1
|
Chang MM, Natoli ME, Wilkinson AF, Tubman VN, Airewele GE, Richards-Kortum RR. A multiplexed, allele-specific recombinase polymerase amplification assay with lateral flow readout for sickle cell disease detection. LAB ON A CHIP 2024; 24:4115-4127. [PMID: 39051493 PMCID: PMC11334763 DOI: 10.1039/d4lc00281d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/17/2024] [Indexed: 07/27/2024]
Abstract
Isothermal nucleic acid amplification tests have the potential to improve disease diagnosis at the point of care, but it remains challenging to develop multiplexed tests that can detect ≥3 targets or to detect point mutations that may cause disease. These capabilities are critical to enabling informed clinical decision-making for many applications, such as sickle cell disease (SCD). To address this, we describe the development of a multiplexed allele-specific recombinase polymerase amplification (RPA) assay with lateral flow readout. We first characterize the specificity of RPA using primer design strategies employed in PCR to achieve point mutation detection, and demonstrate the utility of these strategies in achieving selective isothermal amplification and detection of genomic DNA encoding for the healthy βA globin allele, or genomic DNA containing point mutations encoding for pathologic βS and βC globin alleles, which are responsible for most sickle cell disorders. We then optimize reaction conditions to achieve multiplexed amplification and identification of the three alleles in a single reaction. Finally, we perform a small pilot study with 20 extracted genomic DNA samples from SCD patients and healthy volunteers - of the 13 samples with valid results, the assay demonstrated 100% sensitivity and 100% specificity for detecting pathologic alleles, and an overall accuracy of 92.3% for genotype prediction. This multiplexed assay is rapid, minimally instrumented, and when combined with point-of-care sample preparation, could enable DNA-based diagnosis of SCD in low-resource settings. The strategies reported here could be applied to other challenges, such as detection of mutations that confer drug resistance.
Collapse
Affiliation(s)
- Megan M Chang
- Department of Bioengineering, Rice University, Houston, TX, USA.
| | - Mary E Natoli
- Department of Bioengineering, Rice University, Houston, TX, USA.
| | | | - Venée N Tubman
- Texas Children's Cancer and Hematology Centers, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Gladstone E Airewele
- Texas Children's Cancer and Hematology Centers, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | | |
Collapse
|
2
|
Mano RM, Kuona P, Misihairabgwi JM. Determination of birth prevalence of sickle cell disease using point of care test HemotypeSC™ at Rundu Hospital, Namibia. BMC Pediatr 2024; 24:323. [PMID: 38730340 PMCID: PMC11084002 DOI: 10.1186/s12887-024-04805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD), a noncommunicable disease, has the greatest burden in sub-Saharan Africa. The majority of children (50-90%) with SCD die before their 5th birthday, with approximately 150,000-300,000 annual SCD child deaths in Africa. In developed countries, newborn screening (NBS) has been shown to improve the survival of children with sickle cell disease, with under5 childhood mortality reduced tenfold due to interventions performed before the development of complications. Point -of-care tests have been developed for resource limited settings to expand NBS. The aim of this study was to determine the birth prevalence of sickle cell disease in Namibia using the HemoTypeSC™ point-of-care test. METHODS A cross-sectional descriptive study was carried out at Rundu Intermediate Hospital in the Kavango East Region. Two hundred and two (202) well newborns within 72 h of birth were recruited for the study from 22 February to the 23th March 2023. Descriptive statistics were used to compute the haemoglobin types of the study participants. RESULTS The majority of the participants (n = 105, 52%) were females, and (n = 97,48%) were males. The median age of the participants was 23 h (Q1, Q3; 11; 33),) with an age range of 2-98 h. Sickle cell trait was present in 9.4% of the screened newborns, no homozygous disease was detected, and 90.6% had Hb AA. CONCLUSIONS This study is the first to measure HbS gene carriage at birth using HemotypeSC point-of-care testing in Namibia. There was a moderate prevalence of sickle cell traits but no SCD. This baseline study may provide the foundation for larger epidemiological surveys to map HbS gene carriage in Namibia to provide evidence for policy makers to fashion appropriate SCD newborn screening services.
Collapse
Affiliation(s)
- Runyararo Mashingaidze Mano
- Department of Maternal & Child Health, Division of Paediatrics, School of Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia Hage Geingob Campus, Bach Street, Windhoek, Namibia.
| | - Patience Kuona
- Department of Child, Adolescent and Women's Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jane Masiiwa Misihairabgwi
- Department of Human, Biological and Translational Medical Sciences, School of Medicine, University of Namibia Faculty of Health Sciences & Veterinary Medicine, Windhoek, Namibia
| |
Collapse
|
3
|
O'Brien NF, Moons P, Johnson H, Tshimanga T, Musungufu DA, Ekandji RT, Mbaka JP, Babatila LK, Mayindombe L, Giresse B, Mwanza S, Lupumpaula C, Chilima JS, Nanyangwe A, Kabemba P, Kafula LN, Phiri T, June S, Gushu MB, Chagaluka G, Chunda‐Liyoka CM. Transcranial Doppler ultrasound velocities in a population of unstudied African children with sickle cell anemia. EJHAEM 2024; 5:3-10. [PMID: 38406536 PMCID: PMC10887331 DOI: 10.1002/jha2.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/09/2023] [Accepted: 10/16/2023] [Indexed: 02/27/2024]
Abstract
The greatest burden of sickle cell anemia (SCA) globally occurs in sub-Saharan Africa, where significant morbidity and mortality occur secondary to SCA-induced vasculopathy and stroke. Transcranial Doppler ultrasound (TCD) can grade the severity of vasculopathy, with disease modifying therapy resulting in stroke reduction in high-risk children. However, TCD utilization for vasculopathy detection in African children with SCA remains understudied. The objective was to perform a prospective, observational study of TCD findings in a cohort of children with SCA from the Democratic Republic of the Congo, Zambia, and Malawi. A total of 770 children aged 2-17 years without prior stroke underwent screening TCD. A study was scored as low risk when the time-averaged maximum of the mean (TAMMX) in the middle cerebral artery or terminal internal carotid artery was <170 cm/s but >50 cm/s, conditional risk when 170-200 cm/s, and high risk when >200 cm/s. Low-risk studies were identified in 604 children (78%), conditional risk in 129 children (17%), and high risk in three children (0.4%). Additionally, 34 (4%) were scored as having an unknown risk study (TAMMX <50 cm/s). Over the course of 15 months of follow-up, 17 children (2.2%) developed new neurologic symptoms (six with low-risk studies, seven with conditional risk, and four with unknown risk). African children with SCA in this cohort had a low rate of high-risk TCD screening results, even in those who developed new neurologic symptoms. Stroke in this population may be multifactorial with vasculopathy representing only one determinant. The development of a sensitive stroke prediction bundle incorporating relevant elements may help to guide preventative therapies in high-risk children.
