Sociodemographic and Clinical Factors Predictive of Poor Health-Related Quality of Life of Children with Sickle Cell Anemia in The Gambia

Abstract

Children with sickle cell anemia (SCA) experience recurrent vaso-occlusive crises and complications, significantly impacting their health-related quality of life (HRQoL). This study determined HRQoL in 130 children aged 5 -15 years with SCA in The Gambia, compared to 130 age- and sex-matched hemoglobin AA (HbAA) children. HRQoL was measured using the Pediatric Quality of Life Inventory (PedsQL), with scores below 69.7 defined as poor HRQoL. Predictors of poor HRQoL were analyzed using binary logistic regression. The mean ages of children with SCA and HbAA were similar (9.83 ± 2.79 years vs. 9.65 ± 2.84 years, <i>p</i> = 0.598), with a male-to-female ratio of 1.1:1. SCA children showed significantly higher rates of underweight (<i>p</i> = 0.019) and stunting (<i>p</i> = 0.045) compared to HbAA children. HRQoL scores were significantly lower in the SCA group across physical, emotional, social, school, and overall domains (<i>p</i> < 0.001). A majority (57.7%) of SCA children had poor HRQoL. Key predictors of poor HRQoL among SCA children included frequent pain episodes (>3 episodes in the past 12 months; odds ratio [OR] = 1.9, <i>p</i> = 0.028), late diagnosis of SCA (OR = 1.8, <i>p</i> = 0.012), and clinical stroke (OR = 69.3, <i>p</i> = 0.037). This study demonstrates that SCA significantly reduces HRQoL in all domains. Early diagnosis, effective pain management, and prevention of complications like stroke are critical to improving outcomes. Tailored interventions are needed to mitigate the physical and psychosocial burdens of SCA among children in The Gambia.