Compliance with antibiotic prophylaxis in children with sickle cell anemia: a prospective study

Bitarães, Enio Latini; Oliveira, Benigna Maria de; Viana, Marcos Borato

doi:10.2223/jped.1819

Cited by 23 publications

(9 citation statements)

References 25 publications

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“…(16,17) The reasons involved can include family beliefs, religious beliefs, parents' concern about the consequences of long-term antibiotic therapy and others reasons. Verification in this study was limited to family reporting.…”

Section: Discussionmentioning

confidence: 99%

Quality of assistance provided to children with sickle cell disease by primary healthcare services

Gomes¹,

Reis²,

Vieira³

et al. 2011

Rev. Bras. Hematol. Hemoter.

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ObjectiveTo evaluate the quality of healthcare provided to sickle cell disease children by primary healthcare services in a region of high prevalence.MethodsA cross-sectional, descriptive study was performed by interviewing members of families with sickle cell disease children. The children had been identified from the Neonatal Screening Program in Minas Gerais state over the last 12 years in towns of the Montes Claros-Bocaiuva microregion. A structured questionnaire specially developed for this study and based on three axes was used: indicators of the child's health (immunization, growth and development, prophylaxis antibiotic therapy), perception of care by the family (health education and accessibility) and knowledge of the family about the disease.ResultsSixty-three of 71 families with children identified as having sickle cell disease were interviewed. The predominant genotypes were Hb SS (44.4%) and Hb SC (41.2%). Adequate monitoring of growth and development was recorded for the first year of life in 23 children (36.6%) and for the second year of life in 18 children (28.6%). The basic vaccination schedule was completed by 44 children (69.8%) but 62 vaccination record cards (98.4%) identified delays of special vaccines. Regular use of prophylactic penicillin was reported by 55 caregivers (87.3%). The family's perception of the care provided suggests poor accessibility to health services and lack of opportunities to answer doubts. The average performance of families in knowledge testing was 59.8%.ConclusionThe quality of healthcare is unsatisfactory. The care provided to children with sickle cell disease in primary healthcare services needs improvements.

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Section: Discussionmentioning

confidence: 99%

Quality of assistance provided to children with sickle cell disease by primary healthcare services

Gomes¹,

Reis²,

Vieira³

et al. 2011

Rev. Bras. Hematol. Hemoter.

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“…In Brazil, some authors [6,8,24] have pointed out the need for training primary care professionals to provide better care for patients with sickle cell disease. In the process of reshaping health care in Brazil to place a greater emphasis on family health, it is important that family health care teams are well-prepared to adequately serve patients with sickle cell disease.…”

Section: Discussionmentioning

confidence: 99%

Knowledge of family health program practitioners in Brazil about sickle cell disease: a descriptive, cross-sectional study

et al. 2011

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BackgroundAlthough sickle cell disease is an important public health problem in Brazil, there is a gap in the literature on the level of knowledge of primary health care professionals about the treatment and management of sickle cell disease. Therefore, this study aimed to evaluate the level of knowledge about sickle cell disease of physicians and nurses who work in the Family Health Program in a region of Brazil with a high prevalence of this disease.MethodsThis is a descriptive, cross-sectional study conducted at the municipality of Montes Claros, in the north of Minas Gerais, Brazil. Study participants included 96 physicians and nurses who work at the Family Health Program in an urban area of the city. Data was collected using an original, partially tested questionnaire based on health care check points for children with sickle cell disease established in educational protocols from the State Health Secretary of Minas Gerais and the Ministry of Health. The structured questionnaire contained 47 questions addressing three axes: epidemiology (8 questions); clinical manifestations (13 questions); and management of children with sickle cell disease (26 questions). Knowledge was measured through mean correct responses to proposed questions. Ethical principles were respected and this project was approved by the Committee of Ethics in Research.Results59.4% (57) of the study participants were nurses and 40.6% (39) were physicians. The median length of training and median length of service in primary health care were 4.3 (2.8-8.0) years and 4.0 (2.0-7.1) years, respectively. The mean performance in knowledge tests was < 75%, with 5.7/8 (SD = 1.4) for the "epidemiology" questions; 8.6/13 (SD = 2.2) for "clinical manifestations"; and 17.0/26 (SD = 2.9) for "management of children with sickle cell disease" questions; resulting in a mean total of 31.4/47 (SD = 5.10) correct responses. A statistically significant association was found between the number of correct responses and family health care qualifications (p = 0.015).ConclusionThere is an urgent need to improve primary health care professional training in the care of children with sickle cell disease.

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“…Prophylactic antibiotics have been shown in a randomized controlled trial to be of clear benefit in children with sickle cell anemia [5] and are advised for adults following splenectomy in particular during the first 2 years post-splenectomy [6]–[8]. Poor compliance is often a limiting factor in the continuous use of antibiotic prophylaxis [1], [9]–[12]. An assay that would better stratify risk of OPSI would provide a useful measure to determine those in whom prophylactic antibiotics could be discontinued without significant risk.…”

Section: Introductionmentioning

confidence: 99%

Splenectomy Associated Changes in IgM Memory B Cells in an Adult Spleen Registry Cohort

et al. 2011

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Asplenic patients have a lifelong risk of overwhelming post-splenectomy infection and have been reported to have low numbers of peripheral blood IgM memory B cells. The clinical value of quantitation of memory B cells as an indicator of splenic abnormality or risk of infection has been unclear. To assess changes in B cell sub-populations after splenectomy we studied patients recruited to a spleen registry (n = 591). A subset of 209 adult asplenic or hyposplenic subjects, and normal controls (n = 140) were tested for IgM memory B cells. We also determined a) changes in IgM memory B cells with time after splenectomy using the cross-sectional data from patients on the registry and b) the kinetics of changes in haematological markers associated with splenectomy(n = 45). Total B cells in splenectomy patients did not differ from controls, but memory B cells, IgM memory B cells and switched B cells were significantly (p<0.001) reduced. The reduction was similar for different indications for splenectomy. Changes of asplenia in routine blood films including presence of Howell-Jolly bodies (HJB), occurred early (median 25 days) and splenectomy associated thrombocytosis and lymphocytosis peaked by 50 days. There was a more gradual decrease in IgM memory B cells reaching a stable level within 6 months after splenectomy. IgM memory B cells as proportion of B cells was the best discriminator between splenectomized patients and normal controls and at the optimal cut-off of 4.53, showed a true positive rate of 95% and false positive rate of 20%. In a survey of 152 registry patients stratified by IgM memory B cells around this cut-off there was no association with minor infections and no registry patients experienced OPSI during the study. Despite significant changes after splenectomy, conventional measures of IgM memory cells have limited clinical utility in this population.

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Compliance with antibiotic prophylaxis in children with sickle cell anemia: a prospective study

Cited by 23 publications

References 25 publications

Quality of assistance provided to children with sickle cell disease by primary healthcare services

Quality of assistance provided to children with sickle cell disease by primary healthcare services

Knowledge of family health program practitioners in Brazil about sickle cell disease: a descriptive, cross-sectional study

Splenectomy Associated Changes in IgM Memory B Cells in an Adult Spleen Registry Cohort

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