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Kahema SE, Mbulwa CH, Bagenda CN, Niyonzima N, Muwanguzi E, Mcharo TL. Association between fetal hemoglobin, lactate dehydrogenase, and disease severity in patients with sickle cell disease at Bugando Medical Centre, Mwanza, Tanzania. PLoS One 2024; 19:e0286891. [PMID: 39008448 PMCID: PMC11249230 DOI: 10.1371/journal.pone.0286891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/12/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION There is a wide range of clinical manifestations in sickle cell disease (SCD). Despite having the same condition, each person's response to disease complications differs greatly. Individuals can be categorized according to the severity of their diseases to determine which group they fall into and receive the appropriate care based on their needs. The relationship between fetal hemoglobin (HbF), lactate dehydrogenase (LDH), and disease severity in Tanzania is little understood. This investigation sought to ascertain the relationship between HbF, LDH, and disease severity in SCD patients at the Bugando Medical Center. METHOD This cross-sectional study was carried out on SCD patients aged 6 months and older at the Bugando Medical Center in Mwanza, Tanzania. A total of 130 SCD patients were enrolled. The clinical history and laboratory test results for SCD patients were recorded on a specially constructed patient report form. RESULTS The majority of participants (56.9%) were men. For the population under study, more than half (60.8%) of participants had a moderate clinical phenotype (MCP), followed by 31.5% of asymptomatic participants and 7.7% of people with severe clinical phenotypes (SCP). Participants with SCP had substantially higher levels of LDH, with a mean level of 810.97IU/L (95% CI: 559.31-1062.64) and a p-value of 0.005. The severe clinical phenotype exhibited a significantly higher mean HbF score value of 10.09% (95% CI: 7.44-13.74%) with a p-value of 0.024 when compared to the asymptomatic and moderate clinical phenotypes. CONCLUSION In SCD patients with SCP compared to ACP and MCP, the HbF levels were higher, but did not show a protective effects, and LDH can be used to predict the severity of SCD.
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Affiliation(s)
- Samwel Edward Kahema
- Mbarara University of Science and Technology, Mbarara, Uganda
- Morogoro College of Health and Allied Sciences, Morogoro, Tanzania
| | | | | | | | - Enoch Muwanguzi
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tunzo L Mcharo
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
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2
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Therrell BL, Padilla CD, Borrajo GJC, Khneisser I, Schielen PCJI, Knight-Madden J, Malherbe HL, Kase M. Current Status of Newborn Bloodspot Screening Worldwide 2024: A Comprehensive Review of Recent Activities (2020-2023). Int J Neonatal Screen 2024; 10:38. [PMID: 38920845 PMCID: PMC11203842 DOI: 10.3390/ijns10020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 06/27/2024] Open
Abstract
Newborn bloodspot screening (NBS) began in the early 1960s based on the work of Dr. Robert "Bob" Guthrie in Buffalo, NY, USA. His development of a screening test for phenylketonuria on blood absorbed onto a special filter paper and transported to a remote testing laboratory began it all. Expansion of NBS to large numbers of asymptomatic congenital conditions flourishes in many settings while it has not yet been realized in others. The need for NBS as an efficient and effective public health prevention strategy that contributes to lowered morbidity and mortality wherever it is sustained is well known in the medical field but not necessarily by political policy makers. Acknowledging the value of national NBS reports published in 2007, the authors collaborated to create a worldwide NBS update in 2015. In a continuing attempt to review the progress of NBS globally, and to move towards a more harmonized and equitable screening system, we have updated our 2015 report with information available at the beginning of 2024. Reports on sub-Saharan Africa and the Caribbean, missing in 2015, have been included. Tables popular in the previous report have been updated with an eye towards harmonized comparisons. To emphasize areas needing attention globally, we have used regional tables containing similar listings of conditions screened, numbers of screening laboratories, and time at which specimen collection is recommended. Discussions are limited to bloodspot screening.