Collapse
Affiliation(s)
- Nicole F. O'Brien
- Department of PediatricsDivision of Critical Care MedicineNationwide Children's Hospital, The Ohio State UniversityColumbusOhioUSA
| | - Peter Moons
- Department of Pediatrics and Child HealthKamuzu University of Health SciencesBlantyreMalawi
| | - Hunter Johnson
- Department of PediatricsDivision of Critical Care MedicineNationwide Children's Hospital, The Ohio State UniversityColumbusOhioUSA
| | - Taty Tshimanga
- Departement de PediatrieCliniques Universitaires de Kinshasa, Hopital Pediatrique de Kalembe Lembe, Universite De KinshasaKimwenzaLembeRepublique Democratic du Congo
| | | | - Robert Tandjeka Ekandji
- Universite des Sciences et des Technologie de Lodja, L'Hopital General de Reference de Lodja, Sankuru DistrictLodjaRepublique Democratic du Congo
| | - Jean Pongo Mbaka
- Universite des Sciences et des Technologie de Lodja, L'Hopital General de Reference de Lodja, Sankuru DistrictLodjaRepublique Democratic du Congo
| | - Lydia Kuseyila Babatila
- Departement de PediatrieCliniques Universitaires de Kinshasa, Hopital Pediatrique de Kalembe Lembe, Universite De KinshasaKimwenzaLembeRepublique Democratic du Congo
| | - Ludovic Mayindombe
- Departement de PediatrieCliniques Universitaires de Kinshasa, Hopital Pediatrique de Kalembe Lembe, Universite De KinshasaKimwenzaLembeRepublique Democratic du Congo
| | - Buba Giresse
- Departement de PediatrieCliniques Universitaires de Kinshasa, Hopital Pediatrique de Kalembe Lembe, Universite De KinshasaKimwenzaLembeRepublique Democratic du Congo
| | - Suzanna Mwanza
- Department of PaediatricsChipata Central HospitalChipataZambia
| | | | | | - Alice Nanyangwe
- University Teaching Hospitals—Children's HospitalLusakaZambia
| | - Peter Kabemba
- University Teaching Hospitals—Children's HospitalLusakaZambia
| | | | - Tusekile Phiri
- Queen Elizabeth Central Hospital, The Blantyre Malaria Project, ChichiriBlantyreMalawi
| | - Sylvester June
- Queen Elizabeth Central Hospital, The Blantyre Malaria Project, ChichiriBlantyreMalawi
| | | | - George Chagaluka
- Department of Pediatrics and Child HealthKamuzu University of Health SciencesBlantyreMalawi
| | | |
Collapse
|
4
|
Guindo A, Cisse Z, Keita I, Desmonde S, Sarro YDS, Touré BA, Baraika MA, Tessougué O, Guindo P, Coulibaly M, Traore O, Sylla N, Diassana M, Saye A, Picot V, Lauressergues E, Leroy V. Potential for a large-scale newborn screening strategy for sickle cell disease in Mali: A comparative diagnostic performance study of two rapid diagnostic tests (SickleScan® and HemotypeSC®) on cord blood. Br J Haematol 2024; 204:337-345. [PMID: 37728227 DOI: 10.1111/bjh.19108] [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: 04/26/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
Sickle cell disease (SCD) is a life-threatening disease requiring reliable early diagnosis. We assessed the acceptability and diagnostic performances of two rapid diagnostic tests (RDTs) to identify SCD (HbSS, HbSC, HbS/β-thalassaemia) or SCD carrier (HbS/HbC) in a pilot SCD newborn screening (NBS) strategy in Mali. All consenting delivering women were offered SCD NBS using cord blood sampling on two RDTs (SickleScan® and HemotypeSC®) compared to the high-performance liquid chromatography (HPLC) gold standard to detect SCD states. From April 2021 to August 2021, 4333 delivering women were eligible of whom 96.1% were offered NBS: 1.6% refused, 13.8% delivered before consenting and 84.6% consented; 3648 newborns were diagnosed by HPLC; 1.64% had SCD (0.63% HbSS, 0.85% HbSC, 0.16 HbS/β-plus-thalassaemia); 21.79% were SCD carrier. To detect accurately SCD, SickleScan® had a sensitivity of 81.67% (95% confidence interval [CI]: 71.88-91.46) and a negative predictive value (NPV) of 99.69% (95% CI: 99.51-99.87); HemotypeSC® had a sensitivity of 78.33% (95% CI: 67.91-88.76) and a NPV of 99.64% (95% CI: 99.44-99.83). To detect SCD carrier: SickleScan® sensitivity was 96.10% (95% CI: 94.75-97.45) and NPV, 98.90% (95% CI: 98.51-99.29); HemotypeSC® sensitivity was 95.22% (95% CI: 93.74-96.70) and NPV, 98.66% (95% CI: 98.24-99.03). Routine SCD NBS was acceptable. Compared with HPLC, both RDTs had reliable diagnostic performances to exclude SCD-free newborns and to identify SCD carriers to be further confirmed. This strategy could be implemented in large-scale NBS programmes.
