title: Impact of a Comprehensive Sickle Cell Center on Early Childhood Mortality in a Developing Country: The Jamaican Experience.
abstract: OBJECTIVE
  To compare mortality in children <5 years of age with sickle cell disease (SCD) in Jamaica, a resource-limited country, diagnosed by newborn screening and managed in a comprehensive care facility, to that of the general population.
  
  
  METHODS
  The study was carried out at the Sickle Cell Unit in Kingston, Jamaica. We determined the status (dead/alive) at age 5 years in a cohort of 548 children with SCD diagnosed by newborn screening and managed at the Sickle Cell Unit during the period November 1995 to December 2009. The standardized mortality ratio was calculated using World Health Organization life tables for reference mortality.
  
  
  RESULTS
  Eight deaths (1.5%) occurred in children <5 years of age during the study period. The mean age at death was 2.0 ± 1.5 years. The overall mortality incidence in children <5 years of age was 3.1 (95% CI 1.6, 6.2) per 1000 person-years with a standardized mortality ratio of 0.52 (95% CI 0.3, 1.0).
  
  
  CONCLUSIONS
  Mortality in children <5 years of age with SCD diagnosed at birth and managed at a comprehensive care clinic in Jamaica is equivalent to that of the general population. Children with SCD, a highly vulnerable population, can be effectively managed, even in resource-limited environments.
authors.affiliation: Sickle Cell Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica, West Indies. Electronic address: lesley.king@uwimona.edu.jm.
authors.forename: Lesley G C
authors.initials: LG
authors.lastname: King
authors.affiliation: Sickle Cell Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica, West Indies.
authors.forename: Susanna
authors.initials: S
authors.lastname: Bortolusso-Ali
authors.affiliation: Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica, West Indies.
authors.forename: Colette A
authors.initials: CA
authors.lastname: Cunningham-Myrie
authors.affiliation: Tropical Metabolism Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica, West Indies.
authors.forename: Marvin E G
authors.initials: ME
authors.lastname: Reid
mesh_terms: D000554:Ambulatory Care Facilities; D000755:Anemia, Sickle Cell / Q000175:diagnosis / Q000401:mortality*; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007563:Jamaica / Q000453:epidemiology; D008297:Male; D015997:Neonatal Screening; D012189:Retrospective Studies; D017086:beta-Thalassemia / Q000175:diagnosis / Q000401:mortality