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Irvine T, Brundage M, Hudani A, Kabiru J, Kimani K, Njuguna F, Njambi L, Dimaras H. Development and preliminary evaluation of a genetics education booklet for retinoblastoma. J Genet Couns 2024. [PMID: 39087554 DOI: 10.1002/jgc4.1944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/13/2024] [Accepted: 06/17/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Parents and survivors of retinoblastoma often hold misconceptions about the disease and desire more extensive and detailed information about its genetic nature. The aim of this study was to co-develop and evaluate a genetic education booklet for retinoblastoma. METHODS A human-centered design approach was employed, in which the study team consulted with clinician and patient knowledge user groups to design, produce, and refine an educational booklet. Over three phases of consultation, the study team met with each knowledge user group to review booklet prototypes and collect feedback for its further refinement. A preliminary evaluation using quantitative and qualitative methods was completed with six mothers of children with retinoblastoma. RESULTS The iterative, phased design process produced an educational booklet rich in images and stories, with complex genetic topics described in simplified terms. The preliminary evaluation showed an average improvement in knowledge between pre- and post-test questionnaire of 10%. Participants were satisfied with content and comprehensiveness of the information included in the booklet. CONCLUSION A novel educational tool for families affected by retinoblastoma was developed through collaboration with health care and patient knowledge users. Preliminary evaluation results indicate it is feasible to implement and study the booklet in a prospective, pragmatic trial to evaluate its efficacy.
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Affiliation(s)
- Taylor Irvine
- The Humanities Program, The University of Toronto, Toronto, Ontario, Canada
| | - Monica Brundage
- Human Biology Program, The University of Toronto, Toronto, Ontario, Canada
| | - Ashna Hudani
- International Development, The University of Toronto, Toronto, Ontario, Canada
| | - Joy Kabiru
- Eye Unit, PCEA Kikuyu Hospital, Kikuyu, Kenya
| | - Kahaki Kimani
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Festus Njuguna
- Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Lucy Njambi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Helen Dimaras
- Human Biology Program, The University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, The University of Toronto, Toronto, Ontario, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Ontario, Canada
- Centre for Global Child Health, SickKids Research Institute, Toronto, Ontario, Canada
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Ekoube CE, Bitsie DM, Njiengwe EF, Ma Linwa EM, Eyoum C, Betoko RM, Massako JD, Nsang EH, Soumaiyatou A, Kuate CT. Exploring Factors Associated with Quality of Life in Caregivers of Children and Adolescents with Sickle Cell Disease and HIV: A Comparative Analysis. Anemia 2024; 2024:4429541. [PMID: 38487039 PMCID: PMC10937083 DOI: 10.1155/2024/4429541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/25/2024] [Accepted: 02/29/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Paediatric HIV and sickle cell disease (SCD) are two stigmatising and potentially fatal illnesses that place a significant burden on families. HIV patients benefit from a longstanding free-service national programme in Cameroon, and this could considerably alleviate burden of care on HIV caregivers, possibly leading to better quality of life (QoL) in HIV caregivers compared to SCD caregivers. Our study aimed to compare the QoL between caregivers of children and adolescents with SCD and HIV and explore factors associated with this QoL in Cameroon. Methods and Materials We conducted a hospital-based cross-sectional analytic study at Douala Laquintinie Hospital from February to May 2023. A questionnaire was administered to caregivers of paediatric patients (≤18 years) with SCD and HIV. The Pediatrics Quality of Life-Family Impact Module (PedsQL FIM), the 7-item Generalized Anxiety Disorder (GAD-7), and the 9-item Patient Health Question (PHQ-9) tools were used as measures of quality of life, anxiety, and depression, respectively. Multivariable linear regression was used to determine factors associated with quality of life. A significance level was set at p < 0.05. Results We included 199 caregivers: SCD = 104 and HIV = 95. The mean age of caregivers in our sample was 40.47 ± 10.18 years. Caregivers of paediatric patients with HIV had a better mean quality of life than SCD (93.01 ± 7.35SD versus 64.86 ± 9.20SD, p < 0.001). PHQ-9 score (B = -1.52, 95% CI = [-2.08; -0.96], p=<0.001), GAD-7 score (B = -1.46, 95% CI = [-2.09; -0.83], p=<0.001), spending less than 75 000 FCFA on medications monthly (B = 12.13, 95% CI = [5.73; 18.94], p=<0.001), and being a SCD caregiver (B = -11.62, 95% CI = [-18.46; -4.78], p=0.001) were factors independently associated with quality of life on multivariable analysis. Conclusion Quality of life is lower in caregivers of children and adolescents with SCD than with HIV. Preventing depression and anxiety as well as advocating for the subsidization of medications through a national SCD program may improve quality of life in SCD caregivers.
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Affiliation(s)
- Charlotte Eposse Ekoube
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Laquintinie Hospital of Douala, Douala, Cameroon
| | - Dora Mbonjo Bitsie
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | | | - Christian Eyoum
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Ritha Mbono Betoko
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Laquintinie Hospital of Douala, Douala, Cameroon
| | | | - Emmanuel Heles Nsang
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Abba Soumaiyatou
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Callixte Tegueu Kuate
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
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Munung NS, Treadwell M, Kamga KK, Dennis-Antwi J, Anie K, Bukini D, Makani J, Wonkam A. Caught between pity, explicit bias, and discrimination: a qualitative study on the impact of stigma on the quality of life of persons living with sickle cell disease in three African countries. Qual Life Res 2024; 33:423-432. [PMID: 37889387 PMCID: PMC10850006 DOI: 10.1007/s11136-023-03533-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Sickle cell disease (SCD) is an inherited blood disorder characterized by unpredictable episodes of acute pain and numerous health complications. Individuals with SCD often face stigma from the public, including perceptions that they are lazy or weak tending to exaggerate their pain crisis, which can profoundly impact their quality of life (QoL). METHODS In a qualitative phenomenological study conducted in Cameroon, Ghana, and Tanzania, we explored stakeholders' perceptions of SCD-related stigma using three analytical frameworks: Bronfenbrenner's Ecological Systems Theory; The Health Stigma and Discriminatory Framework; and A Public Health Framework for Reducing Stigma. RESULTS The study reveals that SCD-related stigma is marked by prejudice, negative labelling and social discrimination, with derogatory terms such as sickler, ogbanje (one who comes and goes), sika besa (money will finish), ene mewu (I can die today, I can die tomorrow), vampire (one who consumes human blood), and Efiewura (landlord-of the hospital), commonly used to refer to individuals living with SCD. Drivers of stigma include frequent crises and hospitalizations, distinct physical features of individuals living with SCD, cultural misconceptions about SCD and its association with early mortality. Proposed strategies for mitigating stigma include public health education campaigns about SCD, integrating SCD into school curricula, healthcare worker training and community engagement. CONCLUSION The results highlight the importance of challenging stigmatizing narratives on SCD and recognizing that stigmatization represents a social injustice that significantly diminishes the QoL of individuals living with SCD.