Collapse
Affiliation(s)
- Aldiouma Guindo
- Centre de Recherche et Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - Zenab Cisse
- CERPOP, UMR 1295, INSERM, Université Toulouse 3, Toulouse, France
| | - Ibrahima Keita
- Centre de Recherche et Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - Sophie Desmonde
- CERPOP, UMR 1295, INSERM, Université Toulouse 3, Toulouse, France
| | | | - Boubacari A Touré
- Centre de Recherche et Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - Mohamed Ag Baraika
- Centre de Recherche et Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - Oumarou Tessougué
- Centre de Recherche et Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - Pierre Guindo
- Centre de Recherche et Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - Moussa Coulibaly
- Centre de Recherche et Lutte contre la Drépanocytose (CRLD), Bamako, Mali
| | - Oumar Traore
- Centre de santé de Reference de la commune 5 (CsREF-CV), Bamako, Mali
| | - Niagalé Sylla
- Centre de santé de Reference de la commune 5 (CsREF-CV), Bamako, Mali
| | - Mahamadou Diassana
- Service de Gynécologie et Obstétrique, Hopital Fousseyni Daou de Kayes, Kayes, Mali
| | - Amaguiré Saye
- Centre de santé de Reference de la commune 4 (CsREF-CIV), Bamako, Mali
| | | | | | - Valériane Leroy
- CERPOP, UMR 1295, INSERM, Université Toulouse 3, Toulouse, France
| |
Collapse
|
5
|
Kambale‐Kombi P, Djang'eing'a RM, Alworong'a Opara J, Minon J, Sepulchre E, Bours V, Floch A, Pirenne F, Tshilumba CK, Batina‐Agasa S. Red blood cell alloimmunisation in sickle cell disease patients in the
Democratic Republic of the Congo. Transfus Med 2022; 33:137-146. [PMID: 36377544 DOI: 10.1111/tme.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/25/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the prevalence of red blood cell (RBC) alloimmunisation and alloantibody specificity in sickle cell disease (SCD) patients in Kisangani, Democratic Republic of Congo (DRC) in comparison with those followed at the Centre Hospitalier Régional (CHR) de la Citadelle of Liège (Belgium). BACKGROUND Data regarding RBC alloimmunisation (immune response of the organism to foreign erythrocyte antigens, antigens that lack on its own RBC) in SCD patients are scarce in sub-Saharan Africa. METHODS We conducted a multi-site-based cross-sectional study among 125 SCD patients at Kisangani and 136 at the CHR de la Citadelle of Liège. The diagnosis of SCD was confirmed by high-performance liquid chromatography. Alloantibodies were screened using the agglutination technique on gel cards and their specificity determined using 11 and/or 16 cell panels. Statistical analyses were carried out using SPSS. RESULTS The prevalence of RBC alloimmunisation was 9.6% among SCD patients in Kisangani versus 22.8% in those of Liège. At Kisangani as well as at Liège, the median age of alloimmunised patients was higher than that of non-alloimmunised patients, 15.5 years (IQR:4.8-19.8) and 24 years (IQR:14-31) versus 10 years (IQR: 6.5-17) and 17 years (IQR:12-24), respectively. The median number of blood units was higher in both Kisangani and Liège immunised patients compared to non-immunised patients, 8 (IQR:5-11) versus 5 (IQR:3-13) and 41(IQR:6-93) versus 6.5(3-37) respectively. At Kisangani (N = 14), the most frequent antibodies were anti-D (28.6%) and anti-C versus anti-E (13.6%), anti-S (13.6%) and anti-Lea (11.4%) at Liège (N = 44). CONCLUSIONS These findings stated that alloimmunisation is a common complication in SCD patients in the DRC. In the resource-limited setting of this country, blood transfusion with minimal ABO, D, C and E antigen matching in addition to the use of compatibility test could significantly reduce the incidence of this complication.
Collapse
Affiliation(s)
- Paul Kambale‐Kombi
- Département de Médecine interne, Faculté de Médecine et de Pharmacie Université de Kisangani Kisangani Democratic Republic of the Congo
| | - Roland Marini Djang'eing'a
- Département des Sciences Pharmaceutiques, Laboratoire de chimie analytique, Faculté de Médecine Université de Liège Liège Belgium
| | - Jean‐Pierre Alworong'a Opara
- Département de Pédiatrie, Faculté de Médecine et de Pharmacie Université de Kisangani Kisangani Democratic Republic of the Congo
| | - Jean‐Marc Minon
- Département de Thrombose‐hémostase et Transfusion Centre Hospitalier Régional de la Citadelle Liège Belgium
| | - Edith Sepulchre
- Département de Thrombose‐hémostase et Transfusion Centre Hospitalier Régional de la Citadelle Liège Belgium
| | - Vincent Bours
- Département de Génétique Humaine, Faculté de Médecine Université de Liège Liège Belgium
| | - Aline Floch
- Etablissement français du sang(EFS) Ile‐de‐France Créteil France
- Univ Paris Est Créteil, INSERM U955 Equipe 2 « Transfusion et maladies du globule », IMRB Créteil France
| | - France Pirenne
- Etablissement français du sang(EFS) Ile‐de‐France Créteil France
- Univ Paris Est Créteil, INSERM U955 Equipe 2 « Transfusion et maladies du globule », IMRB Créteil France
| | - Charles Kayembe Tshilumba
- Département de Médecine interne, Faculté de Médecine et de Pharmacie Université de Kisangani Kisangani Democratic Republic of the Congo
| | - Salomon Batina‐Agasa
- Département de Médecine interne, Faculté de Médecine et de Pharmacie Université de Kisangani Kisangani Democratic Republic of the Congo
| |
Collapse
|
6
|
Egesa WI, Nakalema G, Waibi WM, Turyasiima M, Amuje E, Kiconco G, Odoch S, Kumbakulu PK, Abdirashid S, Asiimwe D. Sickle Cell Disease in Children and Adolescents: A Review of the Historical, Clinical, and Public Health Perspective of Sub-Saharan Africa and Beyond. Int J Pediatr 2022; 2022:3885979. [PMID: 36254264 PMCID: PMC9569228 DOI: 10.1155/2022/3885979] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
Sickle cell disease (SCD) is an umbrella term for a group of life-long debilitating autosomal recessive disorders that are caused by a single-point mutation (Glu→Val) that results in polymerization of hemoglobin (Hb) and reversible sickle-shape deformation of erythrocytes. This leads to increased hemolysis of erythrocytes and microvascular occlusion, ischemia-reperfusion injury, and tissue infarction, ultimately causing multisystem end-organ complications. Sickle cell anemia (HbSS) is the most common and most severe genotype of SCD, followed by HbSC, HbSβ 0thalassemia, HbSβ+thalassemia, and rare and benign genotypes. Clinical manifestations of SCD occur early in life, are variable, and are modified by several genetic and environmental factors. Nearly 500 children with SCD continue to die prematurely every day, due to delayed diagnosis and/or lack of access to comprehensive care in sub-Saharan Africa (SSA), a trend that needs to be urgently reversed. Despite proven efficacy in developed countries, newborn screening programs are not universal in SSA. This calls for a consolidated effort to make this possible, through the use of rapid, accurate, and cheap point-of-care test kits which require minimal training. For almost two decades, hydroxyurea (hydroxycarbamide), a century-old drug, was the only disease-modifying therapy approved by the U.S. Food and Drug Administration. Recently, the list expanded to L-glutamine, crizanlizumab, and voxelotor, with several promising novel therapies in the pipeline. Despite its several limitations, hematopoietic stem cell transplant (HSCT) remains the only curative intervention for SCD. Meanwhile, recent advances in gene therapy trials offer a glimpse of hope for the near future, although its use maybe limited to developed countries for several decades.