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Affiliation(s)
- Bradford L. Therrell
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA
- National Newborn Screening and Global Resource Center, Austin, TX 78759, USA
| | - Carmencita D. Padilla
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines;
| | - Gustavo J. C. Borrajo
- Detección de Errores Congénitos—Fundación Bioquímica Argentina, La Plata 1908, Argentina;
| | - Issam Khneisser
- Jacques LOISELET Genetic and Genomic Medical Center, Faculty of Medicine, Saint Joseph University, Beirut 1104 2020, Lebanon;
| | - Peter C. J. I. Schielen
- Office of the International Society for Neonatal Screening, Reigerskamp 273, 3607 HP Maarssen, The Netherlands;
| | - Jennifer Knight-Madden
- Caribbean Institute for Health Research—Sickle Cell Unit, The University of the West Indies, Mona, Kingston 7, Jamaica;
| | - Helen L. Malherbe
- Centre for Human Metabolomics, North-West University, Potchefstroom 2531, South Africa;
- Rare Diseases South Africa NPC, The Station Office, Bryanston, Sandton 2021, South Africa
| | - Marika Kase
- Strategic Initiatives Reproductive Health, Revvity, PL10, 10101 Turku, Finland;
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Thomson AM, McHugh TA, Oron AP, Teply C, Lonberg N, Vilchis Tella V, Wilner LB, Fuller K, Hagins H, Aboagye RG, Aboye MB, Abu-Gharbieh E, Abu-Zaid A, Addo IY, Ahinkorah BO, Ahmad A, AlRyalat SAS, Amu H, Aravkin AY, Arulappan J, Atout MMW, Badiye AD, Bagherieh S, Banach M, Banakar M, Bardhan M, Barrow A, Bedane DA, Bensenor IM, Bhagavathula AS, Bhardwaj P, Bhardwaj PV, Bhat AN, Bhutta ZA, Bilalaga MM, Bishai JD, Bitaraf S, Boloor A, Butt MH, Chattu VK, Chu DT, Dadras O, Dai X, Danaei B, Dang AK, Demisse FW, Dhimal M, Diaz D, Djalalinia S, Dongarwar D, Elhadi M, Elmonem MA, Esezobor CI, Etaee F, Eyawo O, Fagbamigbe AF, Fatehizadeh A, Force LM, Gardner WM, Ghaffari K, Gill PS, Golechha M, Goleij P, Gupta VK, Hasani H, Hassan TS, Hassen MB, Ibitoye SE, Ikiroma AI, Iwu CCD, James PB, Jayaram S, Jebai R, Jha RP, Joseph N, Kalantar F, Kandel H, Karaye IM, Kassahun WD, Khan IA, Khanmohammadi S, Kisa A, Kompani F, Krishan K, Landires I, Lim SS, Mahajan PB, Mahjoub S, Majeed A, Marasini BP, Meresa HA, Mestrovic T, Minhas S, Misganaw A, Mokdad AH, Monasta L, Mustafa G, Nair TS, Narasimha Swamy S, Nassereldine H, Natto ZS, Naveed M, Nayak BP, Noubiap JJ, Noyes T, Nri-ezedi CA, Nwatah VE, Nzoputam CI, Nzoputam OJ, Okonji OC, Onikan AO, Owolabi MO, Patel J, Pati S, Pawar S, Petcu IR, Piel FB, Qattea I, Rahimi M, Rahman M, Rawaf S, Redwan EMM, Rezaei N, Saddik B, Saeed U, Saheb Sharif-Askari F, Samy AM, Schumacher AE, Shaker E, Shetty A, Sibhat MM, Singh JA, Suleman M, Sunuwar DR, Szeto MD, Tamuzi JJLL, Tat NY, Taye BT, Temsah MH, Umair M, Valadan Tahbaz S, Wang C, Wickramasinghe ND, Yigit A, Yiğit V, Yunusa I, Zaman BA, Zangiabadian M, Zheng P, Hay SI, Naghavi M, Murray CJL, Kassebaum NJ. Global, regional, and national prevalence and mortality burden of sickle cell disease, 2000-2021: a systematic analysis from the Global Burden of Disease Study 2021. Lancet Haematol 2023:S2352-3026(23)00118-7. [PMID: 37331373 PMCID: PMC10390339 DOI: 10.1016/s2352-3026(23)00118-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Previous global analyses, with known underdiagnosis and single cause per death attribution systems, provide only a small insight into the suspected high population health effect of sickle cell disease. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, this study delivers a comprehensive global assessment of prevalence of sickle cell disease and mortality burden by age and sex for 204 countries and territories from 2000 to 2021. METHODS We estimated cause-specific sickle cell disease mortality using standardised GBD approaches, in which each death is assigned to a single underlying cause, to estimate mortality rates from the International Classification of Diseases (ICD)-coded vital registration, surveillance, and verbal autopsy data. In parallel, our goal was to estimate a more accurate account of sickle cell disease health burden using four types of epidemiological data on sickle cell disease: birth incidence, age-specific prevalence, with-condition mortality (total deaths), and excess mortality (excess deaths). Systematic reviews, supplemented with ICD-coded hospital discharge and insurance claims data, informed this modelling approach. We employed DisMod-MR 2.1 to triangulate between these measures-borrowing strength from predictive covariates and across age, time, and geography-and generated internally consistent estimates of incidence, prevalence, and mortality for three distinct genotypes of sickle cell disease: homozygous sickle cell disease and severe sickle cell β-thalassaemia, sickle-haemoglobin C disease, and mild sickle cell β-thalassaemia. Summing the three models yielded final estimates of incidence at birth, prevalence by age and sex, and total sickle cell disease mortality, the latter of which was compared directly against cause-specific mortality estimates to evaluate differences in mortality burden assessment and implications for the Sustainable Development Goals (SDGs). FINDINGS Between 2000 and 2021, national incidence rates of sickle cell disease were relatively stable, but total births of babies with sickle cell disease increased globally by 13·7% (95% uncertainty interval 11·1-16·5), to 515 000 (425 000-614 000), primarily due to population growth in the Caribbean and western and central sub-Saharan Africa. The number of people living with sickle cell disease globally increased by 41·4% (38·3-44·9), from 5·46 million (4·62-6·45) in 2000 to 7·74 million (6·51-9·2) in 2021. We estimated 34 400 (25 000-45 200) cause-specific all-age deaths globally in 2021, but total sickle cell disease mortality burden was nearly 11-times higher at 376 000 (303 000-467 000). In children younger than 5 years, there were 81 100 (58 800-108 000) deaths, ranking total sickle cell disease mortality as 12th (compared to 40th for cause-specific sickle cell disease mortality) across all causes estimated by the GBD in 2021. INTERPRETATION Our findings show a strikingly high contribution of sickle cell disease to all-cause mortality that is not apparent when each death is assigned to only a single cause. Sickle cell disease mortality burden is highest in children, especially in countries with the greatest under-5 mortality rates. Without comprehensive strategies to address morbidity and mortality associated with sickle cell disease, attainment of SDG 3.1, 3.2, and 3.4 is uncertain. Widespread data gaps and correspondingly high uncertainty in the estimates highlight the urgent need for routine and sustained surveillance efforts, further research to assess the contribution of conditions associated with sickle cell disease, and widespread deployment of evidence-based prevention and treatment for those with sickle cell disease. FUNDING Bill & Melinda Gates Foundation.