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Affiliation(s)
- Nchangwi Syntia Munung
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Marsha Treadwell
- Department of Pediatrics/Division of Hematology, University of California San Francisco, Oakland, CA, USA
| | - Karen Kengne Kamga
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- University of Yaoundé 1, Yaoundé, Cameroon
| | | | - Kofi Anie
- London Northwest University Healthcare (NHS) Trust, Harrow, UK
- Imperial College London, London, UK
| | - Daima Bukini
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Ambroise Wonkam
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
- McKusick-Nathans Institute and Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
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Mumuni ND, Osman W, Alhassan BA, Alhassan A. Burden experienced by informal caregivers of children with sickle cell disease (SCD): a qualitative exploratory study at Tamale Teaching Hospital, Ghana. BMJ Open 2023; 13:e066311. [PMID: 37024250 PMCID: PMC10083813 DOI: 10.1136/bmjopen-2022-066311] [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] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE This study sought to explore the burden experienced by informal caregivers in caring for their children with sickle cell disease (SCD). DESIGN A qualitative exploratory design was employed in the study using in-depth interviews. SETTING The study was conducted at the sickle cell clinic of the Tamale Teaching Hospital, Ghana. PARTICIPANTS Data were gathered from 15 purposively selected informal caregivers, whose children with SCD received care at the sickle cell clinic of the Tamale Teaching Hospital, using a semistructured in-depth interview guide in May-June 2021. Their responses were audio-taped, transcribed and analysed using the reflexive thematic analysis approach. RESULTS Five major themes emerged from data analysis. These were: the burden of children's ill-health; financial burden; employment challenges; psychosocial burden and determinants of caregivers' burden. These burdens destabilised the personal lives, financial standing, social relationships, and employment of caregivers in general and that of other immediate family members, thus, impacting family processes and health. CONCLUSIONS Health professionals must devise strategies for counselling, early diagnosis and effective management of children with SCD across Ghana. The Ministry of Health must subsidise medications and laboratory services for children with SCD to help minimise the financial burden on caregivers. Further, counselling and psychological support services must be established in hospitals to assist caregivers to cope effectively.
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Affiliation(s)
- Najart Deborah Mumuni
- Nadowli District Hospital, Ghana Health Service, Nadowli, Upper West Region, Ghana
- Faculty of Paediatric Nursing, Ghana College of Nurses and Midwives (GCNM), Accra, Greater Accra Region, Ghana
| | - Wahab Osman
- Faculty of Paediatric Nursing, Ghana College of Nurses and Midwives (GCNM), Accra, Greater Accra Region, Ghana
- Department of Advanced Nursing Practice, School of Nursing and Midwifery, University for Development Studies, Tamale, Northern Region, Ghana
| | - Basour Adam Alhassan
- Department of General Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Northern Region, Ghana
| | - Afizu Alhassan
- Department of General Nursing, Kpembe Nursing and Midwifery Training College, Kpembe, Savannah Region, Ghana
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Atoku AC, Nekaka R, Kagoya EK, Ssenyonga LVN, Iramiot JS, Tegu C. Psycho-social challenges faced by caretakers of children and adolescents aged 0-19 years with sickle cell disease admitted in a tertiary hospital in Eastern Uganda. J Pediatr Nurs 2022; 69:e21-e31. [PMID: 36463013 DOI: 10.1016/j.pedn.2022.11.026] [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: 05/24/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Families of children and adolescents living with sickle cell disease face several challenges ranging from psycho-social to social-economic challenges. This study aimed to explore psycho-social challenges experienced by caretakers of children and adolescents aged 0-19 years with SCD and the various coping mechanisms. METHODS A mixed-methods cross-sectional study was carried out among caregivers of children with SCD who were admitted to the pediatric wards of the Mbale Regional Referral Hospital from September 2019 to November 2019. A total of 333 participants were interviewed using a pretested questionnaire and 11 in-depth interviews were conducted. RESULTS Most participants 285(85.59%) reported that they experienced psychological challenges and almost all the participants in this study 297(89.19%) experienced social challenges during the care of their patients. Only 36(10.81%) reported not experiencing any social challenges. Almost all the participants reported coping with the situation in various ways of which, 296(88.89%) used acceptance, 9(2.7%) still lived in denial, while 9(2.7%) used talking with others and getting counseled to reduce the intensity of the feelings experienced. Three themes were generated from the in-depth interviews; knowledge of the child's health condition; common symptoms and care, the experience of psycho-social challenges, and coping strategies. CONCLUSION Sickle cell disease has affected two sets of people; the people living with the disease and those who are caring for their loved ones. Being conscious of this will help health practitioners to be more empathetic to patients and caregivers when treating people living with sickle cell disease. The biggest proportion of caretakers of children and adolescents 0-19 years experienced psycho-social challenges. The main coping strategy used by the caretakers was acceptance.
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Affiliation(s)
| | - Rebecca Nekaka
- Department of Community Health, Division of Community Based Education and Research Services, Faculty of Health Sciences, Busitema University, Uganda
| | - Enid Kawala Kagoya
- Department of Community Health, Division of Community Based Education and Research Services, Faculty of Health Sciences, Busitema University, Uganda
| | - Lydia V N Ssenyonga
- Department of Nursing, Faculty of Health Sciences, Busitema University, Uganda
| | - Jacob Stanley Iramiot
- Department of Microbiology and Immunology, Faculty of Health Sciences, Busitema University, Uganda.
| | - Crispus Tegu
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Busitema University, Uganda
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Kisanga E, Mutagonda R, Myemba DT, Njiro BJ, Simon F, Marealle AI, Mikomangwa WP, Kilonzi M, Sambayi G, Bwire GM. Premarital genetic screening and care of Tanzanian children with sickle cell disease: a qualitative study on parents' views and experiences. J Community Genet 2021; 12:515-523. [PMID: 34287808 PMCID: PMC8554897 DOI: 10.1007/s12687-021-00539-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022] Open
Abstract
Genetic testing and counselling is one of the approaches to reduce the high birth rate of individuals with sickle cell disease (SCD). A descriptive phenomenological approach was used to explore parents' views on premarital genetic screening for sickle cell trait and their experiences in the care of Tanzanian children with SCD using a face-to-face in-depth interview. The study was conducted at sickle cell clinic at tertiary hospital in Dar es Salaam region between June and August 2020. The study found that most of the parents with SCD children knew about genetic testing and counselling after the diagnosis of their children's SCD status. Major approaches employed in managing SCD crises were supportive, preventive, and symptomatic. Parents expressed a heavy burden related to caretaking due to the lack of financial support and stigmatization. These affected their children's quality of care and management. In conclusion, participants expressed a preference for premarital genetic testing, where others insisted it becomes compulsory. In addition, there should be an adequate clinic for early screening, accessible therapeutic support and long-term follow up for children with SCD. Support to poor families with individual with SCD through national health assurance scheme and free provision of preventive medications such as hydroxyurea, is recommended.
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Affiliation(s)
- Esther Kisanga
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Ritah Mutagonda
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - David T. Myemba
- Department of Pharmaceutics and Pharmacy Practice, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Belinda J. Njiro
- Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania
| | - Franklin Simon
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Alphonce I. Marealle
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Wigilya P. Mikomangwa
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Godfrey Sambayi
- Department of Pharmacognosy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - George M. Bwire
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
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Stewart KA, Parshad-Asnani M, Wonkam A, Bollinger J, Ngo Bitoungui V, Wonkam-Tingang E, Powell J, Desronvil K, Benson KRK, Clark A, Katz M, Martin B, Peterseim C, Williams C, Young N, Shah N, Tanabe P, Babyak M, Royal CDM. "Pain is Subjective": A Mixed-Methods Study of Provider Attitudes and Practices Regarding Pain Management in Sickle Cell Disease Across Three Countries. J Pain Symptom Manage 2021; 61:474-487. [PMID: 32889040 DOI: 10.1016/j.jpainsymman.2020.08.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 11/24/2022]
Abstract
CONTEXT Sickle cell disease (SCD), an autosomal recessive blood disorder, affects millions of people worldwide. Approximately 80% of all cases are located in Africa. OBJECTIVES This cross-national, interdisciplinary, collaborative study investigated provider attitudes about, and practices for, managing (assessing and treating) SCD pain. METHODS We conducted 111 quantitative surveys and 52 semistructured interviews with health-care providers caring for adults and/or children with SCD in Cameroon, Jamaica, and the U.S. RESULTS Applying Haywood's scale for assessing SCD provider attitudes, the Jamaica site scored lower on "Negative Attitudes" than the Cameroonian and U.S. sites (P = 0.03 and <0.001, respectively). Providers at the U.S. site scored lower on "Positive Attitudes" than other sites (P < 0.001). "Red Flag" scores at the Cameroon sites were lower than at other sites (P < 0.001). Qualitative results across all three sites describe the current practices for SCD pain management, as well as the challenges surrounding management for health providers, including pain subjectivity, patient-provider and parent-provider relationships, resource availability, perceptions of drug-seeking behavior, and adherence. Providers also spontaneously offered solutions to reported challenges. CONCLUSION Overall, findings reveal that SCD provider attitudes toward their patients differed across sites, yet at all three sites, treating SCD pain is multidimensional.