Collapse
Affiliation(s)
- Walufu Ivan Egesa
- Department of Pediatrics, Nile International Hospital, Jinja District, Uganda
- Department of Pediatrics & Child Health, Faculty of Clinical Medicine & Dentistry, Kampala International University, Bushenyi District, Uganda
| | - Gloria Nakalema
- Department of Pediatrics & Child Health, Faculty of Clinical Medicine & Dentistry, Kampala International University, Bushenyi District, Uganda
- Department of Pediatrics, Luweero Hospital, Luwero District, Uganda
| | - William M. Waibi
- Department of Pediatrics & Child Health, Faculty of Clinical Medicine & Dentistry, Kampala International University, Bushenyi District, Uganda
| | - Munanura Turyasiima
- Department of Pediatrics & Child Health, Faculty of Clinical Medicine & Dentistry, Kampala International University, Bushenyi District, Uganda
- Standards Compliance Accreditation and Patient Protection (SCAPP) Department, Governance and Regulation Directorate, Ministry of Health, Kampala, Uganda
| | - Emmanuel Amuje
- Department of Pediatrics, Nile International Hospital, Jinja District, Uganda
| | - Gloria Kiconco
- Department of Pediatrics & Child Health, Faculty of Clinical Medicine & Dentistry, Kampala International University, Bushenyi District, Uganda
- Department of Pediatrics, Fort Portal Regional Referral Hospital, Kabarole District, Uganda
| | - Simon Odoch
- Department of Pediatrics & Child Health, Faculty of Clinical Medicine & Dentistry, Kampala International University, Bushenyi District, Uganda
| | - Patrick Kumbowi Kumbakulu
- Department of Pediatrics & Child Health, Faculty of Clinical Medicine & Dentistry, Kampala International University, Bushenyi District, Uganda
| | - Said Abdirashid
- Department of Pediatrics & Child Health, Faculty of Clinical Medicine & Dentistry, Kampala International University, Bushenyi District, Uganda
| | - Daniel Asiimwe
- Department of Surgery, Faculty of Clinical Medicine & Dentistry, Kampala International University, Bushenyi District, Uganda
- Department of Surgery, Holy Family Virika hospital, Kabarole District, Uganda
| |
Collapse
|
7
|
Kawooya I, Kayongo E, Munube D, Mijumbi-Deve R, Elliott S, Vandermeer B, Sewankambo N. Point-of-care diagnostic tests for sickle cell disease. Hippokratia 2022. [DOI: 10.1002/14651858.cd014584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ismael Kawooya
- The Center for Rapid Evidence Synthesis; Makerere University, College of Health Sciences; Kampala Uganda
| | - Edward Kayongo
- Pharmacy Department; Case Western Reserve University Uganda Collaboration; Kampala Uganda
| | - Deogratias Munube
- Department of Paediatrics and Child Health; Makerere University, College of Health Sciences; Kampala Uganda
| | - Rhona Mijumbi-Deve
- Center for Rapid Evidence Synthesis; Makerere University, College of Health Sciences; Kampala Uganda
| | - Sarah Elliott
- Cochrane Child Health, Department of Pediatrics; University of Alberta; Edmonton Canada
| | - Ben Vandermeer
- Department of Pediatrics and the Alberta Research Centre for Health Evidence; University of Alberta; Edmonton Canada
| | - Nelson Sewankambo
- School of Medicine; Makerere University College of Health Sciences; Kampala Uganda
| |
Collapse
|
8
|
Ranque B, Kitenge R, Ndiaye DD, Ba MD, Adjoumani L, Traore H, Coulibaly C, Guindo A, Boidy K, Mbuyi D, Ly ID, Offredo L, Diallo DA, Tolo A, Kafando E, Tshilolo L, Diagne I. Estimating the risk of child mortality attributable to sickle cell anaemia in sub-Saharan Africa: a retrospective, multicentre, case-control study. THE LANCET HAEMATOLOGY 2022; 9:e208-e216. [DOI: 10.1016/s2352-3026(22)00004-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 12/13/2022]
|
9
|
Aimé AK, Etienne SM, Mbongi D, Nsonso D, Serrao E, Léon TMM, Oscar LN, Stanis WO. [HemoTypeSC screening for sickle cell disease in the Democratic Republic of Congo (DRC): a case from the city of Kindu]. Pan Afr Med J 2022; 41:134. [PMID: 35519159 PMCID: PMC9034557 DOI: 10.11604/pamj.2022.41.134.30187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/25/2021] [Indexed: 11/29/2022] Open
Abstract
Early detection of sickle cell disease is crucial to improve people's survival. Both financial and geographic accessibility to sickle cell disease tools are barriers to universal screening in developing countries. The purpose of this study was to determine the hospital prevalence of sickle cell disease and to assess the reliability of a rapid diagnostic tool, HemoTypeSC, in a resource-limited environment. We conducted a prospective cross-sectional descriptive study in the Department of Pediatrics of 5 health facilities in the city of Kindu, Maniema province, DRC, over a period of 10 months. The study consisted of HemoType SC rapid test screening for sickle cell disease and then diagnostic confirmation by hemoglobin electrophoresis. A total of 448 children less than 5 years of age were enrolled in the study. The overall hospital prevalence of patients with sickle cell disease was 31.9%, of whom 12.7% were homozygous (SS) and 19.2% trait carriers; the level of suspicion for sickle cell disease in hospitals was 6%; the clinical presumption regarding sickle cell disease was 8%; HemoType SC rapid test had good indicators of validity for the detection of hemoglobins A and S. The study shows that the hospital prevalence of major sickle cell disease is higher in children under 5 years of age with respect to clinical suspicion in the absence of laboratory tests. HemoTypeSC rapid test seems to be a reliable tool for the screening of the disease in the city of Kindu, a resource-limited environment.
