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Ezenwosu OU, Olawepo JO, Lacroix-Willliamson LJ, Itanyi IU, Ogidi A, Onyeka TC, Gully M, Gregory M, Breeze JL, Ibemere S, Idemili-Aronu N, Molnar BE, Ezeanolue EE. Health education to promote knowledge about sickle cell disease and newborn screening in pregnant women: a community-based pilot study using the healthy beginning initiative. BMC Pregnancy Childbirth 2024; 24:321. [PMID: 38671412 PMCID: PMC11046861 DOI: 10.1186/s12884-024-06498-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Pregnancy presents a critical period for any maternal and child health intervention that may impact the health of the newborn. With low antenatal care attendance by pregnant women in health facilities in Nigeria, community-based programs could enable increased reach for health education about sickle cell disease (SCD) and newborn screening (NBS) among pregnant women. This pilot study aimed to assess the effect of education on the knowledge about SCD and NBS among pregnant women using the Healthy Beginning Initiative, a community-based framework. METHODS A pre-post study design was used to evaluate knowledge of SCD and NBS in a convenience sample of 89 consenting pregnant women from three communities. Participants were given surveys prior to and following completion of a health education session. McNemar's test was used to compare the proportion of participants with correct responses. The level of significance was taken as p < 0.05. RESULTS Compared to pre-test values, post-test values showed that participants understood that SCD is hereditary (93.3% vs. 69.7%), both parents must have at least one gene for someone to have SCD (98.9% vs. 77.5) and blood test is the right way to know if one has SCD (98.8% vs. 78.7%). Also, a large proportion of participants (post-test ~ 89.9%; compared to pre-test ~ 23.6%) understood that the chance of conceiving a child with SCD was 25% for a couple with the sickle cell trait (SCT). Knowledge of the possibility of diagnosing SCD shortly after birth was highly increased in the post test phase of the study when compared to the pre-test phase (93.3% vs. 43.9%, respectively). Concerning the overall knowledge scores, those with high level of knowledge significantly increase from 12.6% pretest to 87.4% posttest (p = 0.015). CONCLUSION The health education intervention was associated with significant improvement on almost all measures of SCD knowledge. Focused health education for pregnant women using community structures can improve knowledge of SCD and NBS.
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Affiliation(s)
- Osita U Ezenwosu
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria.
- Department of Pediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria.
| | - John O Olawepo
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Lorraine J Lacroix-Willliamson
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Ijeoma U Itanyi
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Amaka Ogidi
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
| | - Tonia C Onyeka
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
- Department of Anesthesia/Pain & Palliative Care Unit, University of Nigeria, Enugu, Nigeria
| | - Madeline Gully
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Maisha Gregory
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, USA
| | - Janis L Breeze
- Tufts Clinical and Translational Science Institute, Institute for Clinical Research and Health Policy Studies, Tufts University, Tufts Medical Center, Boston, MA, USA
| | - Stephanie Ibemere
- Duke University School of Nursing, Duke Global Health Institute, Durham, NC, USA
| | - Ngozi Idemili-Aronu
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
| | - Beth E Molnar
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Echezona E Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
- Healthy Sunrise Foundation, Las Vegas, NV, USA
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Ally M, Balandya E. Current challenges and new approaches to implementing optimal management of sickle cell disease in sub-Saharan Africa. Semin Hematol 2023; 60:192-199. [PMID: 37730472 PMCID: PMC10909340 DOI: 10.1053/j.seminhematol.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/01/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
Sickle cell disease (SCD) is the most common life-threatening monogenic disorder in the world. The disease is highly prevalent in malaria endemic areas with over 75% of patients residing in Sub-Saharan Africa (SSA). It is estimated that, without proper care, up to 90% of children with SCD will not celebrate their fifth birthday. Early identification and enrolment into comprehensive care has been shown to reduce the morbidity and mortality related with SCD complications. However, due to resource constraints, the SSA is yet to implement universal newborn screening programs for SCD. Furthermore, care for patients with SCD in the region is hampered by the shortage of qualified healthcare workers, lack of guidelines for the clinical management of SCD, limited infrastructure for inpatient and outpatient care, and limited access to blood and disease modifying drugs such as Hydroxyurea which contribute to poor clinical outcomes. Curative options such as bone marrow transplant and gene therapy are expensive and not available in many SSA countries. In addressing these challenges, various initiatives are ongoing in SSA which aim to enhance awareness on SCD, improve patient identification and retention to care, harmonize the standards of care for SCD, improve the skills of healthcare workers and conduct research on pertinent areas in SCD in the SSA context. Fortifying these measures is paramount to improving the outcomes of SCD in SSA.
