preprint · Preprints.org
Sickle cell disease is a widespread disorder, with significant prevalence in Tanzania where pain episodes remain a frequent cause of hospital admission. A cross-sectional study evaluated 390 patients aged eight and older presenting with painful events at two referral hospitals in Dar es Salaam between August 2022 and February 2023. Using the WHO Pain Management Index, researchers assessed the adequacy of pain relief and analysed linked factors. The findings revealed that one-third of the participants experienced inadequate pain control. Inadequate relief was significantly associated with receiving initial pain treatment at other health facilities, presenting with moderate pain, and having a fever. Conversely, initial treatment at the referral hospitals and presenting with severe pain were linked to lower odds of poor pain control, highlighting significant gaps in early and moderate pain management across local care settings.
Sickle cell disease places a massive health burden on families and hospitals in Africa. Understanding the specific points where pain relief falls short helps healthcare providers and health systems address weak links in treatment pathways, particularly in primary facilities before patients reach major referral centres.
The abstract does not indicate a commercialisation pathway, as it focuses strictly on clinical and observational healthcare outcomes.
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Background: Sickle cell disease (SCD) is the most common hemoglobin disorder in the world. Africa has the highest burden of SCD, accounting for up to 75% of the 300,000 annual births of individuals with SCD worldwide. In Tanzania, 11,000 – 14,000 babies are born with SCD each year. Despite treatment advancement, pain is still an attributable cause of admissions among patients with SCD. However, data is still lacking regarding the adequacy of pain control in patients with SCD in Tanzania. Objective: This study aimed to determine factors affecting pain control among patients with SCD presenting with painful events at Mwananyamala Regional Referral Hospital (MRRH) and Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methodology: This was a cross-sectional study conducted at MRRH and MNH which are tertiary referral hospitals in Dar es Salaam, Tanzania. Patients with SCD aged 8 years and above who presented at the hospitals with painful events (from August 2022 to February 2023) were enrolled into the study. A structured questionnaire was used to collect data on participants' socio-demographic characteristics and clinical parameters. The adequacy of pain control was assessed using the WHO Pain Management Index. Multivariable binary logistic regression was used to determine factors associated with pain control. Differences were considered statistically significant when the p-value was < 0.05. Results: A total of 390 patients with SCD were analysed with mean age (± SD) of 15 (± 6) years. Most patients were recruited from outpatient clinics (88.2%). The male-to-female ratio was 1:1, the majority of patients had less than three pain episodes per year (77.9%), and most patients presented to the hospital with mild pain (64.6%) and were on Hydroxyurea (62.3%). Furthermore, one-third of patients had inadequate pain control. Factors associated with inadequate pain control included receiving initial pain management in other health facilities (adjusted odds ratio [aOR] and 95% confidence interval [CI] = 2.5 (1.5- 4.5), p=0.001), presenting to the hospital with moderate pain (aOR = 2.2, 95% CI [1.3-3.8], p=0.006), and presenting to the hospital with a fever (aOR = 3.8, 95% CI [1.1 – 13.9], p=0.04). Having severe pain and receiving initial treatment at MRRH or MNH seemed to be protective factors (aOR = 0.33, 95% CI [0.11- 0.97], p=0.04, and aOR = 0.29, 95% CI [0.14 -0.61], p=0.001, respectively). Conclusion: A considerable proportion of patients with SCD receive sub-optimal pain control. Receiving initial pain management from other healthcare facilities, presenting to the hospital with moderate pain, and having a fever were associated with inadequate pain control. Further research is warranted to elucidate ways of optimising the management of pain in patients with SCD in Tanzania.
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DOI: 10.20944/preprints202512.2445.v1
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