Collapse
Affiliation(s)
- Abdala Kingwengwe Aimé
- Département de Pédiatrie, Faculté de Médecine, Université de Kindu, Kindu, République Démocratique du Congo
- Unité de Prévention et Contrôle des Maladies, Faculté de Médecine, Université de Kindu, Kindu, République Démocratique du Congo
- Département de Pédiatrie, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Shindano Mwamba Etienne
- Département de Pédiatrie, Faculté de Médecine, Université de Kindu, Kindu, République Démocratique du Congo
- Unité de Prévention et Contrôle des Maladies, Faculté de Médecine, Université de Kindu, Kindu, République Démocratique du Congo
| | - Destin Mbongi
- Centre Hospitalier Mère-Enfant de Monkole, Kinshasa, République Démocratique du Congo
| | - Didier Nsonso
- Centre Hospitalier Mère-Enfant de Monkole, Kinshasa, République Démocratique du Congo
| | - Erik Serrao
- Silver Lake Research Corporation, Azusa, California, United States of America
| | | | - Luboya Numbi Oscar
- Département de Pédiatrie, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Wembonyama Okitotsho Stanis
- Département de Pédiatrie, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| |
Collapse
|
10
|
Dexter D, McGann PT. The promise and role of point of care testing to reduce the global burden of sickle cell disease through early diagnosis and linkage to care. Br J Haematol 2021; 196:63-69. [PMID: 34340260 DOI: 10.1111/bjh.17678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/12/2021] [Indexed: 11/28/2022]
Abstract
Sickle cell disease (SCD) is a devastating and under-recognised global child health issue affecting over 300,000 infants annually, with the highest prevalence in India and sub-Saharan Africa. Most affected infants born in low- and middle-income countries (LMIC) lack access to SCD testing and die from complications in the first years of life without a formal diagnosis. The majority of deaths are preventable with early diagnosis and provision of inexpensive interventions. Despite global recognition of the urgent need, expansion of SCD newborn screening (NBS) programmes beyond the pilot stage has been obstructed by a dependence on an expensive and logistically challenging centralised laboratory testing model. Recently, several point-of-care tests (POCT) for SCD have been developed with promising field validation studies. Here, we summarise the state of POCT for SCD, review barriers and unanswered questions, and discuss optimal strategies for utilising POCT to address the growing global burden of SCD. There is an urgent need to prospectively evaluate the ability of POCT to reduce the morbidity and high early mortality of SCD. To impact a sustainable reduction to this end, it is essential to link a diagnosis with comprehensive SCD care, including wide and affordable access to affordable hydroxycarbamide therapy.
Collapse
Affiliation(s)
- Daniel Dexter
- Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare Trust, London, UK
| | - Patrick T McGann
- Division of Hematology and Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
11
|
Badawi M, Garoot S, Tahlawi M, Hindawi S, Adam S. Evaluation of a point-of-care method for screening blood donors for sickle cell status. Transfusion 2021; 60 Suppl 1:S10-S14. [PMID: 32134127 DOI: 10.1111/trf.15586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 10/12/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Turbidity tests are commonly used for screening blood units for the presence of sickle cell trait (SCT) before transfusion to specific patient populations, based on recommendations of the AABB. In this pilot study, we evaluate a new method for screening blood donors and blood units for the presence of sickle hemoglobin. STUDY DESIGN AND METHODS This study was based at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. Study participants were approached consecutively between July 24, 2016, and August 8, 2016. Blood donors, control individuals, and known patients with sickle cell disease (SCD) were tested using both a point-of-care testing technology (Sickle SCAN, Biomedomics, Inc.) and hemoglobin capillary electrophoresis (HEP). Corresponding blood units were also tested using Sickle SCAN. RESULTS A total of 200 donors, 13 blood units, and 57 patients and controls were included. Sensitivity and specificity of Sickle SCAN for detection of SCT and SCD was 100%, when compared to HEP as the gold standard. CONCLUSION Sickle SCAN is a rapid test that shows high sensitivity and specificity for identification of hemoglobin S among blood donors and when used for testing blood units.