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Affiliation(s)
- Kearsley A Stewart
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.
| | - Monika Parshad-Asnani
- Caribbean Institute for Health Research - Sickle Cell Unit, University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Ambroise Wonkam
- Faculty of Health Sciences, Division of Human Genetics, University of Cape Town, Cape Town, South Africa; Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - John Bollinger
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Valentina Ngo Bitoungui
- Department of Microbiology, Hematology and Immunology, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Edmond Wonkam-Tingang
- Faculty of Health Sciences, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Jill Powell
- Duke Center on Genomics, Race, Identity, Difference, Durham, North Carolina, USA
| | - Kathia Desronvil
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Kathryn R K Benson
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Abby Clark
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Madelaine Katz
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Bianca Martin
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Carolyn Peterseim
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Christina Williams
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nana Young
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nirmish Shah
- Divisions of Hematology and Pediatric Hematology/Oncology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Paula Tanabe
- Duke University Schools of Nursing and Medicine, Durham, North Carolina, USA
| | - Michael Babyak
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University, Durham, North Carolina, USA
| | - Charmaine D M Royal
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Duke Center on Genomics, Race, Identity, Difference, Durham, North Carolina, USA; Department of African & African American Studies, Duke University, Durham, North Carolina, USA
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Pandarakutty S, Murali K, Arulappan J, Al Sabei SD. Health-Related Quality of Life of Children and Adolescents with Sickle Cell Disease in the Middle East and North Africa Region: A systematic review. Sultan Qaboos Univ Med J 2021; 20:e280-e289. [PMID: 33414931 PMCID: PMC7757932 DOI: 10.18295/squmj.2020.20.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/02/2020] [Accepted: 05/15/2020] [Indexed: 11/16/2022] Open
Abstract
Sickle cell disease (SCD) can significantly impair the health-related quality of life (HRQOL) of children and adolescents. This review aimed to assess current evidence regarding the HRQOL of children and adolescents with SCD in the Middle East and North Africa region. A systematic search of various databases was conducted to identify relevant articles, including MEDLINE® (National Library of Medicine, Bethesda, Maryland, USA), Scopus® (Elsevier, Amsterdam, the Netherlands), Cumulative Index to Nursing and Allied Health Literature®, Masader (Oman Virtual Science Library, Muscat, Oman) and EBSCOhost (EBSCO Information Services, Ipswich, Massachusetts, USA). A total of 533 articles were identified; however, only 10 were eligible for inclusion in the final analysis. Results from these studies showed that children and adolescents with SCD had compromised HRQOL compared to their healthy peers, particularly in terms of physical, psychosocial, familial, financial and academic functioning. Therefore, interventions are necessary to improve overall HRQOL outcomes for this population.
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Affiliation(s)
- Suthan Pandarakutty
- Department of Nursing, College of Health Sciences, University of Buraimi, Al Buraimi, Oman
| | - Kamala Murali
- Department of Paediatric Nursing, Rani Meyyammai College of Nursing, Annamalai University, Chidambaram, Tamil Nadu, India
| | | | - Sulaiman D Al Sabei
- Fundamentals & Administration, College of Nursing, Sultan Qaboos University, Muscat, Oman
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9
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Erythrocyte microRNAs: a tiny magic bullet with great potential for sickle cell disease therapy. Ann Hematol 2021; 100:607-614. [PMID: 33398452 DOI: 10.1007/s00277-020-04390-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022]
Abstract
Sickle cell disease (SCD) is a severe hereditary blood disorder caused by a mutation of the beta-globin gene, which results in a substantial reduction in life expectancy. Many studies are focused on various novel therapeutic strategies that include re-activation of the γ-globin gene. Among them, expression therapy caused by the fetal hemoglobin (HbF) at a later age is highly successful. The induction of HbF is one of the dominant genetic modulators of the hematological and clinical characteristics of SCD. In fact, HbF compensates for the abnormal beta chain and has an ameliorant effect on clinical complications. Erythropoiesis is a multi-step process that involves the proliferation and differentiation of a small population of hematopoietic stem cells and is affected by several factors, including signaling pathways, transcription factors, and small non-coding RNAs (miRNAs). miRNAs play a regulatory role through complex networks that control several epigenetic mechanisms as well as the post-transcriptional regulation of multiple genes. In this review, we briefly describe the current understanding of interactions between miRNAs, their molecular targets, and their regulatory effects in HbF induction in SCD.
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Buser JM, Bakari A, Seidu AA, Osei-Akoto A, Paintsil V, Amoah R, Otoo B, Moyer CA. Caregiver Perception of Sickle Cell Disease Stigma in Ghana: An Ecological Approach. J Pediatr Health Care 2021; 35:84-90. [PMID: 32883582 PMCID: PMC7738399 DOI: 10.1016/j.pedhc.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/01/2020] [Accepted: 08/01/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) stigma is a major community health issue. The challenges of caring for someone with SCD can be overwhelming. We explored stigma and related factors for caregivers of pediatric patients with SCD in Kumasi, Ghana. METHOD Guided by the Ecological Systems Theory, we used in-depth interviews with a semistructured guide to learn about the perception of stigmatization for Ghanaian caregivers of patients with SCD. RESULTS Overall, participants were knowledgeable about SCD. We identified three themes, including (1) blame for SCD, (2) public misconception about SCD, and (3) shame for the financial burden of SCD. DISCUSSION Findings demonstrate the need to design an SCD stigma reduction program for caregivers, families, and the community. Providers need to consider SCD stigma and interaction with multiple ecological levels, including the family, community, health care system, culture, and health policy in Ghana. Findings can be used as a catalyst to explore the reduction of stigmatization in other sub-Saharan countries.
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Kuerten BG, Brotkin S, Bonner MJ, Ayuku DO, Njuguna F, Taylor SM, Puffer ES. Psychosocial Burden of Childhood Sickle Cell Disease on Caregivers in Kenya. J Pediatr Psychol 2020; 45:561-572. [PMID: 32374404 PMCID: PMC7825476 DOI: 10.1093/jpepsy/jsaa021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/13/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To characterize the types and magnitude of psychosocial burden present in caregivers who have a child with sickle cell disease (SCD) in Kenya and to identify predictors of caregiver psychosocial burden, including disease severity and financial hardship. METHODS Primary caregivers (N = 103) of children aged 1-10 years diagnosed with SCD completed surveys assessing multiple domains of caregiver quality of life (QOL), adjustment to child illness, mental health, and financial hardship. Descriptive statistics characterize psychosocial burden, and linear models assess associations. RESULTS On indicators of QOL, caregivers report multiple difficulties across most domains, including daily activities and physical, social, cognitive, and emotional well-being. Daily activities emerged as most burdensome. On indicators of parental adjustment to chronic illness, guilt and worry emerged as the greatest concern, followed by long-term uncertainty and unresolved sorrow and anger; relative to these, they reported higher levels of emotional resources. Financial hardship was high, as caregivers reported moderate to major financial losses due to the time spent caring for their child. General linear model analyses revealed that level of financial hardship was a significant predictor of all negative psychosocial outcomes. CONCLUSIONS Results document that Kenyan caregivers of children with SCD experience difficulties across multiple domains of functioning and that financial difficulties are likely associated with psychosocial burden. Results can guide intervention development for caregivers of children with SCD in low-resource, global contexts.