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Menzato F, Bosa L, Sifna A, Da Silva L, Gasperoni E, Martella M, Mustik A, Da Dalt L, Reggiani G, Munaretto V, Liotta G, Riccardi F, Colombatti R. Point-of-care testing allows successful simultaneous screening of sickle cell disease, HIV, and tuberculosis for households in rural Guinea-Bissau, West Africa. Pediatr Blood Cancer 2022; 69:e30009. [PMID: 36161764 DOI: 10.1002/pbc.30009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/07/2022]
Abstract
Diagnosis of noncommunicable genetic diseases like sickle cell disease (SCD) and communicable diseases such as human immunodeficiency virus (HIV) or tuberculosis (TB) is often difficult in rural areas of Africa due to the lack of infrastructures, trained staff, or capacity to involve families living in remote areas. The availability of point-of-care (POC) tests for the above diseases offers the opportunity to build joint programs to tackle all conditions. We report successful simultaneous screening of SCD, HIV, and TB utilizing POC tests in 898 subjects in Fanhe, in rural Guinea-Bissau. Adherence was 100% and all diagnosed subjects were enrolled in care programs.
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Affiliation(s)
- Federica Menzato
- Department of Woman's and Child's Health, Università di Padova, Padua, Italy
| | - Luca Bosa
- Department of Woman's and Child's Health, Università di Padova, Padua, Italy
| | - Armando Sifna
- Hospital Raoul Follereau (HRF), Centro de Referencia Nacional para Tuberculose, Bissau, Guinea-Bissau
| | - Luisa Da Silva
- Hospital Raoul Follereau (HRF), Centro de Referencia Nacional para Tuberculose, Bissau, Guinea-Bissau
| | - Elena Gasperoni
- Aid Health and Development Onlus (AHEAD), Rome, Italy.,San Marino Hospital, San Marino, San Marino
| | - Maddalena Martella
- Department of Woman's and Child's Health, Università di Padova, Padua, Italy
| | - Alfa Mustik
- Non-profit organization "Amici della Guinea-Bissau", Milan, Italy
| | - Liviana Da Dalt
- Department of Woman's and Child's Health, Università di Padova, Padua, Italy
| | - Giulia Reggiani
- Department of Woman's and Child's Health, Università di Padova, Padua, Italy
| | - Vania Munaretto
- Department of Woman's and Child's Health, Università di Padova, Padua, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Fabio Riccardi
- Aid Health and Development Onlus (AHEAD), Rome, Italy.,Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Raffaella Colombatti
- Department of Woman's and Child's Health, Università di Padova, Padua, Italy.,Aid Health and Development Onlus (AHEAD), Rome, Italy
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5
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Nekhai S, Kumari N. HIV-1 infection in sickle cell disease and sickle cell trait: role of iron and innate response. Expert Rev Hematol 2022; 15:253-263. [PMID: 35322747 PMCID: PMC9041812 DOI: 10.1080/17474086.2022.2054799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD), an inherited hemoglobinopathy, affects primarily African Americans in the U.S.A. In addition, about 15% African Americans carry sickle cell trait (SCT). Despite the risk associated with blood transfusions, SCD patients have lower risk of acquiring HIV-1 infection. SCT individuals might also have some protection from HIV-1 infection. AREAS COVERED Here, we will review recent and previous studies with the focus on molecular mechanisms that might underlie and contribute to the protection of individuals with SCD and SCT from HIV-1 infection. As both of these conditions predispose to hemolysis, we will focus our discussion on the effects of systemic and intracellular iron on HIV-1 infection and progression. We will also review changes in iron metabolism and activation of innate antiviral responses in SCD and SCT and their effects on HIV-1 infection. EXPERT OPINION Previous studies, including ours, showed that SCD might protect from HIV-1 infection. This protection is likely due to the upregulation of complex protein network in response to hemolysis, hypoxia and interferon signaling. These findings are important not only for HIV-1 field but also for SCD cure efforts as antiviral state of SCD patients may adversely affect lentivirus-based gene therapy efforts.
