Predictors of the Effectiveness of Health Education Intervention and Infant Diagnosis for Sickle Cell Disease Among Pregnant Women Attending Antenatal Clinics in Dar-es-salaam, Tanzania: a Quasi Experimental Study

Abstract

Background: Globally, Sickle cell disease (SCD) is one of the most common genetic disease with high childhood mortality. Early identification of babies with SCD through newborn screening (NBS) and linking them to care are among the recommended interventions. The purpose of this study was to assess the predictors of the effectiveness of health education intervention and the uptake of infant diagnosis for sickle cell disease among pregnant women attending antenatal clinics in Dar-Es-Salaam, Tanzania.Methods: This was a quasi-experimental study which involved pregnant women attending antenatal clinics at Buguruni health center, Mbagala hospital and Sinza hospital in Dar Es Salaam. A structured questionnaire was used in data collection. Knowledge on SCD (poor if score <7; good if score 7-10) was assessed for all participants before and after two sessions of health education, and participants in Buruguni and Mbagala were also screened for SCD using Sickle SCAN point-of-care test (BioMedomics Inc, USA). We computed “effectiveness” of health education intervention as the post-intervention minus baseline knowledge score. We used two-sample test of proportions, univariate and multivariate logistic regression to analyze the effectiveness of health education intervention and also predictors of infant diagnosis. Results: Total of 467 pregnant women completed two sessions of health education intervention and 218 were screened for SCD during antenatal visits. The proportion of participants with good knowledge on SCD had significantly increased from 12.4% at baseline to 85.9% following the education intervention. During multivariate analysis, sharing the received education on SCD was an independent predictor of the effectiveness of health education intervention. Likewise, independent predictors of the uptake of infant diagnosis for SCD included maternal occupation, maternal SCD status as well as sharing the received education on SCD.Conclusion: This study has demonstrated that maternal health education and maternal screening for SCD are feasible and effective interventions in raising awareness and improving the uptake of infant diagnosis for SCD. These interventions are strongly recommended to be included in the comprehensive care package for pregnant women attending antenatal clinics, particularly in areas with a high burden of SCD.