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Affiliation(s)
| | - Samuel Brotkin
- Department of Psychology & Neuroscience, Duke University
| | - Melanie J Bonner
- Department of Psychology & Neuroscience, Duke University
- Division of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - David O Ayuku
- Department of Behavioral Science, School of Medicine, College of Health Sciences, Moi University
| | - Festus Njuguna
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University
| | - Steve M Taylor
- Duke Global Health Institute, Duke University
- Division of Infectious Diseases, Duke University School of Medicine
- Duke Clinical Research Institute
| | - Eve S Puffer
- Duke Global Health Institute, Duke University
- Department of Psychology & Neuroscience, Duke University
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Eleonore NLE, Cumber SN, Charlotte EE, Lucas EE, Edgar MML, Nkfusai CN, Geh MM, Ngenge BM, Bede F, Fomukong NH, Kamga HLF, Mbanya D. Malaria in patients with sickle cell anaemia: burden, risk factors and outcome at the Laquintinie hospital, Cameroon. BMC Infect Dis 2020; 20:40. [PMID: 31937250 PMCID: PMC6961385 DOI: 10.1186/s12879-019-4757-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/30/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND It is believed that the current prevalence of malaria in endemic areas reflects selection for the carrier form of sickle cell trait through a survival advantage. Malaria has been incriminated as a great cause of mortality in people with sickle cell disease (SCD). However, people with SCD, a high-risk group, do not benefit from free or subsisized malaria prevention and treatment in Cameroon unlike other vulnerable groups which may be due to insufficient evidence to guide policy makers. This study aimed at describing clinical and socio-demographic characteristics of patients with malaria, determining the prevalence of malaria in hospitalized children and in those with SCD and without, compare frequency of presentation of malaria related complications (using clinical and laboratory elements that define severe malaria) between children admitted for malaria with SCD and those without and finally, determing the risk factors for death in children admitted for malaria. METHODS This was a retrospective analysis of admission records of children age 1 to 18 years with a confirmed malaria diagnosis admitted at the Laquintinie Hospital during January 2015 through December 2018. Clinical features, laboratory characteristics and outcome of malarial infections, stratified by SCD status were studied. Patients with HIV infection, malnutrition, renal failure and discharged against medical advice were excluded from the study. Data were analysed using Epi-info 7 software and analysis done. Chi square test, Odds ratios, CI and student's t test were used to determine association between variables. Statistical significance was set at p-value ≤0.05. RESULTS The prevalence of malaria was lower among children with SCD than it was among children without SCD (23.5% vs 44.9%). Similarly, among those with a positive microscopy, the mean parasite density was significantly lower among children with SCD than it was among children without SCD (22,875.6 vs 57,053.6 parasites/ μl with t-value - 3.2, p-value 0.002). The mean hemoglobin concentration was lower in SCD as compared to non SCD (5.7 g/l vs 7.4 g/l, t-value - 12.5, p-value < 0.001). Overall mortality in SCD was 3.4% and malaria was reponsible for 20.4% of these deaths as compared to the 35.4% in non SCD patients. Convulsion and impaired consciousness were significantly lower in SCD group (OR:0.1, CI: 0.1-0.3, p value < 0.01 and OR:0.1, CI:0.1-0.2, p-value < 0.001 respectively). Death was significantly higher in SCD patients with malaria as compared to SCD patients admitted for other pathologies (3.2% vs 1.5%., OR:2.2, CI:1-5, p-value 0.050). CONCLUSION The SCD population has a lower mortality related to malaria compared to the non-SCD population. Meanwhile, within the SCD population, those admitted with malaria are twice more likely to die than those admitted for other pathologies. Jaundice, hepatomegaly and splenomegaly were common in SCD with malaria, however no risk factors for malaria severity or malaria related death was identified.
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Affiliation(s)
| | - Samuel Nambile Cumber
- Institute of Medicine, Department of Public Health and Community Medicine (EPSO), University of Gothenburg, Box 414, SE - 405 30, Gothenburg, Sweden
- Faculty of Health Sciences, University of the Free State, Bloemfontein, 9301 South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Private Bag X323, GezinaPretoria, 0001, Pretoria, South Africa
| | - Eposse Ekoube Charlotte
- Faculty of Medicine and Pharmaceutical sciences, Douala, Cameroon
- Pediatric Department, Laquintinie Hospital Douala, Douala, Cameroon
| | - Esuh Esong Lucas
- Pediatric Department, Laquintinie Hospital Douala, Douala, Cameroon
| | | | | | - Meh Martin Geh
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- St Mary Soledad Catholic Hospital Bamenda, Bamenda, Cameroon
| | - Budzi Michael Ngenge
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Etougebe Baptist Hospital, Yaounde, Cameroon
| | - Fala Bede
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | | | | | - Dora Mbanya
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
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Esezobor CI, Solarin AU, Olagunju AT. Significant Burden and Psychological Distress Among Caregivers of Children With Nephrotic Syndrome: A Cross-Sectional Study. Can J Kidney Health Dis 2020; 7:2054358119898016. [PMID: 31949915 PMCID: PMC6950537 DOI: 10.1177/2054358119898016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/12/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Childhood nephrotic syndrome (NS) follows a chronic course in most children.
However, little is known about the psychosocial burden of NS on the
caregivers despite evidence that caregiver burden or impairment in their
well-being may alter the outcome of chronic childhood illnesses. Objectives: To determine the frequency and predictors of significant caregiver burden and
psychological distress among caregivers of children with NS. Design: A cross-sectional study. Setting: Two pediatric nephrology clinics in Lagos, Nigeria. Patients: We included primary caregivers of children with idiopathic NS for at least 6
months. Measurements: The primary outcomes were psychological distress and significant caregiver
burden among caregivers. Methods: We interviewed caregivers using the 12-item General Health Questionnaire
(GHQ-12) and the 6-item Zarit Burden Interview (ZBI-6). The GHQ-12 scores ≥
3 and ZBI-6 scores ≥ 6 indicated psychological distress and significant
caregiver burden, respectively. Results: The caregivers were mostly mothers (77.9%) and married (92.4%), whereas the
children (n = 172) were mainly male (65.1%). Most of the children (n = 152;
88.4%) had steroid-sensitive NS including 24 (14%) children with frequent
relapses or steroid dependence and 20 (11.6%) with steroid-resistant NS. Of
the 172 caregivers, 53 (30.8%) and 30 (17.4%) reported psychological
distress and significant burden, respectively. Caregivers of children in
relapse had adjusted an odds ratio (aOR) with 95% confidence interval (CI)
of 2.45 (1.05-5.67) and 3.30 (1.22-8.92) of psychological distress and
significant caregiver burden, respectively. Furthermore, caregivers of male
children and those who needed help paying for health care had an aOR of 4.61
(1.34-15.68) and 3.06 (1.06-8.87) of significant caregiver burden,
respectively. Limitations: The study was limited by its cross-sectional design and the use of generic
rather than disease-specific instruments. Conclusion: One in every 6 caregivers of children with idiopathic NS reported significant
caregiver burden, and it was associated with psychological distress. Our
findings underscore the need for psychosocial support for caregivers of
children with NS, especially those with identifiable vulnerability.
