Integrating comprehensive care in the management of sickle cell disease patients in Nigeria

Abstract

INTRODUCTION: Comprehensive sickle cell care is a holistic, multidisciplinary approach spanning from birth to adulthood. It includes newborn screening, routine investigations, medications, specific therapies and structured referrals. It is recognised since the 1972 US Sickle Cell Control Act and reinforced by the American Society of Haematology initiatives. This study evaluates the adoption of these strategies by physicians in Nigeria. AIM: To examine the extent to which comprehensive care strategies are implemented in the management of sickle cell disease by adult and paediatric haematologists in Nigeria. METHODOLOGY: This cross-sectional study was conducted from September to November 2022 across six tertiary hospitals. An adapted and pretested primary care assessment tool was used to collect data on physician demographics and strategic components of comprehensive care. Descriptive statistics and chi-square tests were used to analyse the data. RESULTS: A total of 157 doctors participated with most working in tertiary hospitals. Folic acid and proguanil hydrochloride were the most prescribed drugs; fewer than 50% used hydroxyurea. A complete blood count was the most requested investigation with 58% routinely scheduling investigations. Adult haematologists ordered more echocardiograms and paediatric haematologists requested more transcranial Dopplers. Adult haematologists referred more across specialities (p-value = 0.0001). All participants routinely counselled patients on clinic attendance, medication adherence and healthy lifestyle practices. CONCLUSION: Key components of comprehensive care are practised at varying levels by health professionals in Nigeria, mainly in urban/tertiary hospitals. To strengthen nationwide delivery of care, health policies should prioritise equitable workforce distribution and integration of additional services, like neonatal screening and emerging therapies.