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Trends in sickle cell trait and disease screening in the Republic of Uganda, 2014–2019
Author(s) -
Hernandez Arielle G.,
Kiyaga Charles,
Howard Thad A.,
Ssewanyana Isaac,
Ndeezi Grace,
Aceng Jane R.,
Ware Russell E.
Publication year - 2021
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13506
Subject(s) - medicine , sickle cell trait , cohort , disease , public health , epidemiology , newborn screening , pediatrics , disease burden , cohort study , hemoglobinopathy , sickle cell anemia , environmental health , pathology
Objective Sickle cell disease is an important public health issue that is increasingly recognised as a substantial contributor to morbidity and early childhood mortality in sub‐Saharan Africa. We aimed to provide information from large‐scale, long‐term sickle cell screening efforts in Africa. Methods We used nationally representative data from the centralised public health laboratory database in Uganda to examine epidemiological trends in sickle cell screening over a five‐year period, comparing age and geographic adjustments to prevalence among different testing cohorts of children aged 0–24 months, and calculating screening coverage within high‐burden districts. Results A total of 324 356 children aged 0–24 months were screened for sickle cell trait and disease from February 2014 to March 2019. A high national burden of sickle cell disease (0.9%) was confirmed among a cohort of samples co‐tested with HIV. In the cohort of samples referred specifically for sickle cell testing, the overall prevalence of sickle cell disease was 9.7% and particularly elevated in high‐burden districts where focused screening occurred. The majority of children were screened before age 4 months, but the sickle‐specific cohort had a larger proportion of affected children tested between age 5–9 months, coincident with onset of disease signs and symptoms. Successful screening coverage of sickle cell disease births was achieved in several high‐burden districts. Conclusions Examination and analysis of national sickle cell screening trends in Uganda documents the successes of focused screening strategies as an important step towards universal screening. With this evidence and increased healthcare provider knowledge, Uganda can optimise sickle cell diagnosis and management across the country.