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Affiliation(s)
- Christopher I Esezobor
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Mushin, Nigeria
| | - Adaobi U Solarin
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Nigeria
| | - Andrew T Olagunju
- Department of Psychiatry, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Mushin, Nigeria
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Olwit C, Mugaba M, Osingada CP, Nabirye RC. Existence, triggers, and coping with chronic sorrow: a qualitative study of caretakers of children with sickle cell disease in a National Referral Hospital in Kampala, Uganda. BMC Psychol 2018; 6:50. [PMID: 30342559 PMCID: PMC6196010 DOI: 10.1186/s40359-018-0263-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Worldwide, sickle cell disease is recognized as one of the major causes of morbidity and mortality. Caregivers and patients with such chronic illnesses experience economic, physical, social and psychological distresses which may lead to chronic sorrow. Chronic sorrow is viewed as a normal reaction to loss, however it can progress to a pathological state such as depression if the coping styles are ineffective. Therefore, the aim of this study was to explore the existence of chronic sorrow, triggers and coping with grief related feelings among caretakers of children with sickle cell disease. METHODS A descriptive qualitative study was conducted. Twelve in-depth interviews were conducted with eligible participants who were purposively selected. Deductive thematic analysis methods were used for data analysis. RESULTS Many (9 out of 12) of the caretakers experienced chronic sorrow. The grief related feelings were triggered by health worker related, disease related and support related factors. Caretakers used both external and internal coping strategies. External support was derived from community, family and health facility. Internal coping strategies were behavioral and cognitive. CONCLUSION Caretakers of children with sickle cell disease experienced chronic sorrow and employed both internal and external coping strategies to deal with it, which could be either effective or ineffective. This study recommends that health workers should routinely screen for chronic sorrow among caretakers of children with sickle cell disease and assist caretakers to strengthen effective coping strategies to ameliorate the negative effects of chronic sorrow.
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Affiliation(s)
- Connie Olwit
- Department of Nursing, College of health sciences, Makerere University, P.O.BOX. 7072, Kampala, Uganda.
| | - Maureen Mugaba
- Department of Nursing, College of health sciences, Makerere University, P.O.BOX. 7072, Kampala, Uganda
| | - Charles Peter Osingada
- Department of Nursing, College of health sciences, Makerere University, P.O.BOX. 7072, Kampala, Uganda
| | - Rose Chalo Nabirye
- Department of Nursing, College of health sciences, Makerere University, P.O.BOX. 7072, Kampala, Uganda
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Karadağ G, Güngörmüş Z, Olçar Z. Experiences and Problems Encountered by Families of Children with Sickle Cell Anemia. J Caring Sci 2018; 7:125-129. [PMID: 30283756 PMCID: PMC6163154 DOI: 10.15171/jcs.2018.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 06/02/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction: Sickle Cell Anemia is a disease that has a high level of morbidity and early mortality for patients that are not followed and controlled properly. Study was conducted the aim of determining experiences and problems of families whose children with sickle cell anemia. Methods: Descriptive study was conducted the aim of determining experiences and problems of families (n= 206) whose children with sickle cell anemia. Before conducting this study, a written permission from the related institution and research ethics committee approval from Gaziantep University were obtained. Questionnaire is made up of two sections (10 questions), socio-demographic of families and data about their problems (15 questions and 11 statements). Data were evaluated SPSS (21.0), number and percentage calculations. Results: It was determined that 96.1% of participants knew nothing about disease before their children were diagnosed, 92.7% of them are aware the disease was genetically inherited, all participants were a disease carrier themselves, and 93.7% of them had no blood tests before marriage. 97.1% of participants have no support from their spouses, It was determined that 98.5% of children suffer from pain, 60.7% suffer from weakness 51.5% of the participants apply to hospitals to decrease the problems and 48.5% use medications at home. Conclusion: A great number of families have problems regarding fear of losing their children, lack of social aid and support. Majority of children suffer from pain, weakness, exhaustion, they stay at hospital between at least 1 and 5 times a year, they need blood transfusion.
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Affiliation(s)
- Gülendam Karadağ
- Department of Public Health Nursing, Faculty of Nursing, Dokuz Eylül University, İzmir, Turkey
| | - Zeynep Güngörmüş
- Department of Public Health Nursing, Faculty of Health Sciences, University of Gaziantep, Gaziantep, Turkey
| | - Zeynep Olçar
- Department of Heamotology and Oncology, Nurse of University Hospital, Mustafa Kemal University, Hatay, Turkey
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Madani BM, Al Raddadi R, Al Jaouni S, Omer M, Al Awa MI. Quality of life among caregivers of sickle cell disease patients: a cross sectional study. Health Qual Life Outcomes 2018; 16:176. [PMID: 30200992 PMCID: PMC6131823 DOI: 10.1186/s12955-018-1009-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 09/03/2018] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To assess the quality of life (QoL) of caregivers of children with sickle cell disease (SCD) and to determine the risk factors associated with poor QoL. METHOD A cross sectional study was conducted between 01 and 30 June 2015, in a tertiary care center in western Saudi Arabia to assess various dimensions of QoL by using TNO-AZL Questionnaire for Adult's Health-related Quality of Life (TAAQOL). A total 164 adult caregivers (aged 16 years or more) of children with SCD, who were regularly visiting the department were enrolled (refusal rate = 61.6%). The questionnaire scores were transformed into 0-100 scale; with higher scores indicating less difficulty and better QoL Demographic, socioeconomic data and a satisfaction questionnaire regarding participants' lifestyle were collected and analyzed as risk factors for impaired QoL, by comparing different QoL dimensions' scores using independent t-test, Oneway ANOVA, or linear regression, as appropriate. RESULTS Sixty-three caregivers were included; 79.4% were mothers, age range 21-71 years, 64.5% were from low social class receiving insufficient support and financial needs were unmet for considerable number of families. Analysis of QoL using TAAQOL showed that emotions (median [75th centile] = 44.44 [66.67] for negative and 61.11 [72.22] for positive emotions), sleep quality (66.67 [91.67]) and sexual life (50.00 [83.33]) were the most affected dimensions. Professional achievement (91.67 [100]), cognitive skills (83.33 [100]), and social contact (100 [100]) were relatively preserved. Negative emotions were more marked in mothers and mostly predicted by satisfaction with social relations notably with partner (B = 3.14, p = 0.016), friends (B = 2.51, p = 0.015) and relatives (B = 2.69, p = 0.016). Positive emotions were predicted by the levels of satisfaction of the caregiver with his/her health (B = 2.56, p = 0.001), job achievement (B = 4.54, p = 0.001), living conditions (B = 2.60, p = 0.034) and the condition of the diseased child (B = 2.55, p = 0.011). A strong correlation was found between sleep quality and cognitive skills. CONCLUSION There are notable financial and emotional burdens on the caregivers of children with SCD affecting various aspects of their QoL, which are likely to be impacted by the individual levels of social and professional achievement. Physicians and health authorities should give particular attention to the QoL of caregivers and families of children with SCD, to help them cope up with the disease and overcome its related psychological and financial impacts.
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Affiliation(s)
- Badr M Madani
- University of Jeddah, Asfan road, Jeddah, 23881, Saudi Arabia.
| | | | - Soad Al Jaouni
- University of Jeddah, Asfan road, Jeddah, 23881, Saudi Arabia
| | - Mohab Omer
- University of Jeddah, Asfan road, Jeddah, 23881, Saudi Arabia
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Dennis-Antwi JA, Ohene-Frempong K, Anie KA, Dzikunu H, Agyare VA, Boadu RO, Antwi JS, Asafo MK, Anim-Boamah O, Asubonteng AK, Agyei S, Wonkam A, Treadwell MJ. Relation Between Religious Perspectives and Views on Sickle Cell Disease Research and Associated Public Health Interventions in Ghana. J Genet Couns 2018; 28:10.1007/s10897-018-0296-7. [PMID: 30171429 PMCID: PMC6395545 DOI: 10.1007/s10897-018-0296-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 08/22/2018] [Indexed: 01/08/2023]
Abstract
Sickle cell disease (SCD) is highly prevalent in Africa with a significant public health burden for under-resourced countries. We employed qualitative research methods to understand the ethical, legal, and social implications of conducting genomic research in SCD under the Human Heredity and Health in Africa (H3Africa) initiative. The present study focused on religious and cultural aspects of SCD with the view to identifying beliefs and attitudes relevant to public health interventions in Ghana. Thematic analyses from individual and group interviews revealed six key areas of importance, namely, reliance on a supreme being; religion as a disruptive influence on health behaviors; role of religious leaders in information sharing and decision-making; social, religious, and customary norms; health and religious/supernatural beliefs; and need for social education and support through church and community. Findings suggest that public health programs in Ghana should not only aim at increasing knowledge and awareness about SCD and its management but also create an understanding of the relevance of genomics and alternative technological advancement to diagnosis and ethical decision-making around available options for health seeking. Future research should engage communities to help address the ethical and social implications of a persuasive religious influence on SCD-related health decisions.