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Affiliation(s)
- Sergei Nekhai
- Center for Sickle Cell Disease, College of Medicine, Howard University, Washington DC, USA
- Department of Medicine, Howard University, Washington DC, USA
- Corresponding Author: Sergei Nekhai, , Center for Sickle Cell Disease, Howard University, HUIRB, Suite 321D, 2201 Georgia Avenue, NW, Washington DC 20059, USA, Phone: (202) 806-3378
| | - Namita Kumari
- Center for Sickle Cell Disease, College of Medicine, Howard University, Washington DC, USA
- Department of Medicine, Howard University, Washington DC, USA
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6
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Idro R, Boehme AK, Kawooya M, Lubowa SK, Munube D, Bangirana P, Opoka R, Mupere E, Lignelli A, Kasirye P, Green NS, Minja FJ. Brain Magnetic Resonance Imaging and Angiography in Children with Sickle Cell Anaemia in Uganda in a Cross-Sectional Sample. J Stroke Cerebrovasc Dis 2022; 31:106343. [PMID: 35158150 PMCID: PMC9004405 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Children with sickle cell anaemia (SCA) are highly susceptible to cerebrovascular injury. We performed brain magnetic resonance imaging and angiography (MRI-MRA) in Ugandan children with SCA to identify structural cerebrovascular abnormalities and examine their relationship to standardized clinical assessments. METHODS A sub-sample (n=81) was selected from a cross-sectional study of children attending SCA clinic, including 52 (64.2%) with and 29 (35.8%) without clinically detected abnormalities. Clinical evaluation included assessment for prior stroke, cognitive testing and cerebral arterial transcranial doppler (TCD) flow velocity. MRI-MRA scans were interpreted by at least two neuroradiologists. RESULTS Mean age was 6.5±2.7 years, with 39 (48.1%) female. Mean haemoglobin was 7.3±0.9 g/dl. Overall, 13 (16.0%) were malnourished. Infarcts and/or stenoses were detected in 55 (67.9%) participants, with stenoses primarily in the anterior circulation. Infarcts were seen in those with normal 17/29 (58.6%) or abnormal 34/52 (65.4%) clinical testing (p=0.181). Neither abnormal MRI nor MRA was associated with age, sex, haemoglobin, or malnutrition. Abnormal MRA was highly associated with infarcts (p<0.0001). Participants with abnormal imaging had two-fold higher proportion of stroke on exam and/or impaired cognition. Stroke on exam was strongly associated with an imaging abnormality after adjusting for age, sex, malnutrition, and haemoglobin (OR 11.8, 95%CI 1.87-74.2). CONCLUSION Over half of these SCA children had cerebrovascular infarcts and/or arterial stenoses. Cerebrovascular disease was frequently undetectable by clinical assessments. While rarely available in under-resourced settings, MRI-MRA brain imaging is an important tool for defining SCA cerebrovascular disease and for assessing impact of clinical intervention trials.
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Affiliation(s)
| | | | - Michael Kawooya
- Radiology, Makerere University College of Health Sciences, Kampala, Uganda; Ernest Cook Ultrasound Research and Education Institute (ECUREI) Mengo Hospital, Kampala, Uganda
| | - Samson K Lubowa
- Radiology, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | | | | | - Angela Lignelli
- Radiology, Columbia University Irving Medical Center, NY, USA
| | | | | | - Frank J Minja
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Kumari N, Nouraie M, Ahmad A, Lassiter H, Khan J, Diaz S, Afangbedji N, Wang S, Houston PE, Ammosova T, de Mulder Rougvie M, Rana S, Nixon DF, Anastos K, Lazar J, French AL, Gange S, Adimora AA, Weitzmann MN, Fischl M, Kempf MC, Kassaye S, Taylor JG, Nekhai S. Restriction of HIV-1 infection in sickle cell trait. Blood Adv 2021; 5:4922-4934. [PMID: 34496009 PMCID: PMC9153004 DOI: 10.1182/bloodadvances.2021004247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/07/2021] [Indexed: 12/02/2022] Open
Abstract
Patients with sickle cell disease (SCD) have a lower risk for HIV-1 infection. We reported restriction of ex vivo HIV-1 infection in SCD peripheral blood mononuclear cells (PBMCs) that was due, in part, to the upregulation of antiviral, inflammatory, and hemolytic factors, including heme oxygenase-1 (HO-1). Here, we investigated whether individuals with sickle cell trait (SCT), who develop mild hemolysis, also restrict HIV-1 infection. Ex vivo infection of SCT PBMCs exhibited an approximately twofold reduction of HIV-1 replication and lower levels of HIV-1 reverse transcription products, 2-long terminal repeat circle, HIV-1 integration, and gag RNA expression. SCT PBMCs had higher HO-1 messenger RNA (mRNA) and protein levels and reduced ribonucleotide reductase 2 (RNR2) protein levels. HO-1 inhibition by tin porphyrin eliminated ex vivo HIV-1 restriction. Among Howard University clinic recruits, higher levels of HO-1 and RNR2 mRNA and lower HIV-1 env mRNA levels were found in SCT individuals living with HIV-1. To determine the population-level effect of SCT on HIV-1 prevalence, we assessed SCT among women living with HIV (WLH) in the WIHS (Women Interagency HIV-1 Study). Among WIHS African-American participants, the prevalence of SCT was lower among women with HIV compared with uninfected women (8.7% vs 14.2%; odds ratio, 0.57; 95% confidence interval, 0.36-0.92; P = .020). WIHS WLH with SCT had higher levels of CD4+/CD8+ ratios over 20 years of follow-up (P = .003) than matched WLH without SCT. Together, our findings suggest that HIV-1 restriction factors, including HO-1 and RNR2, might restrict HIV-1 infection among individuals with SCT and limit the pathogenicity of HIV.