Collapse
Affiliation(s)
- Maha Badawi
- Department of Hematology, King Abdulaziz University, Jeddah, Saudi Arabia.,King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | | | - Mofida Tahlawi
- King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Salwa Hindawi
- Department of Hematology, King Abdulaziz University, Jeddah, Saudi Arabia.,King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Soheir Adam
- Department of Hematology, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medicine, Duke University, Durham, North Carolina
| |
Collapse
|
12
|
Kambale-Kombi P, Marini Djang'eing'a R, Alworong'a Opara JP, Minon JM, Boemer F, Bours V, Tonen-Wolyec S, Kayembe Tshilumba C, Batina-Agasa S. Management of sickle cell disease: current practices and challenges in a northeastern region of the Democratic Republic of the Congo. ACTA ACUST UNITED AC 2021; 26:199-205. [PMID: 33594960 DOI: 10.1080/16078454.2021.1880752] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Democratic Republic of the Congo (DRC) is the third most affected country worldwide by sickle cell disease (SCD). However, this disease is still orphaned in the country; large-scale control actions are rare, and little is known about its management. OBJECTIVE To assess current practices in the management of SCD in Kisangani, DRC. METHODS This cross-sectional study was conducted in six health facilities in Kisangani. It involved 198 presumed sickle cell patients attending the above health facilities. The study focused on the sociodemographic and clinical data of the participants, obtained through a clinical examination and their medical records. Diagnostic confirmation of SCD was made by high-performance liquid chromatography coupled to mass spectrometry. Data were analyzed using SPSS 20.0. RESULTS The diagnosis of SCD was confirmed in 194 (98.0%; 95% CI: 94.9-99.2) participants, while it was not confirmed in 4 (2.0%; 95% CI: 0.8-5.1) participants. The diagnosis was mainly made by the Emmel test (42.9%). 45.8% of participants had previously been transfused with the blood of their parents. Folic acid was taken by 48.5% of participants and the previous intake of hydroxyurea was reported in 5.1% of participants. The participants vaccinated against Pneumococcus were 13.6% and against Haemophilus influenzae type b 28.3%. Penicillin prophylaxis was received by only 1.5% and malaria prophylaxis by 11.6% of participants. CONCLUSION Standard-care practices for SCD patients in Kisangani are insufficient. The Congolese government should regard this disease as a health priority and consider actions to improve its management.
Collapse
Affiliation(s)
- Paul Kambale-Kombi
- Faculty of Medicine and Pharmacy, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Roland Marini Djang'eing'a
- Faculty of Medicine and Pharmacy, University of Kisangani, Kisangani, Democratic Republic of the Congo.,Faculty of Medicine, University of Liège, Liège, Belgium
| | | | | | | | - Vincent Bours
- Faculty of Medicine, University of Liège, Liège, Belgium
| | - Serge Tonen-Wolyec
- Faculty of Medicine and Pharmacy, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Charles Kayembe Tshilumba
- Faculty of Medicine and Pharmacy, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Salomon Batina-Agasa
- Faculty of Medicine and Pharmacy, University of Kisangani, Kisangani, Democratic Republic of the Congo
| |
Collapse
|
13
|
Analytic Characteristics and Performance of Novel Immunoassay Point-of-Care Tests for Early Diagnosis of Sickle Cell Disease. POINT OF CARE 2020. [DOI: 10.1097/poc.0000000000000210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Mukinayi Mbiya B, Tumba Disashi G, Gulbis B. Sickle Cell Disease in the Democratic Republic of Congo: Assessing Physicians' Knowledge and Practices. Trop Med Infect Dis 2020; 5:tropicalmed5030127. [PMID: 32751148 PMCID: PMC7559132 DOI: 10.3390/tropicalmed5030127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 01/01/2023] Open
Abstract
Background: Sickle cell disease is a major public health issue in the Democratic Republic of Congo (DRC), but it is still poorly understood by health professionals. The objective of this study was to assess the knowledge and practices of Congolese physicians treating sickle cell disease (SCD), in order to identify the areas for improvement in clinical care. Methods: This was a descriptive observational study conducted among Congolese physicians using a questionnaire. Participants were evaluated using a pre-established answer grid. Results: A total of 460 physicians participated, including 81 women (18%), with an average age of 35 years (range 25–60 years). Most physicians were general practitioners. Although self-assessment of their level of knowledge on SCD was estimated as average to good, less than half of the participants (n = 460; 46%) reported adequate management of vaso-occlusive crises, and only 1% of them had received specific training on SCD. Most physicians reported difficulties both in terms of diagnostic (65%) and management (79%) options of SCD patients. This study also showed that 85% of these physicians did not have access to the diagnostic tools for SCD. Conclusions: Insufficient knowledge on SCD and poor diagnostic and treatment options might contribute to increased morbidity and mortality of patients living in the DRC. Interventions aiming to improve physicians’ knowledge, patient follow-up, and treatment access are needed. Specific training alongside existing programs (HIV, malaria), early diagnosis of the disease, and the creation of patient advocacy groups should be implemented to improve SCD patient care.
Collapse
Affiliation(s)
- Benoît Mukinayi Mbiya
- Pediatrics Department, Faculty of Medicine, University of Mbujimayi, Mbujimayi 06201, Democratic Republic of Congo;
| | - Ghislain Tumba Disashi
- Internal Medicine Department, Faculty of Medicine, University of Mbujimayi, Mbujimayi 06201, Democratic Republic of Congo;
| | - Béatrice Gulbis
- Clinical Chemistry Department-Hereditary Red Blood Cell Disorders, Laboratoire Hospitalier Universitaire de Bruxelles-Universitaire Laboratorium Brussel, Université Libre de Bruxelles, 1070 Brussels, Belgium
- Correspondence:
| |
Collapse
|
15
|
Nnodu OE, Sopekan A, Nnebe-Agumadu U, Ohiaeri C, Adeniran A, Shedul G, Isa HA, Owolabi O, Chianumba RI, Tanko Y, Iyobosa JH, Adekile AD, Olopade OI, Piel FB. Implementing newborn screening for sickle cell disease as part of immunisation programmes in Nigeria: a feasibility study. Lancet Haematol 2020; 7:e534-e540. [PMID: 32589979 PMCID: PMC7322555 DOI: 10.1016/s2352-3026(20)30143-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sickle cell disease is highly prevalent in sub-Saharan Africa, where it accounts for substantial morbidity and mortality. Newborn screening is paramount for early diagnosis and enrolment of affected children into a comprehensive care programme. Up to now, this strategy has been greatly impaired in resource-poor countries, because screening methods are technologically and financially intensive; affordable, reliable, and accurate methods are needed. We aimed to test the feasibility of implementing a sickle cell disease screening programme using innovative point-of-care test devices into existing immunisation programmes in primary health-care settings. METHODS Building on a routine immunisation programme and using existing facilities and staff, we did a prospective feasibility study at five primary health-care centres within Gwagwalada Area Council, Abuja, Nigeria. We systematically screened for sickle cell disease consecutive newborn babies and infants younger than 9 months who presented to immunisation clinics at these five centres, using an ELISA-based point-of care test (HemoTypeSC). A subgroup of consecutive babies who presented to immunisation clinics at the primary health-care centres, whose mothers gave consent, were tested by the HemoTypeSC point-of-care test alongside a different immunoassay-based point-of-care test (SickleSCAN) and the gold standard test, high-performance liquid chromatography (HPLC). FINDINGS Between July 14, 2017, and Sept 3, 2019, 3603 newborn babies and infants who presented for immunisation were screened for sickle cell disease at five primary health-care centres using the ELISA-based point-of-care test. We identified 51 (1%) children with sickle cell anaemia (HbSS), four (<1%) heterozygous for HbS and HbC (HbSC), 740 (21%) with sickle cell trait (HbAS), 34 (1%) heterozygous for HbA and HbC (HbAC), and 2774 (77%) with normal haemoglobin (HbAA). Of the 55 babies and infants with confirmed sickle cell disease, 41 (75%) were enrolled into a programme for free folic acid and penicillin, of whom 36 (88%) completed three visits over 9 months (median follow-up 226 days [IQR 198-357]). The head-to-head comparison between the two point-of-care tests and HPLC showed concordance between the three testing methods in screening 313 newborn babies, with a specificity of 100% with HemoTypeSC, 100% with SickleSCAN, and 100% by HPLC, and a sensitivity of 100% with HemoTypeSC, 100% with SickleSCAN, and 100% by HPLC. INTERPRETATION Our pilot study shows that the integration of newborn screening into existing primary health-care immunisation programmes is feasible and can rapidly be implemented with limited resources. Point-of-care tests are reliable and accurate in newborn screening for sickle cell disease. This feasibility study bodes well for the care of patients with sickle cell disease in resource-poor countries. FUNDING Doris Duke Charitable Foundation, Imperial College London Wellcome Trust Centre for Global Health Research, and Richard and Susan Kiphart Family Foundation.
