QT interval prolongation in patients receiving bedaquiline-based regimens for drug-resistant tuberculosis in Sub-Saharan Africa: A systematic review and meta-analysis

Abstract

Sickle cell anemia (SCA) is a significant public health challenge, particularly in sub-Saharan Africa, where 80% of affected individuals reside. This study aimed to evaluate the clinical presentation and outcomes of children with SCA hospitalized at GRRH. A retrospective cross-sectional study was conducted, reviewing medical records of children aged 0–18 years hospitalized with SCA at Gulu Regional Referral Hospital (GRRH) between January 2019 and June 2024. Data on demographics, clinical presentations, interventions, and outcomes were collected and analyzed with descriptive statistics in Stata 18.0. Of 126 children enrolled, the median age was 7 years (IQR 3–10 years), with 55.6% male (n = 70). Painful crises (86.5%, n = 109) and fever (66.7%, n = 84) were the most common presentations, followed by jaundice (21.4%, n = 27) and respiratory distress (8.7%, n = 11). Most children (98.4%, n = 124) had hospital stays of less than one week, with 94.4% (n = 119) achieving complete recovery. Treatment included folic acid supplementation (99.2%, n = 125), antibiotics (96.8%, n = 122), and hydroxyurea (14.3%, n = 18). Mortality was 3.9% (n = 5), and 1.6% (n = 2) were transferred. Painful crises and fever were predominant clinical features, with high recovery rates and short hospital stays suggesting relatively favourable outcomes at GRRH. Mortality was 3.9%, which is lower than or comparable to reported inpatient mortality rates of 4–12% for paediatric sickle cell anaemia in other sub-Saharan African settings. However, limited hydroxyurea use highlights access barriers. Strengthening SCA healthcare policies, increasing hydroxyurea availability, and further research into severe cases are recommended to improve outcomes.