Interventions for the Prevention and Control of Sickle Cell Disease at Primary Health Care Centres in Gwagwalada Area Council of the Federal Capital Territory, Nigeria.

Abstract

With its population of 167 million, Nigeria has the highest burden of sickle cell disease (SCD) in the world with birth prevalence of 2% and 0.05% in adults due to deaths in early childhood. Sickle cell disease is thus a major contributor to Nigeria’s "under five" mortality figures. Failure to pay attention to such a widespread condition in the population is slowing progress towards Nigeria’s achievement of the Millennial Development Goals (MDG) 3-5. Although the Federal Government set up six MDG Sickle Cell Centres in 2012 in six geopolitical zones and equipped them with variant newborn high performance liquid chromatography equipment, these centres are not carrying out newborn screening in a systematic and standardized way and the equipment is not being fully utilized. There is no universal screening of babies for SCD and identification at the primary care level. The care of SCD has been confined to tertiary health care centres with few dedicated sickle cell clinics. The average age of presentation at these centres is eight years, and there is no formal referral system of patients through the lower levels of care. In developed countries, major benefits in the health and survival of patients with SCD have been achieved through the implementation of a few highly effective evidence-based interventions. A community-based intervention program is described which will provide parents, caregivers, and health care workers at primary health centres and ward levels with basic health education to look after patients with SCD, recognize early warning signs of complications, and institute appropriate referral mechanism to the comprehensive centres where advanced medical care can be given as necessary. Introduction & Background Sickle cell disease (SCD) is an inherited blood disorder, which affects children early in life often with repeated episodes of catastrophic illness and bone pains with varying periods of relative good health in between. Children with SCD are susceptible to severe infections; they have negative nutrition balance and are less able to cope with respiratory infections and diarrhoeal diseases as it worsens their clinical state. Less than 50% of babies with SCD will live beyond their fifth birthday if unattended [1]. Sickle cell disease affects almost every organ system and may result in complications, such as heart disease, stroke, hypertension, and renal failure [2]. Sickle cell disease is thus fuelling better-known childhood infectious illnesses as well as adult chronic non-communicable diseases. According to the National Demographic Survey (NDS) [3], the prevalence of SCD is 2% at birth and 0.05% in adults. With our current population of 167M, Nigeria thus has the largest population of SCD in the world. The difference in prevalence SCD of 2% at birth and 0.05% in adults is attributable to deaths in early childhood making SCD a major contributor (8%) to our dismal national "under five" mortality figures. Failure to pay attention to such a widespread condition in the population is affecting negatively on Nigeria’s achievement of the Millennial Development Goals 3-5.