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Affiliation(s)
- Jemima A Dennis-Antwi
- Ghana College of Nurses and Midwives, Accra, Ghana
- Sickle Cell Foundation of Ghana, Accra, Ghana
| | | | - Kofi A Anie
- Hematology and Sickle Cell Centre, London North West University Healthcare NHS Trust and Imperial College London, London, UK
| | | | | | | | | | - Mabel K Asafo
- Regional Health Administration, Ghana Health Services, Kumasi, Ashanti Region, Ghana
| | | | | | | | - Ambroise Wonkam
- Division of Human Genetics, Department of Clinical Laboratory Sciences, National Health Laboratory Service and University of Cape Town, Cape Town, South Africa
| | - Marsha J Treadwell
- Department of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA.
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Pantaleao A, DiPlacido J, Guite JW, Zempsky WT. Caregiver factors related to emergency department utilization for youth with sickle cell disease. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1454838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ashley Pantaleao
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Joanne DiPlacido
- Department of Psychological Science, Central Connecticut State University, New Britain, CT, USA
| | - Jessica W. Guite
- The Center for Behavioral Health, Connecticut Children’s Medical Center, Hartford, CT, USA
| | - William T. Zempsky
- Division of Pain & Palliative Medicine, Connecticut Children’s Medical Center, Hartford, CT, USA
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Asnani MR, Barton-Gooden A, Grindley M, Knight-Madden J. Disease Knowledge, Illness Perceptions, and Quality of Life in Adolescents With Sickle Cell Disease: Is There a Link? Glob Pediatr Health 2017; 4:2333794X17739194. [PMID: 29152543 PMCID: PMC5680938 DOI: 10.1177/2333794x17739194] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 01/12/2023] Open
Abstract
Disease knowledge, illness perceptions, and quality of life (QOL) were examined in 150 adolescents (mean age = 16.1 years, SD = 1.9; 49.3% males) with sickle cell disease (SCD). Females had higher knowledge (P = .004), lower QOL (P = .02), and perceived their illness to be more unpredictable (P = .03). Those with more severe disease perceived their illness to be unpredictable with worse outcomes. Those with higher knowledge scores perceived their illness to be chronic, made more sense of their illness, and perceived greater personal and treatment control. Final hierarchical regression model showed that secondary education as compared to primary education level (P < .001) was positively correlated whereas disease severity (P < .001), perceived unpredictability (P = .024), and negative emotions (P < .001) were negatively correlated with QOL. Health practitioners should assess adolescents’ illness perceptions and encouraging continuing schooling and addressing emotional/psychological problems could improve their QOL.
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20
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Geard A, Pule GD, Chetcha Chemegni B, Ngo Bitoungui VJ, Kengne AP, Chimusa ER, Wonkam A. Clinical and genetic predictors of renal dysfunctions in sickle cell anaemia in Cameroon. Br J Haematol 2017; 178:629-639. [PMID: 28466968 DOI: 10.1111/bjh.14724] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/22/2017] [Indexed: 01/08/2023]
Abstract
Micro-albuminuria and glomerular hyperfiltration are primary indicators of renal dysfunctions in Sickle Cell Disease (SCD), with more severe manifestations previously associated with variants in APOL1 and HMOX1 among African Americans. We have investigated 413 SCD patients from Cameroon. Anthropometric variables, haematological indices, crude albuminuria, albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) were measured. Patients were genotyped for 3·7 kb alpha-globin gene (HBA1/HBA2) deletion, and for variants in APOL1 (G1/G2; rs60910145, rs73885319, rs71785313) and HMOX1 (rs3074372, rs743811). The median age was 15 years; the majority presented with micro-albuminuria (60·9%; n = 248), and approximately half with glomerular hyperfiltration (49·5%; n = 200). Age, male sex, haemoglobin level, leucocyte count, mean corpuscular volume, blood pressure, body mass index and creatinine levels significantly affected albuminuria and/or eGFR. Co-inheritance of alpha-thalassaemia was protective against macro-albuminuria (P = 0·03). APOL1 G1/G2 risk variants were significantly associated with the ACR (P = 0·01) and borderline with eGFR (P = 0·07). HMOX1 - rs743811 was borderline associated with micro-albuminuria (P = 0·07) and macro-albuminuria (P = 0·06). The results revealed a high proportion of micro-albuminuria and glomerular hyperfiltration among Cameroonian SCD patients, and support the possible use of targeted genetic biomarkers for risks assessment.
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Affiliation(s)
- Amy Geard
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gift D Pule
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | | | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Emile R Chimusa
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Ali RMA, Razeq NMA. The Lived Experience of Parents of Children with Sickle Cell Disease: A Qualitative Study. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojn.2017.711097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wonkam A, Makani J, Ofori-Aquah S, Nnodu OE, Treadwell M, Royal C, Ohene-Frempong K. Sickle cell disease and H3Africa: enhancing genomic research on cardiovascular diseases in African patients. Cardiovasc J Afr 2016; 26:S50-5. [PMID: 25962948 PMCID: PMC4547555 DOI: 10.5830/cvja-2015-040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Sickle cell disease (SCD) has a high prevalence in sub-Saharan Africa. There are several cardiovascular phenotypes in SCD that contribute to its morbidity and mortality. Discussion SCD is characterised by marked clinical variability, with genetic factors playing key modulating roles. Studies in Tanzania and Cameroon have reported that singlenucleotide polymorphisms in BCL11A and HBS1L-MYB loci and co-inheritance of alpha-thalassaemia impact on foetal haemoglobin levels and clinical severity. The prevalence of overt stroke among SCD patients in Cameroon (6.7%) and Nigeria (8.7%) suggests a higher burden than in high-income countries. There is also some evidence of high burden of kidney disease and pulmonary hypertension in SCD; however, the burden and genetics of these cardiovascular conditions have seldom been investigated in Africa. Conclusions Several H3Africa projects are focused on cardiovascular diseases and present major opportunities to build genome-based research on existing SCD platforms in Africa to transform the health outcomes of patients.