Collapse
Affiliation(s)
- Obiageli E Nnodu
- Sickle Cell Disease Desk, Non-Communicable Disease Unit, Federal Ministry of Health, Federal Secretariat, Abuja, Nigeria.
| | - Alayo Sopekan
- Sickle Cell Disease Desk, Non-Communicable Disease Unit, Federal Ministry of Health, Federal Secretariat, Abuja, Nigeria
| | | | - Chinatu Ohiaeri
- Department of Paediatrics, Federal Medical Centre, Keffi, Nigeria
| | - Adeyemi Adeniran
- Department of Health, Gwagwalada Area Council Secretariat, Gwagwalada, Abuja, Nigeria
| | - Grace Shedul
- Pharmacy Department, University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria
| | - Hezekiah A Isa
- Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Olumide Owolabi
- Department of Computer Science, University of Abuja, Abuja, Nigeria
| | - Reuben I Chianumba
- Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Yohanna Tanko
- Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Juliet H Iyobosa
- Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | | | - Olufunmilayo I Olopade
- Centre for Clinical Cancer Genetics and Global Health, University of Chicago, Chicago, IL, USA
| | - Frédéric B Piel
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| |
Collapse
|
16
|
Oron AP, Chao DL, Ezeanolue EE, Ezenwa LN, Piel FB, Ojogun OT, Uyoga S, Williams TN, Nnodu OE. Caring for Africa's sickle cell children: will we rise to the challenge? BMC Med 2020; 18:92. [PMID: 32340612 PMCID: PMC7187492 DOI: 10.1186/s12916-020-01557-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 03/12/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Most of the world's sickle cell disease (SCD) burden is in Africa, where it is a major contributor to child morbidity and mortality. Despite the low cost of many preventive SCD interventions, insufficient resources have been allocated, and progress in alleviating the SCD burden has lagged behind other public-health efforts in Africa. The recent announcement of massive new funding for research into curative SCD therapies is encouraging in the long term, but over the next few decades, it is unlikely to help Africa's SCD children substantially. MAIN DISCUSSION A major barrier to progress has been the absence of large-scale early-life screening. Most SCD deaths in Africa probably occur before cases are even diagnosed. In the last few years, novel inexpensive SCD point-of-care test kits have become widely available and have been deployed successfully in African field settings. These kits could potentially enable universal early SCD screening. Other recent developments are the expansion of the pneumococcal conjugate vaccine towards near-universal coverage, and the demonstrated safety, efficacy, and increasing availability and affordability of hydroxyurea across the continent. Most elements of standard healthcare for SCD children that are already proven to work in the West, could and should now be implemented at scale in Africa. National and continental SCD research and care networks in Africa have also made substantial progress, assembling care guidelines and enabling the deployment and scale-up of SCD public-health systems. Substantial logistical, cultural, and awareness barriers remain, but with sufficient financial and political will, similar barriers have already been overcome in efforts to control other diseases in Africa. CONCLUSION AND RECOMMENDATIONS Despite remaining challenges, several high-SCD-burden African countries have the political will and infrastructure for the rapid implementation and scale-up of comprehensive SCD childcare programs. A globally funded effort starting with these countries and expanding elsewhere in Africa and to other high-burden countries, including India, could transform the lives of SCD children worldwide and help countries to attain their Sustainable Development Goals. This endeavor would also require ongoing research focused on the unique needs and challenges of SCD patients, and children in particular, in regions of high prevalence.
