Complications of sickle cell anaemia in children in Northwestern Tanzania

Abstract

Objectives Tanzania has the 3rd highest birth rate of sickle cell anaemia (SCA) in Africa, but few studies describe severity of complications or available treatments, especially in North West Tanzania around Lake Victoria where the sickle gene is most prevalent. This is a report of the spectrum of clinical disease and range of interventions available at Bugando Medical Centre (Bugando) in North West Tanzania in Africa. Methods A cross-sectional study was carried out in Bugando between August 1, 2012 and September 30, 2012. Children (< 15 years old) with SCA attending Bugando were sequentially enrolled. A trained research assistant completed a Swahili questionnaire with the parent or guardian of each participant concerning demographic information, clinical features of disease, and treatments received. Results Among the 124 participants enrolled, the median age was 6 years [IQR 4-8.5], and only 13 (10.5%) were < 3 years old. Almost all participants (97.6%) had a prior history of a vaso-occlusive episode, 83 (66.9%) had prior acute chest syndrome, and 21 (16.9%) had prior stroke. In the preceding 12 months, 120 (96.8%) had been hospitalized, and a vaso-occlusive episode was the most common reason for hospitalization (35.5%). Prescriptions for folic acid (92.7%) and malaria prophylaxis (84.7%) were common, but only one had received a pneumococcal vaccine, and none had received hydroxyurea or prophylactic penicillin. Conclusion Children with SCA receiving care in Tanzania are diagnosed late, hospitalized frequently, and have severe complications. Opportunities exist to improve care through wider access to screening and diagnosis as well as better coordination of comprehensive care.

Paediatric immunisation and chemoprophylaxis in a Ugandan sickle cell disease clinic

“…In contrast to our study, the Kinshasa study did not report vaccine documentation . Pneumococcal vaccination level of <1% was reported in a clinic sample of children with SCD in Northern Tanzania, underscoring that its penetrance outside of capital cities may be even lower …”

Sickle cell anemia in sub-Saharan Africa: advancing the clinical paradigm through partnerships and research

“…However, stroke rates and complications are documented from Nigeria, Benin, Cameroon, Uganda, and Tanzania. [48][49][50][51][52] TCD screening is realistic in sub-Saharan Africa for primary stroke screening, 53 but indefinite transfusion therapy for thousands of children is an insurmountable challenge. Hydroxyurea represents an alternative to transfusions for stroke prevention, but its safety and feasibility for sub-Saharan Africa are not yet established.…”

Evaluation of the Most Common Complications of Sickle Cell Anemia and Management in Children: Simple Literature Review

“…Saidi et al (6) found that the majority of SCA patient's complications are vaso-occlusive episode, acute chest syndrome, and a few number of patients developed strokes respectively. Also, they found that the most significant cause of re-hospitalization is vaso-occlusive crisis.…”

“…In children with SCD, the routine use of transcranial Doppler (TCD) screening along with chronic transfusion therapy has decreased the prevalence of overt stroke from 11% to 1% (16) . Saidi et al (6) mentioned that stroke risk could be decreased through the transcranial Doppler screening (TCD) and transfusion therapy. Lagunju et al (9) mentioned that the increase in the blood flow velocity increases the risk of silent strokes in SCA patients.…”

“…Saidi et al (6) evaluated the lifetime prevalence of SCA-related complications in children attending a tertiary care center in Tanzania as well as the interventions used to treat them. According to a specific inclusion and exclusion criteria, a total of 124 participates included in the study.…”