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Affiliation(s)
- Ambroise Wonkam
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar-Es-Salaam, Tanzania
| | - Solomon Ofori-Aquah
- Center for Translational and International Hematology, University of Pittsburgh, Pittsburgh, USA
| | - Obiageli E Nnodu
- Department of Haematology and Blood Transfusion, College of Health Sciences, University of Abuja, Abuja, Nigeria/Department of Haematology and Blood Transfusion, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Marsha Treadwell
- Hematology/Oncology Department, UCSF Benioff Children's Hospital, Oakland, USA
| | - Charmaine Royal
- Department of African and African American Studies, Duke University, Durham, USA
| | - Kwaku Ohene-Frempong
- Children's Hospital of Philadelphia, Comprehensive Sickle Cell Centre, Philadelphia, USA
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SOARES FF, CANGUSSU MCT, VIANNA MIP, ROSSI TRA, CARVALHO AS, BRITO MGS. Maternal risk behavior and caries incidence in children with sickle cell disease. Braz Oral Res 2016; 30:S1806-83242016000100202. [DOI: 10.1590/1807-3107bor-2016.vol30.0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 07/16/2015] [Indexed: 11/22/2022] Open
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Bitoungui VJN, Pule GD, Hanchard N, Ngogang J, Wonkam A. Beta-globin gene haplotypes among cameroonians and review of the global distribution: is there a case for a single sickle mutation origin in Africa? OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2015; 19:171-9. [PMID: 25748438 DOI: 10.1089/omi.2014.0134] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Studies of hemoglobin S haplotypes in African subpopulations have potential implications for patient care and our understanding of genetic factors that have shaped the prevalence of sickle cell disease (SCD). We evaluated HBB gene cluster haplotypes in SCD patients from Cameroon, and reviewed the literature for a global distribution. We reviewed medical records to obtain pertinent socio-demographic and clinical features for 610 Cameroonian SCD patients, including hemoglobin electrophoresis and full blood counts. RFLP-PCR was used to determine the HBB gene haplotype on 1082 chromosomes. A systematic review of the current literature was undertaken to catalogue HBB haplotype frequencies in SCD populations around the world. Benin (74%; n = 799) and Cameroon (19%; n = 207) were the most prevalent haplotypes observed among Cameroonian patients. There was no significant association between HBB haplotypes and clinical life events, anthropometric measures, hematological parameters, or fetal hemoglobin (HbF) levels. The literature review of the global haplotype distributions was consistent with known historical migrations of the people of Africa. Previously reported data from Sudan showed a distinctly unusual pattern; all four classical haplotypes were reported, with an exceptionally high proportion of the Senegal, Cameroon, and atypical haplotypes. We did not observe any significant associations between HBB haplotype and SCD disease course in this cohort. Taken together, the data from Cameroon and from the wider literature suggest that a careful reassessment of African HBB haplotypes may shed further light on the evolutionary dynamics of the sickle allele, which could suggest a single origin of the sickle mutation.
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Affiliation(s)
- Valentina J Ngo Bitoungui
- 1 Department of Microbiology, Parasitology, and Hematology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé , Yaoundé, Cameroon
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Brown SE, Weisberg DF, Sledge WH. Family caregiving for adults with sickle cell disease and extremely high hospital use. J Health Psychol 2015; 21:2893-2902. [PMID: 26078296 DOI: 10.1177/1359105315588215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated coping with chronic illness in the adult patient-caregiver relationship for sickle cell disease, marked by debilitating acute and chronic pain. One-on-one interviews (N = 16) were conducted with eight primary caregivers of eight adults with extremely high hospital use, severe sickle cell disease with hospital admissions several times monthly over successive years. Caregivers were predominantly parents; two were romantic partners. Caregivers attributed disruptions to the disease's variability, tensions in how much support to give, and adults' inability to fulfill parental obligations. Both groups expressed fears of patients' increasing age, declining health, and early death. Targeted counseling and resilience training is recommended.
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Wonkam A, Ngo Bitoungui VJ, Ngogang J. Perspectives in Genetics and Sickle Cell Disease Prevention in Africa: Beyond the Preliminary Data from Cameroon. Public Health Genomics 2015; 18:237-41. [PMID: 26044545 DOI: 10.1159/000431020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/29/2015] [Indexed: 11/19/2022] Open
Abstract
Management of sickle cell disease (SCD) in Africa needs to be accompanied by various preventive strategies, including early detection via prenatal genetic diagnosis (PND). Contrary to Cameroonian doctors who considered termination of an affected pregnancy (TAP) for SCD in 36.1%, the majority of parents (62.5%) with affected children accepted TAP in principle. In practice, most women opted for TAP (90%), justified by a huge psycho-social burden. The ethical and legal challenges of PND prompted the need to explore the use of genetics for secondary prevention of SCD. In 610 Cameroonian SCD patients, the genomic variations in two principal foetal haemoglobin-promoting loci were significantly associated with foetal haemoglobin levels. In addition, the co-inheritance of a 3.7-kb α-globin gene deletion and SCD was associated with a late disease onset and possibly improved survival: there was a much higher allele frequency of the 3.7-kb α-globin gene deletion in SCD patients (∼ 40%) than in haemoglobin AA controls (∼ 10%). The data indicate the urgent need to develop and implement policy actions in sub-Saharan Africa on at least four levels: (1) the implementation of SCD screening practices and early neonatal follow-up; (2) the development and incorporating of socio-economic support to alleviate the burden of SCD on affected families; (3) the exploration of the appropriateness of the medical abortion laws for SCD, and (4) the development of national plans for genetic medicine, including research on genomic variants that affect the phenotypes of SCD, in order to potentially use them for anticipatory guidance.
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Affiliation(s)
- Ambroise Wonkam
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, Republic of South Africa
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Rumaney MB, Ngo Bitoungui VJ, Vorster AA, Ramesar R, Kengne AP, Ngogang J, Wonkam A. The co-inheritance of alpha-thalassemia and sickle cell anemia is associated with better hematological indices and lower consultations rate in Cameroonian patients and could improve their survival. PLoS One 2014; 9:e100516. [PMID: 24978191 PMCID: PMC4076272 DOI: 10.1371/journal.pone.0100516] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/24/2014] [Indexed: 01/07/2023] Open
Abstract
Background Co-inheritance of α-thalassemia was reported to be associated with a delayed age of disease onset among Cameroonian Sickle Cell Anemia (SCA) patients. The present study aimed to explore the correlation between α-thalassemia, hematological indices, and clinical events in these patients. Methods and Findings We studied 161 Cameroonian SCA patients and 103 controls (59.1% HbAA) with median ages of 17.5 and 23 years. RFLP-PCR was used to confirm SCA genotype and to describe haplotypes in the HBB-like genes cluster. Multiplex Gap-PCR was performed to investigate the 3.7 kb α-globin gene deletions. SNaPshot PCR, capillary electrophoresis and cycle sequencing were used for the genotyping of 10 SNPs in BCL11A, HMIP1/2, OR51B5/6 and HBG loci, known to influence HbF levels. Generalised linear regression models adjusted for age, sex and SNPs genotypes was used to investigate effects of α-thalassemia on clinical and hematological indices. The median rate of vaso-occlusive painful crisis and hospitalisations was two and one per year, respectively. Stroke was reported in eight cases (7.4%). Benin haplotype was the most prevalent (66.3%; n = 208 chromosomes). Among patients, 37.3% (n = 60) had at least one 3.7 kb deletion, compared to 10.9% (n = 6) among HbAA controls (p<0.001). Among patients, the median RBC count increased with the number of 3.7 kb deletions [2.6, 3.0 and 3.4 million/dl, with no, one and two deletions (p = 0.01)]. The median MCV decreased with the number of 3.7 kb deletion [86, 80, and 68fl, with no, one and two deletions (p<0.0001)], as well as median WBC counts [13.2, 10.5 and 9.8×109/L (p<0.0001. The co-inheritance of α-thalassemia was associated with lower consultations rate (p = 0.038). Conclusion The co-inheritance of α-thalassemia and SCA is associated with improved hematological indices, and lower consultations rate in this group of patients. This could possibly improve their survival and explain the higher proportion of α-thalassemia among patients than controls.