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Affiliation(s)
- Namita Kumari
- Center for Sickle Cell Disease
- Department of Medicine, Howard University, Washington, DC
| | - Mehdi Nouraie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Javed Khan
- Department of Pediatrics, Howard University, Washington, DC
| | | | | | | | | | - Tatiana Ammosova
- Center for Sickle Cell Disease
- Department of Medicine, Howard University, Washington, DC
| | | | - Sohail Rana
- Center for Sickle Cell Disease
- Department of Pediatrics, Howard University, Washington, DC
| | - Douglas F. Nixon
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | | | - Audrey L. French
- Division of Infectious Diseases, John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Stephen Gange
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Adaora A. Adimora
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - M. Neale Weitzmann
- Division of Endocrinology, Diabetes and Lipids, Department of Medicine, Emory University School of Medicine and The Atlanta VA Medical Center, Decatur, GA
| | - Margaret Fischl
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, AL; and
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, DC
| | - James G. Taylor
- Center for Sickle Cell Disease
- Department of Medicine, Howard University, Washington, DC
| | - Sergei Nekhai
- Center for Sickle Cell Disease
- Department of Medicine, Howard University, Washington, DC
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8
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Hernandez AG, Kiyaga C, Howard TA, Ssewanyana I, Ndeezi G, Aceng JR, Ware RE. Operational analysis of the national sickle cell screening programme in the Republic of Uganda. Afr J Lab Med 2021; 10:1303. [PMID: 34522631 PMCID: PMC8424771 DOI: 10.4102/ajlm.v10i1.1303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 04/13/2021] [Indexed: 11/07/2022] Open
Abstract
Background Sickle cell anaemia is a common global life-threatening haematological disorder. Most affected births occur in sub-Saharan Africa where children usually go undiagnosed and die early in life. Uganda’s national sickle cell screening programme was developed in response to a 2014 sickle cell surveillance study that documented a high disease prevalence. Objective This study describes the temporal and financial aspects of Uganda’s 2014–2019 sickle cell screening programme. Methods National sickle cell screening data from Uganda’s Central Public Health Laboratories were used to calculate turn-around times (TATs) from sample collection to delivery, testing, and result reporting for blood samples collected from February 2014 to March 2019. The parameters affecting specific TATs were assessed. The exact programme expenditures were analysed to determine cost per test and per positive sickle cell disease case detected. Results A total of 278 651 samples were analysed. The median TAT from sample collection to laboratory receipt was 8 days (interquartile range [IQR]: 6–12), receipt to testing was 3 days (IQR: 1–7), and testing to result reporting was 6 days (IQR: 3–12). Altogether, the sample continuum averaged 16 days (IQR: 11–24). Lower level healthcare facilities were associated with longer sample delivery TATs. Calendar months (January and December) and larger sample volumes impacted testing and result reporting TATs. The cost per test was $4.46 (United States dollars [USD]) and $483.74 USD per positive case detected. Conclusion Uganda’s sickle cell screening programme is efficient and cost-effective. Universal newborn screening is the best strategy for detecting sickle cell anaemia in Uganda.
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Affiliation(s)
- Arielle G Hernandez
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.,Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.,Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, Texas, United States
| | - Charles Kiyaga
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Thad A Howard
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.,Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Isaac Ssewanyana
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Russell E Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.,Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
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9
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Tegha G, Topazian HM, Kamthunzi P, Howard T, Tembo Z, Mvalo T, Chome N, Kumwenda W, Mkochi T, Hernandez A, Ataga KI, Hoffman IF, Ware RE. Prospective Newborn Screening for Sickle Cell Disease and Other Inherited Blood Disorders in Central Malawi. Int J Public Health 2021; 66:629338. [PMID: 34335138 PMCID: PMC8284589 DOI: 10.3389/ijph.2021.629338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Newborn screening in the United States and Europe allows early identification of congenital disorders but does not yet exist in most low-resource settings, especially in sub-Saharan Africa. Newborn screening can identify multiple inherited hematological disorders, but feasibility and effectiveness for Africa are not fully determined. Methods: Surplus dried blood spot collected in Central Malawi through the HIV Early Infant Diagnosis surveillance program were repurposed and tested by isoelectric focusing for sickle cell disease and trait. Additional genetic testing identified G6PD deficiency and alpha thalassemia. Results: Testing of 10,529 cards revealed an overall sickle cell trait prevalence of 7.0% (range 3.9-9.7% by district); 10 of 14 infants identified with sickle cell disease (prevalence 0.1%) were located and received care at a specialized clinic. Subsequent testing of 1,329 randomly selected cards identified alpha thalassemia trait in 45.7% of samples, and G6PD deficiency in 20.4% of males and 3.4% of females, with 29.0% of females as heterozygous carriers. Conclusion: Inherited hematological disorders are common in Central Malawi; early identification through newborn screening can improve clinical outcomes and should be supported throughout Africa.