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Affiliation(s)
- Mwashungi Ally
- Sickle Pan African Research Consortium, Tanzania site Sickle Cell Program Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania.
| | - Emmanuel Balandya
- Sickle Pan African Research Consortium, Tanzania site Sickle Cell Program Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
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Tutuba HJ, Jonathan A, Lloyd W, Masamu U, Marco E, Makani J, Ruggajo P, Kidenya BR, Minja IK, Balandya E. The efficacy of maternal health education and maternal screening on knowledge and the uptake of infant screening for sickle cell disease in Dar-Es-Salaam, Tanzania; a quasi experimental study. BMC Public Health 2023; 23:70. [PMID: 36627609 PMCID: PMC9832626 DOI: 10.1186/s12889-022-14859-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Globally, Sickle cell disease (SCD) is one of the most common genetic disease with high childhood mortality. Early identification of babies with SCD through newborn screening (NBS) and linking them to care are among the recommended interventions. The purpose of this study was to assess the efficacy of maternal health education and maternal screening for SCD on knowledge and the uptake of infant screening for SCD among mother-infant pairs attending antenatal clinics at Government health facilities in Dar-es-salaam, Tanzania. METHODS: This study was a pre-test post-test, quasi-experimental which involved pregnant women attending antenatal clinics at three hospitals; Mbagala hospital, Sinza hospital and Buguruni health center in Dar Es Salaam. A structured questionnaire was used in data collection. Knowledge on SCD was assessed for all participants before and after two sessions of health education. Participants in Mbagala and Buguruni were also screened for SCD using Sickle SCAN point-of-care test (BioMedomics Inc, USA). The efficacy for health education intervention was computed as the post-intervention minus baseline knowledge score. For proportions, a two-sample z-test was used. Univariate and multivariate logistic regression were used to analyze the efficacy of health education intervention and also predictors of infant diagnosis. RESULTS: For two sessions of health education intervention, a total of 467 pregnant women completed the sessions. During antenatal visits, a total of 218 were screened for SCD. The proportion of participants with good knowledge of SCD had significantly increased to 85.9% from 12.4% at baseline following the education intervention. In multivariate analysis, sharing the received education on SCD was an independent predictor of the efficacy of health education intervention. Maternal occupation, maternal SCD status as well as sharing the received education on SCD were independent predictors of the uptake of SCD infant diagnosis. CONCLUSION This study has demonstrated that maternal health education and maternal screening for SCD are feasible and efficacious interventions in raising knowledge and improving the uptake of infant diagnosis for SCD. These interventions are strongly recommended to be included in the comprehensive care package for pregnant women attending antenatal clinics, particularly in areas with a high burden of SCD.
