title: Newborn Screening for Sickle Cell Disease in Liberia: A Pilot Study.
abstract: BACKGROUND
  In malaria-endemic countries in West Africa, sickle cell disease (SCD) contributes to childhood mortality. Historically, Liberia had regions wherein hemoglobin S and beta-thalassemia trait were mutually exclusive. Data on hemoglobinopathies in the Monrovia, the capital, are outdated and do not reflect urban migration. Updating the epidemiology of SCD is necessary to plan a public health and clinical agenda. Neither newborn screening (NBS) nor screening tools were available in country. This pilot study aimed to determine the feasibility of NBS using a South-South partnership and define the incidence of sickle cell trait (SCT) and SCD in Monrovia.
  
  
  METHODS
  This descriptive epidemiologic feasibility study collected dried blood spots from 2,785 consecutive newborns delivered at a hospital in Monrovia. Samples were analyzed by isoelectric focusing at a regional reference laboratory. Infants with SCD were referred for preventive care.
  
  
  RESULTS
  SCT occurred in 10.31% of infants screened. SCD occurred in 33 infants screened [1.19% (95% confidence interval [CI]: 0.79-1.59%)] (FS: 28/33, FSB: 2/33, FSA: 2/33, FSX: 1/33). There were no infants with FSC phenotype observed. Nonsickling hemoglobin phenotypes "FC" and "F" were each present in three infants screened. Seventy-six percent of infants with SCD were brought to care, demonstrating the feasibility of our approach.
  
  
  CONCLUSIONS
  The incidence of SCD and other hemoglobinopathies remains high in Liberia. Additional studies are needed to clarify sickle genotypes and identify the contribution of silent beta-thalassemia alleles. By developing regional partnerships, countries similar to Liberia can acquire current data to inform NBS as an important public health initiative toward improving child health.
authors.affiliation: Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.|Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Venée N
authors.initials: VN
authors.lastname: Tubman
authors.affiliation: John F. Kennedy Hospital, Monrovia, Liberia.|Department of Pediatrics, A. M. Dogliotti College of Medicine, Monrovia, Liberia.
authors.forename: Roseda
authors.initials: R
authors.lastname: Marshall
authors.affiliation: Hope for Women's Health, Monrovia, Liberia.
authors.forename: Wilhemina
authors.initials: W
authors.lastname: Jallah
authors.affiliation: Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.
authors.forename: Dongjing
authors.initials: D
authors.lastname: Guo
authors.affiliation: Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.
authors.forename: Clement
authors.initials: C
authors.lastname: Ma
authors.affiliation: Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Kwaku
authors.initials: K
authors.lastname: Ohene-Frempong
authors.affiliation: Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.|Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Wendy B
authors.initials: WB
authors.lastname: London
authors.affiliation: Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.|Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Heeney
mesh_terms: D000755:Anemia, Sickle Cell / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007525:Isoelectric Focusing; D007988:Liberia / Q000453:epidemiology; D008297:Male; D015997:Neonatal Screening; D010865:Pilot Projects
keywords: epidemiology; hemoglobinopathies; pediatric hematology/oncology; sickle cell disease