title: Complications of sickle cell anaemia in children in Northwestern Tanzania.
abstract: OBJECTIVE
  Tanzania has the third highest birth rate of sickle cell anaemia (SCA) in Africa, but few studies describe severity of complications or available treatments, especially in Northwest Tanzania around Lake Victoria where the sickle gene is most prevalent. This is a report of the spectrum of clinical disease and range of interventions available at Bugando Medical Centre (Bugando) in Northwest Tanzania in Africa.
  
  
  METHODS
  A cross-sectional study was carried out in Bugando between 1 August 2012 and 30 September 2012. Children (<15 years old) with SCA attending Bugando were sequentially enrolled. A trained research assistant completed a Swahili questionnaire with the parent or guardian of each participant concerning demographic information, clinical features of disease, and treatments received.
  
  
  RESULTS
  Among the 124 participants enrolled, the median age was 6 years (interquartile range [IQR] 4-8.5), and only 13 (10.5%) were < 3 years old. Almost all participants (97.6%) had a prior history of a vaso-occlusive episode, 83 (66.9%) had prior acute chest syndrome, and 21 (16.9%) had prior stroke. In the preceding 12 months, 120 (96.8%) had been hospitalized, and a vaso-occlusive episode was the most common reason for hospitalization (35.5%). Prescriptions for folic acid (92.7%) and malaria prophylaxis (84.7%) were common, but only one had received a pneumococcal vaccine, and none had received hydroxyurea or prophylactic penicillin.
  
  
  CONCLUSIONS
  Children with SCA receiving care in Tanzania are diagnosed late, hospitalized frequently, and have severe complications. Opportunities exist to improve care through wider access to screening and diagnosis as well as better coordination of comprehensive care.
authors: Muhimbili Wellcome Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors: Hamza
authors: H
authors: Saidi
authors: Department of Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.|Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors: Luke R
authors: LR
authors: Smart
authors: Department of Biochemistry, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
authors: Erasmus
authors: E
authors: Kamugisha
authors: Department of Paediatrics, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
authors: Emmanuela E
authors: EE
authors: Ambrose
authors: Muhimbili Wellcome Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors: Deogratias
authors: D
authors: Soka
authors: Department of Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.|Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors: Robert N
authors: RN
authors: Peck
authors: Muhimbili Wellcome Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.|Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
authors: Julie
authors: J
authors: Makani
mesh_terms: D056586:Acute Chest Syndrome / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006760:Hospitalization; D006801:Humans; D008288:Malaria / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D013636:Tanzania / Q000453:epidemiology; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000628:therapy
chemical_list: D022242:Pneumococcal Vaccines; D005492:Folic Acid
keywords: Acute chest syndrome; Children; Sickle cell anaemia; