Structural factors affecting the quality of sickle cell disease care in a low-resource setting

Abstract

Purpose This study examined the structural factors affecting the patient-reported quality of Sickle Cell Disease (SCD) care at the Ghana Institute of Clinical Genetics (GICG), providing evidence to inform health system improvements, policy, and chronic disease management strategies. Design/methodology/approach A cross-sectional study was conducted at the GICG between September and October 2023. A self-developed structured questionnaire captured data on socio-demographic characteristics, structural factors (including facility accessibility, availability of essential medicines, and health financing options), and patient-reported quality of care. Data were analysed using STATA 17.0. Descriptive statistics summarised participant characteristics, Pearson’s Chi-square explored bivariate associations, and multivariable logistic regression identified factors independently associated with care quality at p < 0.05. Findings The study achieved a 100% response rate with 424 participants. Most respondents were females (67.4%), aged 20–29 (37.5%), had SS genotype (51.9%), and used hydroxyurea (68.6%). Overall, 81.8% of respondents rated their care as good. Significant predictors of good quality care included age, hydroxyurea use, facility accessibility, and health financing options. Research limitations/implications The single-centre, convenience sampling and reliance on self-reported data may limit generalisability. Future multi-centre studies exploring mixed methods and incorporating provider perspectives are recommended. Originality/value This study provides empirical evidence linking structural determinants with the quality of SCD care in Ghana. Findings are contextualised within national, regional, and global frameworks, offering actionable insights for improving chronic disease management in low- and middle-income countries (LMICs).