Newborn screening for sickle cell disease in India: the need for defining optimal clinical care

Dental tissues of sickle cell anemia and its impact on the quality of life related to oral health

OBJECTIVE

The aim of this study was to determine the association between dental tissues and sickle cell anemia (SCA) and how it impacts the quality of life related to oral health.

MATERIALS AND METHODS

It was a cohort study of 154 Congolese participants with and without SCA conducted in the dental service of SCA at the Yolo Center, Kinshasa, aged at least 6 years and without a history of clinically severe conditions (hospitalization and blood transfusion), who were regularly monitored. The inclusion criteria were the diagnosis confirmation of SCA at the health service in a period of at least 6 months before enrollment in this study. Dental tissues were assessed by a clinical examination using a dental mirror and probe. The index of Decayed-Missing-Filled Teeth (DMFT) was used to assess the dental state of the participants. For Oral Health-related Quality of Life (OHrQoL), the Congolese versions of the perception questionnaires, modified from the Oral Health Impacts Profile (OHIP-23), were used for participants. Each question had to be answered by yes or no, depending on whether the participant was satisfied (outcome = 1) or dissatisfied (outcome = 0) about an oral health-related quality of life.

RESULTS

Of the 154 participants, aged from 6 to 64 years, with a mean age of 19.5 ± 7 (SD) years, 96 presented with SCA and only 68 were correctly followed; 102 did not present SCA and only 86 were correctly followed. The DMFT and dmft indexes were higher in the SCA group, being 2.9 and 2.5, respectively. The difference between the SCA group and the control group was significant for decayed teeth, missing teeth, filled teeth and no caries. Of the different dimensions of quality of life that were compared between the SCA group and control group, 15 of 23 items were statistically significant.

CONCLUSION

The present study strongly confirmed an association between dental caries and missing teeth with sickle cell anemia. Secondly, the quality of life for SCA participants seems to be poor, compared to the control group.

Evolving locally appropriate models of care for indian sickle cell disease

The sickle cell gene in India represents a separate occurrence of the HbS mutations from those in Africa. Sickle cell disease in India occurs against different genetic and environmental backgrounds from those seen in African patients and there is evidence of clinical differences between the populations. Knowledge of the clinical features of African disease was drawn from the Jamaican Cohort Study, based on prospective follow up of all cases of sickle cell disease detected by the screening of 100,000 consecutive newborns in Kingston, Jamaica, and supplemented by observations from the Cooperative Study of Sickle Cell Disease in the US. Defining the principal causes of early morbidity in African sickle cell disease led to successful interventions including pneumococcal prophylaxis, parental education in the early diagnosis of acute splenic sequestration, and the early detection by trans-cranial Doppler of cerebral vessel stenosis predictive of stroke but their success depended on early diagnosis, ideally at birth. Although reducing mortality among patients with African forms of SS disease, the question remains whether these interventions are appropriate or justified in Indian patients. This dilemma is approached by comparing the available data in African and Indian forms of SS disease seeking to highlight the similarities and differences and to identify the deficiencies in knowledge of Indian disease. These deficiencies could be most readily addressed by cohort studies based on newborn screening and since much of the morbidity of African disease occurs in the first five years of life, these need not be a daunting prospect for Indian health care personnel. Newborn screening programmes for sickle cell disease are already underway in India and appropriate protocols and therapeutic trials could quickly answer many of these questions. Without this knowledge, Indian physicians may continue to use possibly unnecessary and expensive models of care.

Caries prevalence and impact on oral health-related quality of life in children with sickle cell disease: cross-sectional study

BACKGROUND

Children with sickle cell disease (SCD) may present oral conditions that can compromise children's health even more. However, there is still no consensus on the association between SCD and dental caries. The aim of this study was to assess caries prevalence in children with sickle cell disease (SCD), and the association of dental caries with socioeconomic factors, disease severity, and oral-health related to quality of life (OHRQoL).

METHODS

The sample was comprised of 106 children with SCD aged 8 to 14 years who were attending the Center for Hematology (Hemominas) in Belo Horizonte, Brazil. They were matched to 385 healthy peers. Data collection included interviews with guardians concerning SCD characteristics, and previous social and oral examinations to determine the caries prevalence. Caries prevalence as measured through the Decayed, Missing and Filled (dmft and DMFT) indices. OHRQoL was evaluated through the Brazilian versions of the Child Perceptions Questionnaires (CPQ8-10, and CPQ11-14 short-form version). Statistical analyses were performed using the chi-square test or Fisher`s exact test and the Mann Whitney test, as well as linear regression.

RESULTS

The DMFT index was 1.3 (SD: 2.1) in younger children with SCD and 1.5 (SD: 1.9) in SCD teens. Younger children with SCD had lower caries experience compared to healthy peers (p = .03). The experience of dental caries among teens with SCD was similar to healthy peers (p > 0.05). In addition, we did not see a significant difference on the mean overall scores of CPQ8-10 between SCD younger children and controls. There was no statistically significant difference in the mean overall scores of teens CPQ11-14 between SCD and the control group. Socioeconomic variables were not associated with dental caries in the participants with SCD. However, SCD severity was associated with higher DMFT indexes (p < 0.05).

CONCLUSIONS

Younger children with SCD had a low experience of dental caries. The dental caries experience in teenagers with SCD was similar to their healthy peers. OHRQoL was similar between SCD participants and controls.

Newborn screening for sickle cell disease: technical and legal aspects of a German pilot study with 38,220 participants

Sickle cell disease (SCD) does not occur in the indigenous German population, but with the increasing number of immigrants from countries at high risk for hemoglobinopathies, the question emerges whether or not a newborn screening program (NBS) for SCD disease should be initiated in Germany anyhow. We have recently shown that in Berlin, a city with a very large immigrant population, the incidence of SCD is considerable, but our findings are insufficient to make a decision for the country as a whole. In this paper we will show that a large body of epidemiological data can be generated in a relatively short period of time, with a very high degree of precision and at relatively little expense--a result that might motivate other working groups to start such a pilot project locally. We examined previously collected dried blood cards that were up to six months old, using high performance liquid chromatography (HPLC) as first method and capillary electrophoresis (CE) as second method. A single, part-time laboratory technician processed 38,220 samples in a period of 162 working days. The total costs per sample including all incidentals (as well as labor costs) were EUR 1.44.