Controlling sickle cell disease in Ghana ethics and options

Abstract

Sickle Cell Disease (SCD) is a significant public health burden in Ghana. Recent studies indicate that 2% of Ghanaian newborns are affected by SCD; one in three Ghanaians has the hemoglobin S and/or C gene. As a means of controlling the disease, some authorities have recommended prenatal diagnosis (PND) and selective abortion. In the current era, SCD has a good prognosis and fairly reasonable quality of life. Advances in bone marrow transplantation have shown the disease is curable in selected patients. PND and selective abortion therefore raises a myriad of ethical dilemmas which are considered in this review. In the light of the demonstration of improved prognosis in recent times, PND and selective abortion appears to be applying capital punishment to the unborn child for “crimes” only the parents can be responsible for. In this review, we recommend control of SCD on three levels – preconception genetic testing and strategic reproductive choices, PND and education for carrier parents, and holistic management of persons with SCD. We emphasize the critical importance of self-management, especially self-awareness, in assuring a good quality of life for persons with SCD. We believe such an approach is cost-effective, and consistent with sound ethical principles and good conscience.

Non-communicable diseases among children in Ghana: health and social concerns of parent/caregivers

“…The analysis showed most caregivers believed NCDs had negatively affected child's physical growth and school attendance and had caused caregivers/ parents to spend so much money. This finding conforms to earlier research on the social and economic burden of NCDs on families in Ghana 20,24 . Diabetes, especially, type 2 diabetes in the young, is also an increasing problem with potentially serious outcomes 25 .The increasing prevalence of pediatric type 2 diabetes coincides with increasing obesity in children 26 .…”

“…Sickle cell disease has long been identified to afflict children in Ghana and has severe educational and developmental challenges as well as economic and social challenges for the family 20,24 . The analysis showed most caregivers believed NCDs had negatively affected child's physical growth and school attendance and had caused caregivers/ parents to spend so much money.…”

Awareness of Sickle Cell Trait Status: A Cross-Sectional Survey of Antenatal Women in Ghana

“…This is much lower than the reported national prevalence of 30% and the report of Edwin and others. 5,11 Most participants (87.4%) knew their trait status. This is in contrast to the study of Treadwell et al, where only 16% knew their trait status, but very similar to the finding of Boyd and others, where 89% of African-American women aged 18-30 years were aware of their trait status.…”

Rapid screening for sickle cell disease by polymerase chain reaction-high resolution melting analysis

“…Natural selection factors are the main reason for the high frequencies of the disease in tropical countries and in countries to which large populations have migrated from these regions. The World Health Organization reported that ~2% of newborns in Nigeria and Ghana were affected by sickle cell anemia, with a total of 150,000 affected children born each year in Nigeria alone (5,6). The frequency of SCD ranges from 10 to 40% across equatorial Africa, decreasing to 1-2% at the North African coast and <1% in South Africa (5).…”