Collapse
Affiliation(s)
- Assaf P Oron
- Maternal, Newborn and Child Health, Institute for Disease Modeling, Bellevue, WA, USA
| | - Dennis L Chao
- Maternal, Newborn and Child Health, Institute for Disease Modeling, Bellevue, WA, USA
| | - Echezona E Ezeanolue
- Healthy Sunrise Foundation, Las Vegas, NV, USA
- College of Medicine, University of Nigeria, Nsukka, Nigeria
| | | | - Frédéric B Piel
- Department of Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | | | - Sophie Uyoga
- KEMRI-Wellcome Trust Research Programme, PO Box 230, Kilifi, Kenya
| | | | - Obiageli E Nnodu
- Centre of Excellence for Sickle Cell Disease Research & Training, University of Abuja, Abuja, Nigeria
| |
Collapse
|
17
|
Kasai ET, Boemer F, Djang’eing’a RM, Ntokumunda JK, Agasa SB, Dauly NN, Opara JPA. Systematic Screening of Neonatal Sickle Cell Disease with HemoTypeSC<sup>TM</sup> Kit-Test: Case Study and Literature Review. ACTA ACUST UNITED AC 2020. [DOI: 10.4236/ojbd.2020.101002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
18
|
Alvarez OA, Hustace T, Voltaire M, Mantero A, Liberus U, Saint Fleur R. Newborn Screening for Sickle Cell Disease Using Point-of-Care Testing in Low-Income Setting. Pediatrics 2019; 144:peds.2018-4105. [PMID: 31530717 DOI: 10.1542/peds.2018-4105] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Newborn screening provides early diagnosis for children with sickle cell disease (SCD), reducing disease-related mortality. We hypothesized that rapid point-of-care (POC) Sickle SCAN would be reliable in Haiti and would assist newborn screening. METHODS Dried blood specimens were obtained from infant heel sticks and analyzed by isoelectric focusing (IEF) at a public hospital in Cap-Haïtien during a 1-year period. A total of 360 Guthrie cards were also analyzed for quality assurance by high-performance liquid chromatography at the Florida Newborn Screening Laboratory. In addition, two-thirds of the infants were also screened by the POC to assess differences with the IEF. The hemoglobinopathy incidence and the specificity and sensitivity of the POC scan were assessed. RESULTS Overall, 1.48% of the children screened positive for SCD. The specificity and the sensitivity of POC Sickle SCAN were 0.97 (confidence interval 0.95-0.99) and 0.90 (confidence interval 0.55-1.00), respectively, relative to high-performance liquid chromatography gold standard. The confirmatory testing rate was 75% before POC and improved to 87% after POC was added for dual screening. Confirmatory testing revealed that 0.83% of children screened had SCD. Children who screened positive for SCD by POC started penicillin earlier, had their first pediatric follow-up a median of 38 days earlier, and received antipneumococcal vaccination on time when compared with those who screened positive for SCD by IEF alone. CONCLUSIONS The observational study revealed a high incidence of SCD among Haitian newborns. Sickle SCAN had excellent specificity and sensitivity to detect SCD during newborn screening and shortened health care access for children positive for SCD.
Collapse
Affiliation(s)
- Ofelia A Alvarez
- Division of Pediatric Hematology, Department of Pediatrics, and .,Hôpital Universitaire Justinien, Cap-Haïtien, Haiti
| | - Tally Hustace
- Division of Pediatric Hematology, Department of Pediatrics, and.,Hôpital Universitaire Justinien, Cap-Haïtien, Haiti
| | | | - Alejandro Mantero
- Department of Public Health, University of Miami, Miami, Florida; and
| | | | | |
Collapse
|
19
|
Italia MB, Kirolos S. Sickle cell disease in anaemic children in a Sierra Leonean district hospital: a case series. Oxf Med Case Reports 2019; 2019:omz061. [PMID: 31312461 PMCID: PMC6625001 DOI: 10.1093/omcr/omz061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/19/2019] [Accepted: 05/09/2019] [Indexed: 11/13/2022] Open
Abstract
Sickle cell disease (SCD) is the most common inherited haemoglobinopathy wordwide, with the highest prevalence in sub-Saharan Africa. Due to the lack of national strategies and scarcity of diagnostic tools in resource-limited settings, the disease may be significantly underdiagnosed. We carried out a 6-month retrospective review of paediatric admissions in a district hospital in northern Sierra Leone. Our aim was to identify patients with severe anaemia, defined as Hb < 7 g/dl, and further analyse the records of those tested for SCD. Of the 273 patients identified, only 24.5% had had an Emmel test, among which 34.3% were positive. Furthermore, only 17% of patients with a positive Emmel test were discharged on prophylactic antibiotics. Our study shows that increased awareness of SCD symptoms is required in high-burden areas without established screening programmes. In addition, the creation or strengthening of follow-up programmes for SCD patients is essential for disease control.
Collapse
Affiliation(s)
- Maria B Italia
- Medical Department, Médecins Sans Frontières, Barcelona, Spain
| | - Sandy Kirolos
- Paediatric Department, Koinadugu Government Hospital, Kabala, Sierra Leone
| |
Collapse
|
20
|
Wilson DJ, Kumar AA, Mace CR. Overreliance on Cost Reduction as a Featured Element of Sensor Design. ACS Sens 2019; 4:1120-1125. [PMID: 31008585 DOI: 10.1021/acssensors.9b00260] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In this Perspective, we examine the role of cost in sensor design, its meaning within the context of converting academic prototypes into commercial products, and the importance of these issues to clear scientific communication. The possible motivations to consider the cost of a technology, sensor, or assay are both numerous and apparent. However, the idea that the cost of reagents and materials at the laboratory scale will directly translate to the purchase price for a user is inaccurate. While calculating the bill of materials is easy, there are many business considerations that make commercial products entirely different from academic prototypes. With these critical aspects of commercialization considered, academics are often not equipped to predict what the final price of an assay, sensor, or instrument will be to the end user. When used without proper context and accuracy, an overreliance on the phrase "low cost" in the absence of a sufficient discussion of cost weakens the meaning of this popular term and precludes practical scientific advancements. To demonstrate how the relationship between a bill of materials and "expected purchase price" breaks down when considering academic innovations, we discuss pregnancy tests as a case study where an academic bill of materials can lead to both overestimations and underestimations of pricing.
Collapse
Affiliation(s)
- Daniel J. Wilson
- Department of Chemistry, Tufts University, 62 Talbot Avenue, Medford, Massachusetts 02155, United States
| | - Ashok A. Kumar
- Jana Care, 8 St. Mary’s St. #611, Boston, Massachusetts 02215, United States
| | - Charles R. Mace
- Department of Chemistry, Tufts University, 62 Talbot Avenue, Medford, Massachusetts 02155, United States
| |
Collapse
|
21
|
Access to emergency departments for acute events and identification of sickle cell disease in refugees. Blood 2019; 133:2100-2103. [PMID: 30745303 DOI: 10.1182/blood-2018-09-876508] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
|