The feasibility of establishing sickle cell disease screening services at health centers in Uganda
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A thesis submitted in partial fulfillment of the requirements for the award of the Doctor of Philosophy Degree of Makerere University
A cross sectional study was done to determine the feasibility of introducing sickle cell disease (SCD) screening services at health centers in the districts of Uganda. The knowledge gaps, attitudes and beliefs of the communities about SCD and its detection were determined. The prevalence of SCD among infants was established. The reliability and cost benefit analysis of solubility and sickling tests; and peripheral blood film method was done. Respondents from the East were more aware of SCD than those from the West (p <0.001). Less than 20% of the respondents knew their SCD status and (<14%) of the health staff knew how to screen it. The prevalence of sickle cell trait (AS) was higher in the East (17.5%) and Bundibugyo (13.4%) than in Mbarara and Ntungamo (3%) (p<0.001), The difference in the prevalence of homozygous genotype (SS) was statistically insignificant between Bundibugyo (3%) and the East (1.7%) (p>0.05). No SS was detected in Mbarara and Ntungamo. The sickling test had sensitivity and specificity (65%; 96.5%) and positive and negative predictive values (61.9%; 96.1%) respectively. The solubility test and peripheral blood film method had sensitivities of 45.0% and 35.0% respectively. Their positive and negative predictive values were (33.3%; 85.5%) and (53.9% ; 93.1%) respectively. Screening children at health centers using sickling test, then confirming positive samples at the regional hospital using cellulose acetate Hb electrophoresis would be both sensitive and cheaper than confirming positives in Mulago National referral hospital. Detection of SCD children would be expensive for districts far from the regional hospitals. There is a need to sensitize the communities about SCD and screen children for SCD at district health centers using sickling test, then confirm positive cases at regional hospital (for near districts) or at district hospitals (for districts far from regional hospital) using cellulose acetate Hb electrophoresis.
A cross sectional study was done to determine the feasibility of introducing sickle cell disease (SCD) screening services at health centers in the districts of Uganda. The knowledge gaps, attitudes and beliefs of the communities about SCD and its detection were determined. The prevalence of SCD among infants was established. The reliability and cost benefit analysis of solubility and sickling tests; and peripheral blood film method was done. Respondents from the East were more aware of SCD than those from the West (p <0.001). Less than 20% of the respondents knew their SCD status and (<14%) of the health staff knew how to screen it. The prevalence of sickle cell trait (AS) was higher in the East (17.5%) and Bundibugyo (13.4%) than in Mbarara and Ntungamo (3%) (p<0.001), The difference in the prevalence of homozygous genotype (SS) was statistically insignificant between Bundibugyo (3%) and the East (1.7%) (p>0.05). No SS was detected in Mbarara and Ntungamo. The sickling test had sensitivity and specificity (65%; 96.5%) and positive and negative predictive values (61.9%; 96.1%) respectively. The solubility test and peripheral blood film method had sensitivities of 45.0% and 35.0% respectively. Their positive and negative predictive values were (33.3%; 85.5%) and (53.9% ; 93.1%) respectively. Screening children at health centers using sickling test, then confirming positive samples at the regional hospital using cellulose acetate Hb electrophoresis would be both sensitive and cheaper than confirming positives in Mulago National referral hospital. Detection of SCD children would be expensive for districts far from the regional hospitals. There is a need to sensitize the communities about SCD and screen children for SCD at district health centers using sickling test, then confirm positive cases at regional hospital (for near districts) or at district hospitals (for districts far from regional hospital) using cellulose acetate Hb electrophoresis.
Keywords
Sickle Cell anaemia, Sickle Cell Screening, Sicklers Uganda Health Centres Mulago Hospital