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Affiliation(s)
- Gerald Tegha
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Hillary M. Topazian
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
| | - Portia Kamthunzi
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States
| | - Thad Howard
- Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Zondwayo Tembo
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Tisungane Mvalo
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, United States
| | - Nelecy Chome
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Wiza Kumwenda
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Tawonga Mkochi
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Arielle Hernandez
- Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Kenneth I. Ataga
- Center for Sickle Cell Disease, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Irving F. Hoffman
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States
| | - Russell E. Ware
- Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Global Health Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
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10
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Ambrose EE, Smart LR, Charles M, Hernandez AG, Latham T, Hokororo A, Beyanga M, Howard TA, Kamugisha E, McElhinney KE, Tebuka E, Ware RE. Surveillance for sickle cell disease, United Republic of Tanzania. Bull World Health Organ 2020; 98:859-868. [PMID: 33293746 PMCID: PMC7716099 DOI: 10.2471/blt.20.253583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/17/2020] [Accepted: 08/28/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To determine the regional- and district-level newborn prevalence of sickle cell trait and disease, and the prevalence of haemoglobin variants and genetic modifiers of sickle cell disease, in the nine regions of north-western United Republic of Tanzania. Methods We repurposed dried blood spot samples from children (aged 0–24 months) born to mothers living with human immunodeficiency virus (HIV), collected as part of the HIV Early Infant Diagnosis programme, for sickle cell diagnosis. We performed isoelectric focusing to determine whether samples had normal haemoglobin, sickle cell trait, sickle cell disease or a rare haemoglobin variant. We shipped samples diagnosed as disease or variant to Cincinnati Children’s Hospital in the United States of America for deoxyribonucleic-acid-based analyses to determine the prevalence of α-thalassaemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency or fetal haemoglobin genetic modifiers. Findings We analysed a total of 17 200 specimens during February 2017–May 2018. We observed a prevalence of sickle cell trait and disease of 20.3% (3492/17 200) and 1.2% (210/17 200), respectively. District-level trait varied from 8.6% (5/58) to 28.1% (77/274). Among confirmed sickle cell disease specimens, we noted 42.7% (61/143) had 1-gene deletion and 14.7% (21/143) had 2-gene deletion α-thalassaemia trait. We documented G6PD A– deficiency in 19.2% (14/73) of males. Conclusion Our calculated prevalence is twice as high as previously reported and reinforces the need for enhanced sickle cell diagnostic services. Our district-level data will inform public health policy, allowing screening and disease-modifying hydroxyurea therapy to be focused on high-prevalence areas, until universal newborn screening is available.
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Affiliation(s)
- Emmanuela E Ambrose
- Department of Paediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Luke R Smart
- Division of Hematology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 7015 Cincinnati, Ohio 45229, United States of America
| | - Mwesige Charles
- Department of Laboratory Services, Bugando Medical Centre, Mwanza, United Republic of Tanzania
| | - Arielle G Hernandez
- Division of Hematology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 7015 Cincinnati, Ohio 45229, United States of America
| | - Teresa Latham
- Division of Hematology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 7015 Cincinnati, Ohio 45229, United States of America
| | - Adolfine Hokororo
- Department of Paediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Medard Beyanga
- Department of Laboratory Services, Bugando Medical Centre, Mwanza, United Republic of Tanzania
| | - Thad A Howard
- Division of Hematology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 7015 Cincinnati, Ohio 45229, United States of America
| | - Erasmus Kamugisha
- Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Kathryn E McElhinney
- Division of Hematology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 7015 Cincinnati, Ohio 45229, United States of America
| | - Erius Tebuka
- Department of Pathology, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Russell E Ware
- Division of Hematology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 7015 Cincinnati, Ohio 45229, United States of America
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11
