in a middle-income country

Lobo

Moura

Fidlarczyk

et al. 2022

BMC Health Serv Res

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Background The costs associated with the treatment of sickle cell disease (SCD) are understudied in low and middle-income countries (LMIC). We evaluated the cost of treating SCD-related acute complications and the potential cost-savings of hydroxyurea in a specialized hematology center in Brazil. Methods The costs (US dollars) of emergency department (ED) and hospitalizations from SCD-related complications between 01.01.2018 and 06.30.2018 were ascertained using absorption and micro-costing approaches. The reasons for acute hospital visits were grouped as: 1) vaso-occlusive (VOC) pain, 2) infection, 3) anemia exacerbation, and 4) chronic organ damage complications. Hydroxyurea adherence was estimated by medication possession ratio (MPR) during the study period. Results In total, 1144 patients, median age 17 years (range 0–70), 903 (78.9%) with HbSS/HbSβ0-thalassemia, 441 (38.5%) prescribed hydroxyurea, visited the ED, of whom 381 (33%) were admitted. VOC accounted for 64% of all ED visits and 60% of all admissions. Anemia exacerbation was the most expensive reason for ED visit ($321.87/visit), while chronic organ damage carried the highest admission cost ($2176.40/visit). Compared with other genotypes, individuals with HbSS/HbSβ0-thalassemia were admitted more often (79% versus 21%, p < 0.0001), and their admission costs were higher ($1677.18 versus $1224.47/visit, p = 0.0001). Antibiotics and analgesics accounted for 43% and 42% of the total ED costs, respectively, while housing accounted for 46% of the total admission costs. Costs of ED visits not resulting in admissions were lower among HbSS/HbSβ0-thalassemia individuals with hydroxyurea MPR ≥65% compared with visits by patients with MPR <65% ($98.16/visit versus $182.46/visit, p = 0.0007). No difference in admission costs were observed relative to hydroxyurea use. Discussion In a LMIC hematology-specialized center, VOCs accounted for most acute visits from patients with SCD, but costs were highest due to anemia exacerbation. Analgesics, antibiotics, and housing drove most expenses. Hydroxyurea may reduce ED costs among individuals with HbSS/HbSβ0-thalassemia but is dependent on adherence level.

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Evidence-based interventions implemented in low-and middle-income countries for sickle cell disease management: A systematic review of randomized controlled trials

Cited by 11 publications

References 72 publications

A rapid evidence assessment of sickle cell disease educational interventions

A rapid evidence assessment of sickle cell disease educational interventions

Barriers to Therapeutic Use of Hydroxyurea for Sickle Cell Disease in Nigeria: A Cross-Sectional Survey

Cost analysis of acute care resource utilization among individuals with sickle cell disease in a middle-income country

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