title: Implementing haemophilia care in Senegal, West Africa.
abstract: Despite significant progres on haemophilia care in developed world, this disease remains unknown in many sub-Saharan African countries. The objectives of this article were to report Senegalese experience on the management of haemophilia care through 18 years of follow-up. This cohort study included 140 patients (127 haemophilia A, 13 haemophilia B), followed in Dakar's haemophilia treatment centre from 1995 to 2012. Our study reported a prevalence of 2.3/100,000 male births, accounting for 11.6% of what is expected in Senegal. From the period 1995-2003 to 2004-2012, significant progress was seen including 67.9% increase in new patient's identification, 11.3 years reduction in mean age at diagnosis (from 15.5 to 4.2 years), lower mortality rate (from 15.3% to 6.8%) and age at death evolved from 6.5 to 23.3 years. Of the 50 haemophilia A patients who were tested for inhibitor presence, 10 were positive (eight severe and two moderate) that is prevalence of 20%. All patients were low responders since inhibitor titre was between 1.5 and 3.8 BU. Disabilities were seen in 36.5% of patients above 20 years old who had musculoskeletal sequels and 39% had no scholar or professional activities in our setting. Implementing haemophilia care in sub-Saharan Africa is a great challenge as this disease is not yet counted in national health problems in many countries. Lessons learned from this study show a significant improvement in diagnosis and prognosis parameters. This emphasizes the needs to set up such follow-up initiatives and to enhance medical and lay cooperation for better results.
authors.affiliation: Department of Hematology, Universite Cheikh Anta Diop, Dakar, Senegal; Department of Hematology, National Blood Transfusion Center, Dakar, Senegal.
authors.forename: S
authors.initials: S
authors.lastname: Diop
authors.forename: M
authors.initials: M
authors.lastname: Seck
authors.forename: D
authors.initials: D
authors.lastname: Sy-Bah
authors.forename: B F
authors.initials: BF
authors.lastname: Faye
authors.forename: A
authors.initials: A
authors.lastname: Sow-Ndoye
authors.forename: Y B
authors.initials: YB
authors.lastname: Gueye
authors.forename: A B
authors.initials: AB
authors.lastname: Senghor
authors.forename: A
authors.initials: A
authors.lastname: Sall-Fall
authors.forename: A O
authors.initials: AO
authors.lastname: Toure-Fall
authors.forename: T N
authors.initials: TN
authors.lastname: Dièye
authors.forename: D
authors.initials: D
authors.lastname: Thiam
authors.forename: L
authors.initials: L
authors.lastname: Diakhate
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003695:Delivery of Health Care; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D002836:Hemophilia B / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D009026:Mortality; D015995:Prevalence; D012042:Registries; D012675:Senegal / Q000453:epidemiology; D055815:Young Adult
keywords: Senegal; haemophilia; sub-Saharan Africa