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Belisário AR, Blatyta PF, Vivanco D, Oliveira CDL, Carneiro-Proietti AB, Sabino EC, de Almeida-Neto C, Loureiro P, Máximo C, de Oliveira Garcia Mateos S, Flor-Park MV, de Oliveira Werneck Rodrigues D, Afonso Mota R, Gonçalez TT, Hoffmann TJ, Kelly S, Custer B. Association of HIV infection with clinical and laboratory characteristics of sickle cell disease. BMC Infect Dis 2020; 20:638. [PMID: 32854639 PMCID: PMC7457248 DOI: 10.1186/s12879-020-05366-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/19/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a multisystem disorder characterized by a wide spectrum of clinical manifestations and severity. Studies investigating potential effects of co-morbid human immunodeficiency virus (HIV) and SCD have produced conflicting results, and additional investigations are needed to elucidate whether the interaction between the two disease states might impact both HIV and SCD clinical outcomes. The association of HIV infection with clinical and laboratory characteristics of patients with SCD was assessed. METHODS This nested case-control study included individuals with SCD with HIV treated at six Brazilian SCD centers. Clinical and laboratory data were abstracted from medical records. HIV positive participants were compared to age, gender, center, and SCD genotype matched HIV negative participants (ratio 1:4). Individual clinical outcomes as well as a composite outcome of any SCD complication and a composite outcome of any HIV-related complication were compared between the two groups. RESULTS Fifteen HIV positive participants were included, 12 (80%) alive and 3 (20%) deceased. Most of the HIV positive patients had HbSS (60%; n = 9), 53% (n = 8) were female, and mean age was 30 ± 13 years. The frequency of individual SCD complications of acute chest syndrome/pneumonia, sepsis/bacteremia, pyelonephritis, ischemic stroke, hemorrhagic stroke, abnormal transcranial Doppler (TCD), and pulmonary hypertension was higher in HIV positive participants when compared to HIV negative, although analyzed individually none were statistically significant. HIV positive participants had significantly higher risk of any SCD complication and of a composite HIV-related complication compared to the HIV negative group (HR = 4.6; 95%CI 1.1-19.6; P = 0.04 and HR = 7.7; 95%CI 1.5-40.2; P = 0.02, respectively). There was a non-significant trend towards higher risk of any infections in participants with HIV positive (HR = 3.5; 95%CI 0.92-13.4; P = 0.07). Laboratory parameters levels were not significantly different in individuals with and without HIV. CONCLUSIONS In summary, our study in SCD patients shows that those with HIV have an increased risk of any SCD complication and HIV-related complications, as well as a suggestive but not significantly increased risk of infections.
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Affiliation(s)
- André Rolim Belisário
- Fundação Hemominas, Alameda Ezequiel Dias, 321, Belo Horizonte, Minas Gerais, 30130-110, Brazil.
| | - Paula F Blatyta
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Diana Vivanco
- University of California, San Francisco (UCSF), San Francisco, CA, USA
| | | | | | - Ester Cerdeira Sabino
- Faculdade de Medicina (FMUSP) and Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | - Cesar de Almeida-Neto
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, SP, Brazil
| | - Paula Loureiro
- Fundação Hemope, Recife, Pernambuco, Brazil
- Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Sheila de Oliveira Garcia Mateos
- Faculdade de Medicina (FMUSP) and Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
- Fundação Hemorio, Rio de Janeiro, Brazil
| | - Miriam V Flor-Park
- ITACI, Unidade de Onco-hematologia, Instituto da Criança, HCFMUSP, São Paulo, Brazil
| | | | - Rosimere Afonso Mota
- Fundação Hemominas, Alameda Ezequiel Dias, 321, Belo Horizonte, Minas Gerais, 30130-110, Brazil
| | | | - Thomas J Hoffmann
- University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Shannon Kelly
- Vitalant Research Institute, San Francisco, USA
- UCSF Benioff Children's Hospital Oakland, Oakland, USA
| | - Brian Custer
- University of California, San Francisco (UCSF), San Francisco, CA, USA
- Vitalant Research Institute, San Francisco, USA
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12
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Therrell BL, Lloyd-Puryear MA, Ohene-Frempong K, Ware RE, Padilla CD, Ambrose EE, Barkat A, Ghazal H, Kiyaga C, Mvalo T, Nnodu O, Ouldim K, Rahimy MC, Santos B, Tshilolo L, Yusuf C, Zarbalian G, Watson MS. Empowering newborn screening programs in African countries through establishment of an international collaborative effort. J Community Genet 2020; 11:253-268. [PMID: 32415570 PMCID: PMC7295888 DOI: 10.1007/s12687-020-00463-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/02/2020] [Indexed: 02/02/2023] Open
Abstract
In an effort to explore new knowledge and to develop meaningful collaborations for improving child health, the First Pan African Workshop on Newborn Screening was convened in June 2019 in Rabat, Morocco. Participants included an informal network of newborn screening stakeholders from across Africa and global experts in newborn screening and sickle cell disease. Over 150 attendees, representing 20 countries, were present including 11 African countries. The agenda focused on newborn screening rationale, techniques, system development, implementation barriers, ongoing research, and collaborations both globally and across Africa. We provide an overview of the workshop and a description of the newborn screening activities in the 11 African countries represented at the workshop, with a focus on sickle cell disease.
