Low educational level of head of household, as a proxy for poverty, is associated with severe anaemia among children with sickle cell disease living in a low‐resource setting: evidence from the SPRING trial

Abstract

Summary Severe anaemia, defined as haemoglobin level < 6·0 g/dl, is an independent risk factor for death in individuals with sickle cell disease living in resource‐limited settings. We conducted a cross‐sectional study of 941 children with sickle cell anaemia, who had been defined as phenotype HbSS or HbSβ0 thalassaemia, aged five to 12 years, and were screened for enrollment into a large primary stroke prevention trial in Nigeria (SPRING; NCT02560935). The main aim of the study was to determine the prevalence and risk factors for severe anaemia. We found severe anaemia to be present in 3·9% (37 of 941) of the SPRING study participants. Severe anaemia was significantly associated with the lower educational level of the head of the household (P = 0·003), as a proxy for poverty, and a greater number of children per room in the household (P = 0·004). Body mass index was not associated with severe anaemia. The etiology of severe anaemia in children living with sickle cell anaemia in Nigeria is likely to be multifactorial with an interplay between an individual's disease severity and other socio‐economic factors related to poverty.

Sickle cell disease and social determinants of health: A scoping review

“…A few studies conducted in the United States and Nigeria examined the effects of sociodemographic factors, parental education, and family functioning in children with SCD. [52][53][54][55] In Nigeria, socioeconomic factors, number of individuals living per room in a house, social support, and educational level of the head of the household determined the severity of anemia in children with SCD who lived in a low-resource setting. 54,55 A few other studies conducted in the United States found that the home environment and family functioning were significantly associated with cognitive development and HRQoL in children with SCD.…”

“…[52][53][54][55] In Nigeria, socioeconomic factors, number of individuals living per room in a house, social support, and educational level of the head of the household determined the severity of anemia in children with SCD who lived in a low-resource setting. 54,55 A few other studies conducted in the United States found that the home environment and family functioning were significantly associated with cognitive development and HRQoL in children with SCD. 56,57 In the United States, adult patients with SCD who did not achieve higher education experienced a greater rate of ED utilization and were often unemployed compared to their peers who completed post-high school education.…”

Capacity Building for Primary Stroke Prevention Teams in Children Living With Sickle Cell Anemia in Africa

“…The clinical features of the population screened for eligibility are described elsewhere. 4,7 This descriptive study focused on specific study challenges encountered in a low-resource setting and how these challenges were addressed with a goal of building capacity for research and clinical care with ongoing quality assurance and improvement processes.…”

Hydroxyurea and blood transfusion therapy for Sickle cell disease in South Asia: inconsistent treatment of a neglected disease

“…Five classical HBB haplotypes of SCD (Central African Republic, Benin, Senegal, Cameroon and Arab-Indian) have also described and are widely believed to contribute to the phenotypic variability largely through their effects on foetal haemoglobin (Hb F) levels [ 3 ]. Irrespective of the haplotype, evidence suggests that poverty influenced by lower socio-economic status could lead to adverse outcomes in the disease [ 4 , 5 ]. In the western world, more than 90% of children with SCD survive to adulthood whilst in Sub-Saharan Africa where there is the greatest burden of sickle cell anaemia estimates suggest that 50–80% of patients will die before adulthood [ 2 ].…”