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Affiliation(s)
- Hilda J. Tutuba
- Sickle Pan-African Research Consortium (SPARCO), Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Hematology and Blood Transfusion, Sickle Cell Program, MUHAS, Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Physiology, MUHAS, Dar-Es-Salaam, Tanzania
| | - Agnes Jonathan
- Sickle Pan-African Research Consortium (SPARCO), Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Hematology and Blood Transfusion, Sickle Cell Program, MUHAS, Dar-Es-Salaam, Tanzania
| | - William Lloyd
- grid.25867.3e0000 0001 1481 7466Department of Hematology and Blood Transfusion, Sickle Cell Program, MUHAS, Dar-Es-Salaam, Tanzania
| | - Upendo Masamu
- grid.25867.3e0000 0001 1481 7466Department of Hematology and Blood Transfusion, Sickle Cell Program, MUHAS, Dar-Es-Salaam, Tanzania
| | - Emanuela Marco
- grid.25867.3e0000 0001 1481 7466Department of Hematology and Blood Transfusion, Sickle Cell Program, MUHAS, Dar-Es-Salaam, Tanzania
| | - Julie Makani
- Sickle Pan-African Research Consortium (SPARCO), Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Hematology and Blood Transfusion, Sickle Cell Program, MUHAS, Dar-Es-Salaam, Tanzania
| | - Paschal Ruggajo
- Sickle Pan-African Research Consortium (SPARCO), Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Internal Medicine, MUHAS, Dar-Es-Salaam, Tanzania
| | - Benson R. Kidenya
- Sickle Pan-African Research Consortium (SPARCO), Dar-Es-Salaam, Tanzania ,grid.411961.a0000 0004 0451 3858Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences- Bugando, Mwanza, Tanzania
| | - Irene K. Minja
- Sickle Pan-African Research Consortium (SPARCO), Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Internal Medicine, MUHAS, Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Restorative Dentistry, MUHAS, Dar-Es-Salaam, Tanzania
| | - Emmanuel Balandya
- Sickle Pan-African Research Consortium (SPARCO), Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Physiology, MUHAS, Dar-Es-Salaam, Tanzania
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Al-Shroby WA, Sulimani SM, Alhurishi SA, Bin Dayel ME, Alsanie NA, Alhraiwil NJ. Awareness of Premarital Screening and Genetic Counseling among Saudis and its Association with Sociodemographic Factors: a National Study. J Multidiscip Healthc 2021; 14:389-399. [PMID: 33628031 PMCID: PMC7898212 DOI: 10.2147/jmdh.s296221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background Premarital screening and genetic counseling (PMSGC) is compulsory in Saudi Arabia and aims to identify and decrease the prevalence of some genetic and sexually transmitted infectious diseases. However, there are little data on community awareness about PMSGC. This study assessed knowledge levels, attitudes, and behaviors associated with PMSGC in the general Saudi Arabian population and their associations with sociodemographic characteristics. Methods This was a cross-sectional, population-based study of 6263 participants randomly selected from all 20 health regions in Saudi Arabia, stratified according to age and fulfilling predefined selection criteria. Trained data collectors used a comprehensive pretested questionnaire to collect data. Data were collected in March and April 2019. Univariable and multivariable associations between sociodemographic characteristics and knowledge levels, attitudes, and behaviors were examined. Results While all 6263 study participants had heard about PMSGC, only 575 (9.2%) participants had satisfactory knowledge, while 3283 (52.4%) participants had fair knowledge. Predictors of high knowledge scores were university or higher education level (aOR=2.06; 95% CI: 1.80–2.36), positive medical history of PMSGC-screened disease (aOR=2.02; 95% CI: 1.51–2.69), family income ≥3000 SR/month (aOR=1.70; 95% CI: 1.50–1.93), being married/previously married (aOR=1.46; 95% CI: 1.25–1.70), female gender (aOR=1.25; 95% CI: 1.12–1.40), and age >18 years (aOR=1.25; 95% CI: 1.06–1.48). The majority of participants (5246, 83.8%) had positive attitudes towards the importance of PMSGC, the burden of screened genetic and infectious diseases on the family, and that marrying was inadvisable with incompatible results. Of the 3986 engaged or married participants, 2911 (73.0%) had undertaken premarital screening, of whom 360 (12.4%) had incompatible results; 98 (37.1%) married despite this information. Conclusion Despite advances in public healthcare measures in Saudi Arabia, gaps remain in the knowledge, beliefs, and behaviors associated with PMSGC. Culturally specific community health education programs for PMSGC must be devised that emphasize the risks associated with consanguineous marriage.
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Affiliation(s)
- Walid A Al-Shroby
- Evaluation & Impact Measurement Unit, Deputyship of Public Health, Ministry of Health, Kingdom of Saudi Arabia, Riyadh, Saudi Arabia.,Public Health & Community Medicine Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Suha M Sulimani
- Healthy Marriage Program, Deputyship of Public Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Sultana A Alhurishi
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Maram E Bin Dayel
- Evaluation & Impact Measurement Unit, Deputyship of Public Health, Ministry of Health, Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
| | - Nora A Alsanie
- Healthy Marriage Program, Deputyship of Public Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Najla J Alhraiwil
- Evaluation & Impact Measurement Unit, Deputyship of Public Health, Ministry of Health, Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
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