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Affiliation(s)
- Bradford L Therrell
- National Newborn Screening and Global Resource Center, University of Texas Health Science Center at San Antonio, Austin, TX, USA.
| | | | - Kwaku Ohene-Frempong
- Sickle Cell Foundation of Ghana, National Newborn Screening Program for Sickle Cell Disease, Accra, Ghana
| | - Russell E Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Emmanuela E Ambrose
- Bugando Medical Centre and Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Amina Barkat
- Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Hassan Ghazal
- National Center for Scientific and Technological Research, Rabat, Morocco
| | - Charles Kiyaga
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Obiageli Nnodu
- Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Karim Ouldim
- Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Abdellah, Fes, Morocco
| | - Mohamed Chérif Rahimy
- National Sickle Cell Disease Center, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Brígida Santos
- Centro de Apoio ao Doente Anémico, Hospital Pediátrico David Bernardino, Luanda, Angola
| | - Léon Tshilolo
- Centre Hospitalier Monkole, Kinshasa, Democratic Republic of the Congo
| | - Careema Yusuf
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Guisou Zarbalian
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Michael S Watson
- American College of Medical Genetics and Genomics, Bethesda, MD, USA
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13
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Oron AP, Chao DL, Ezeanolue EE, Ezenwa LN, Piel FB, Ojogun OT, Uyoga S, Williams TN, Nnodu OE. Caring for Africa's sickle cell children: will we rise to the challenge? BMC Med 2020; 18:92. [PMID: 32340612 PMCID: PMC7187492 DOI: 10.1186/s12916-020-01557-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 03/12/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Most of the world's sickle cell disease (SCD) burden is in Africa, where it is a major contributor to child morbidity and mortality. Despite the low cost of many preventive SCD interventions, insufficient resources have been allocated, and progress in alleviating the SCD burden has lagged behind other public-health efforts in Africa. The recent announcement of massive new funding for research into curative SCD therapies is encouraging in the long term, but over the next few decades, it is unlikely to help Africa's SCD children substantially. MAIN DISCUSSION A major barrier to progress has been the absence of large-scale early-life screening. Most SCD deaths in Africa probably occur before cases are even diagnosed. In the last few years, novel inexpensive SCD point-of-care test kits have become widely available and have been deployed successfully in African field settings. These kits could potentially enable universal early SCD screening. Other recent developments are the expansion of the pneumococcal conjugate vaccine towards near-universal coverage, and the demonstrated safety, efficacy, and increasing availability and affordability of hydroxyurea across the continent. Most elements of standard healthcare for SCD children that are already proven to work in the West, could and should now be implemented at scale in Africa. National and continental SCD research and care networks in Africa have also made substantial progress, assembling care guidelines and enabling the deployment and scale-up of SCD public-health systems. Substantial logistical, cultural, and awareness barriers remain, but with sufficient financial and political will, similar barriers have already been overcome in efforts to control other diseases in Africa. CONCLUSION AND RECOMMENDATIONS Despite remaining challenges, several high-SCD-burden African countries have the political will and infrastructure for the rapid implementation and scale-up of comprehensive SCD childcare programs. A globally funded effort starting with these countries and expanding elsewhere in Africa and to other high-burden countries, including India, could transform the lives of SCD children worldwide and help countries to attain their Sustainable Development Goals. This endeavor would also require ongoing research focused on the unique needs and challenges of SCD patients, and children in particular, in regions of high prevalence.
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Affiliation(s)
- Assaf P Oron
- Maternal, Newborn and Child Health, Institute for Disease Modeling, Bellevue, WA, USA
| | - Dennis L Chao
- Maternal, Newborn and Child Health, Institute for Disease Modeling, Bellevue, WA, USA
| | - Echezona E Ezeanolue
- Healthy Sunrise Foundation, Las Vegas, NV, USA
- College of Medicine, University of Nigeria, Nsukka, Nigeria
| | | | - Frédéric B Piel
- Department of Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | | | - Sophie Uyoga
- KEMRI-Wellcome Trust Research Programme, PO Box 230, Kilifi, Kenya
| | | | - Obiageli E Nnodu
- Centre of Excellence for Sickle Cell Disease Research & Training, University of Abuja, Abuja, Nigeria
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14
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Dexter D, Simons D, Kiyaga C, Kapata N, Ntoumi F, Kock R, Zumla A. Mitigating the effect of the COVID-19 pandemic on sickle cell disease services in African countries. LANCET HAEMATOLOGY 2020; 7:e430-e432. [PMID: 32334676 PMCID: PMC7180020 DOI: 10.1016/s2352-3026(20)30122-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/08/2020] [Accepted: 04/15/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Daniel Dexter
- Great Ormond Street Hospital for Children, London, UK
| | - David Simons
- The Royal Veterinary College, University of London, Hatfield, Hertfordshire, AL9 7TA, UK.
| | | | - Nathan Kapata
- Zambia National Public Health Institute, Minsitry of Health, Lusaka, Zambia
| | | | - Richard Kock
- The Royal Veterinary College, University of London, Hatfield, Hertfordshire, AL9 7TA, UK
| | - Alimuddin Zumla
- Center for Clinical Microbiology, Division of Infection and Immunity, Royal Free Hospital Campus, University College London, London, United Kingdom; Division of Infection and Immunity, University College London and National Institute for Health Research Biomedical Research Centre, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
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