TY - JOUR
T1 - Mortality in sickle cell anemia in africa
T2 - A prospective cohort study in Tanzania
AU - Makani, Julie
AU - Cox, Sharon E.
AU - Soka, Deogratius
AU - Komba, Albert N.
AU - Oruo, Julie
AU - Mwamtemi, Hadija
AU - Magesa, Pius
AU - Rwezaula, Stella
AU - Meda, Elineema
AU - Mgaya, Josephine
AU - Lowe, Brett
AU - Muturi, David
AU - Roberts, David J.
AU - Williams, Thomas N.
AU - Pallangyo, Kisali
AU - Kitundu, Jesse
AU - Fegan, Gregory
AU - Kirkham, Fenella J.
AU - Marsh, Kevin
AU - Newton, Charles R.
PY - 2011
Y1 - 2011
N2 - Background:The World Health Organization has declared Sickle Cell Anemia (SCA) a public health priority. There are 300,000 births/year, over 75% in Africa, with estimates suggesting that 6 million Africans will be living with SCA if average survival reaches half the African norm. Countries such as United States of America and United Kingdom have reduced SCA mortality from 3 to 0.13 per 100 person years of observation (PYO), with interventions such as newborn screening, prevention of infections and comprehensive care, but implementation of interventions in African countries has been hindered by lack of locally appropriate information. The objective of this study was to determine the incidence and factors associated with death from SCA in Dar-es-Salaam.Methods and Findings:A hospital-based cohort study was conducted, with prospective surveillance of 1,725 SCA patients recruited from 2004 to 2009, with 209 (12%) lost to follow up, while 86 died. The mortality rate was 1.9 (95%CI 1.5, 2.9) per 100 PYO, highest under 5-years old [7.3 (4.8-11.0)], adjusting for dates of birth and study enrollment. Independent risk factors, at enrollment to the cohort, predicting death were low hemoglobin (<5 g/dL) [3.8 (1.8-8.2); p = 0.001] and high total bilirubin (≥102 μmol/L) [1.7 (1.0-2.9); p = 0.044] as determined by logistic regression.Conclusions:Mortality in SCA in Africa is high, with the most vulnerable period being under 5-years old. This is most likely an underestimate, as this was a hospital cohort and may not have captured SCA individuals with severe disease who died in early childhood, those with mild disease who are undiagnosed or do not utilize services at health facilities. Prompt and effective treatment for anemia in SCA is recommended as it is likely to improve survival. Further research is required to determine the etiology, pathophysiology and the most appropriate strategies for management of anemia in SCA.
AB - Background:The World Health Organization has declared Sickle Cell Anemia (SCA) a public health priority. There are 300,000 births/year, over 75% in Africa, with estimates suggesting that 6 million Africans will be living with SCA if average survival reaches half the African norm. Countries such as United States of America and United Kingdom have reduced SCA mortality from 3 to 0.13 per 100 person years of observation (PYO), with interventions such as newborn screening, prevention of infections and comprehensive care, but implementation of interventions in African countries has been hindered by lack of locally appropriate information. The objective of this study was to determine the incidence and factors associated with death from SCA in Dar-es-Salaam.Methods and Findings:A hospital-based cohort study was conducted, with prospective surveillance of 1,725 SCA patients recruited from 2004 to 2009, with 209 (12%) lost to follow up, while 86 died. The mortality rate was 1.9 (95%CI 1.5, 2.9) per 100 PYO, highest under 5-years old [7.3 (4.8-11.0)], adjusting for dates of birth and study enrollment. Independent risk factors, at enrollment to the cohort, predicting death were low hemoglobin (<5 g/dL) [3.8 (1.8-8.2); p = 0.001] and high total bilirubin (≥102 μmol/L) [1.7 (1.0-2.9); p = 0.044] as determined by logistic regression.Conclusions:Mortality in SCA in Africa is high, with the most vulnerable period being under 5-years old. This is most likely an underestimate, as this was a hospital cohort and may not have captured SCA individuals with severe disease who died in early childhood, those with mild disease who are undiagnosed or do not utilize services at health facilities. Prompt and effective treatment for anemia in SCA is recommended as it is likely to improve survival. Further research is required to determine the etiology, pathophysiology and the most appropriate strategies for management of anemia in SCA.
UR - http://www.scopus.com/inward/record.url?scp=79951924307&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0014699
DO - 10.1371/journal.pone.0014699
M3 - Article
C2 - 21358818
AN - SCOPUS:79951924307
SN - 1932-6203
VL - 6
JO - PLoS ONE
JF - PLoS ONE
IS - 2
M1 - e14699
ER -
