Document Type

Capstone Experience

Graduation Date

8-2018

Degree Name

Master of Public Health

First Committee Member

Dr. Raikes

Second Committee Member

Dr. Delair

Third Committee Member

Ms. Amy Rezac

Abstract

Abstract

Sickle cell disease (SCD) is caused by a genetic defect that results in abnormal hemoglobin genes that can cause devastating health effects like chronic hemolytic anemia and vaso-occlusive crises. Additionally, sickle cell disease can cause defects in the immune system, leaving those with the disease highly susceptible to a variety of different infections. In the pediatric population specifically, the complications of sickle cell disease contribute significantly to the under-five mortality rate of Nigeria. In response to the Millennium Development Goals 4, 5 and 6, as well as with growing national concern over the challenges faced by sickle cell disease there was a collaboration with the Federal Ministry of Health (FMOH) with the Millennium Development Goal office to create a national standard of care for sickle cell disease treatment. This document was created and published on November 28, 2014, and since then there has not been a study done to determine if the national guidelines that were created have been adopted or if there were barriers preventing this from occurring.

The purpose of this study was to seek out health providers in Nigeria from different parts of the country, with different clinic and provider demographics to examine what current practices are being used and how they compare with the guidelines. The study aimed to provide a better understanding of providers awareness of the national guidelines for treatment, what the proportion of their patients had treatment that followed the guidelines, if their prescription habits aligned with the guidelines and if not, what the barriers to following the national guidelines were.

To investigate how provider practices compared to the national guideline for SCD, a comprehensive online survey was distributed to 96 Nigerian healthcare providers at the joint 14th Triennial Congress of Union of National African Paediatric Societies and Associations (UNAPSA) and the 49th Paediatric Association of Nigeria (PAN) Annual General Meeting and Scientific Conference in Abuja, Nigeria from January 24-26, 2018. Of the 96 participants that were contacted, 31 fully completed the survey with a response rate of 32.3%. Important to note was that the majority of the providers, 58.1%, were not aware that there was a national guideline for sickle cell disease treatment available. The results of the study show that while specific treatment practices like malarial prophylaxis and folic acid supplementation are widely used, there is still much room for improvement for newborn screening, pneumococcal vaccination and hydroxyurea. In addition to the elements of the national guidelines, there was also interest in the role of other medications like Ciklavit and herbal preparations when it came to sickle cell disease for which there was little provider support. This study will provide the foundation for future interventions to increase the awareness and provider knowledge of the national guidelines for pediatric sickle cell disease treatment to provide better streamlined and universal care for those affected by this disease in Nigeria.

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