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Affiliation(s)
- Maryam Bibi Rumaney
- Division of Human Genetics, Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town (UCT), Cape Town, Republic of South Africa
| | - Valentina Josiane Ngo Bitoungui
- Department of Microbiology, Parasitology and Haematology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Anna Alvera Vorster
- Division of Human Genetics, Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town (UCT), Cape Town, Republic of South Africa
| | - Raj Ramesar
- Division of Human Genetics, Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town (UCT), Cape Town, Republic of South Africa
- MRC Human Genetics Research Unit), Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town (UCT), Cape Town, Republic of South Africa
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council and University of Cape Town, Cape Town, South Africa
| | - Jeanne Ngogang
- Department of Microbiology, Parasitology and Haematology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Ambroise Wonkam
- Division of Human Genetics, Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town (UCT), Cape Town, Republic of South Africa
- * E-mail:
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Wonkam A, Rumaney MB, Ngo Bitoungui VJ, Vorster AA, Ramesar R, Ngogang J. Coinheritance of sickle cell anemia and α-thalassemia delays disease onset and could improve survival in Cameroonian's patients (Sub-Saharan Africa). Am J Hematol 2014; 89:664-5. [PMID: 24639123 DOI: 10.1002/ajh.23711] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/13/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Ambroise Wonkam
- Division of Human Genetics; Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town (UCT); Cape Town Republic of South Africa
| | - Maryam Bibi Rumaney
- Division of Human Genetics; Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town (UCT); Cape Town Republic of South Africa
| | - Valentina Josiane Ngo Bitoungui
- Department of Microbiology; Parasitology and Haematology; Faculty of Medicine and Biomedical Sciences; University of Yaoundé 1; Yaoundé Cameroon
| | - Anna Alvera Vorster
- Division of Human Genetics; Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town (UCT); Cape Town Republic of South Africa
- Division of Human Genetics; MRC Human Genetics Research Unit, Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town (UCT); Cape Town Republic of South Africa
| | - Raj Ramesar
- Division of Human Genetics; Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town (UCT); Cape Town Republic of South Africa
- Division of Human Genetics; MRC Human Genetics Research Unit, Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town (UCT); Cape Town Republic of South Africa
| | - Jeanne Ngogang
- Department of Microbiology; Parasitology and Haematology; Faculty of Medicine and Biomedical Sciences; University of Yaoundé 1; Yaoundé Cameroon
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Wonkam A, Hurst S. A call for policy action in sub-Saharan Africa to rethink diagnostics for pregnancy affected by sickle cell disease: differential views of medical doctors, parents and adult patients predict value conflicts in Cameroon. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2014; 18:472-80. [PMID: 24754796 DOI: 10.1089/omi.2013.0167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sickle cell disease (SCD) is a debilitating illness that affects the life expectancy of patients. It is possible to test for SCD before birth, to allow for reproductive options to parents. However, under Cameroonian Law, voluntary abortion is a criminal offense and medical abortion is permitted only "…if it is done by an authorized professional and justified by the need to save the mother from grave health jeopardy." The objective of the present study was to compare the views of Cameroonian doctors, parents with at least one living SCD-affected child, and adult SCD patients, regarding prenatal genetic diagnosis and termination of SCD-affected pregnancy. We conducted a quantitative sociological survey of 110 doctors, 130 parents, and 89 adult patients. The majority accepted the prenatal genetic diagnosis for SCD (78.7%, 89.8%, and 89.2%, respectively). Parents (62.5%) were more in favor of termination of SCD-affected pregnancy, than doctors and adults patients (36.1% and 40.9% acceptance, respectively). Parents and patients who found medical abortion acceptable cited fear to have a SCD-affected child (98.1 and 88.9%) and the poor quality of the affected child's health (92.6% and 81.5%). The data underscore the urgency of policy action to place emphasis on: premarital screening, early detection and care of SCD, socio-economic measures to assist SCD-affected families, appropriateness to consider maternal distress due to fetal anomalies in medical abortion legislation. These novel findings signal potential value-based conflicts on the horizon, and can usefully inform the future policy actions in the African continent as OMICS biotechnologies are increasingly employed in global health. To the best of our knowledge, the present study is the first attempt in sub-Saharan Africa to attempt to triangulate the views of multiple stakeholders towards prenatal diagnosis of SCD and termination of an affected pregnancy.
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Affiliation(s)
- Ambroise Wonkam
- 1 Division of Human Genetics, Faculty of Health Sciences, University of Cape Town , Cape Town, South Africa
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Wonkam A, Ngo Bitoungui VJ, Vorster AA, Ramesar R, Cooper RS, Tayo B, Lettre G, Ngogang J. Association of variants at BCL11A and HBS1L-MYB with hemoglobin F and hospitalization rates among sickle cell patients in Cameroon. PLoS One 2014; 9:e92506. [PMID: 24667352 PMCID: PMC3965431 DOI: 10.1371/journal.pone.0092506] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 02/21/2014] [Indexed: 01/03/2023] Open
Abstract
Background Genetic variation at loci influencing adult levels of HbF have been shown to modify the clinical course of sickle cell disease (SCD). Data on this important aspect of SCD have not yet been reported from West Africa. We investigated the relationship between HbF levels and the relevant genetic loci in 610 patients with SCD (98% HbSS homozygotes) from Cameroon, and compared the results to a well-characterized African-American cohort. Methods and Findings Socio-demographic and clinical features were collected and medical records reviewed. Only patients >5 years old, who had not received a blood transfusion or treatment with hydroxyurea were included. Hemoglobin electrophoresis and a full blood count were conducted upon arrival at the hospital. RFLP-PCR was used to describe the HBB gene haplotypes. SNaPshot PCR, Capillary electrophoresis and cycle sequencing were used for the genotyping of 10 selected SNPs. Genetic analysis was performed with PLINK software and statistical models in the statistical package R. Allele frequencies of relevant variants at BCL11A were similar to those detected in African Americans; although the relationships with Hb F were significant (p <.001), they explained substantially less of the variance in HbF than was observed among African Americans (∼ 2% vs 10%). SNPs in HBS1L-MYB region (HMIP) likewise had a significant impact on HbF, however, we did not find an association between HbF and the variations in HBB cluster and OR51B5/6 locus on chromosome 11p, due in part to the virtual absence of the Senegal and Indian Arab haplotypes. We also found evidence that selected SNPs in HBS1L-MYB region (HMIP) and BCL11A affect both other hematological indices and rates of hospitalization. Conclusions This study has confirmed the associations of SNPs in BCL11A and HBS1L-MYB and fetal haemoglobin in Cameroonian SCA patients; hematological indices and hospitalization rates were also associated with specific allelic variants.
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Affiliation(s)
- Ambroise Wonkam
- Division of Human Genetics, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Republic of South Africa
- * E-mail:
| | - Valentina J. Ngo Bitoungui
- Department of Microbiology, Parasitology and Haematology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Anna A. Vorster
- Division of Human Genetics, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Republic of South Africa
| | - Raj Ramesar
- Division of Human Genetics, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Republic of South Africa
- UCT/MRC Human Genetics Research Unit, Division of Human Genetics, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Republic of South Africa
| | - Richard S. Cooper
- Department of Public Health Sciences, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, United States of America
| | - Bamidele Tayo
- Department of Public Health Sciences, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, United States of America
| | - Guillaume Lettre
- Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Jeanne Ngogang
- Department of Microbiology, Parasitology and Haematology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
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Psychosocial stressors of sickle cell disease on adult patients in Cameroon. J Genet Couns 2014; 23:948-56. [PMID: 24557660 DOI: 10.1007/s10897-014-9701-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
Sickle Cell Disease (SCD) is a debilitating illness that affects quality of life. Studies of the psychosocial burden of SCD on patients have been rarely reported in Africa. We used a quantitative method, with face-to-face administered questionnaires, to study indices of psychosocial stressors on adult SCD patients in Cameroon. The questionnaire included a 36-item stress factors scale evaluating general perceptions of stress and five main stressors' domain: disease factors, hospital factors, financial factors, family factors and quality of personal-life factors. Items pertaining to psychosocial stressors involved four response options with increasing severity: 0, 1, 2 or 3. Non-parametric tests were used for analysis. The majority of the 83 participants were urban dwellers, female, 20-30 years old, single, unemployed, with at least a secondary or tertiary education. Median age at diagnosis was 100 months; 47.8% had >3 painful vaso-oclusive crises annually. Only 4.8% had been treated with hydroxyurea. The majority reported moderate to severe difficulty coping with SCD. The "degree of clinical severity" category displayed the highest median score (2.0), while familial stressors showed the lowest (0.8). Being female, married, with low education level, an additional affected sibling and low direct income were significantly associated with specific stressors' categories. In Cameroon, there is an urgent need to implement policies that ensure affordable access to health-care and practices to reduce SCD morbidity and improve patients' quality of life.
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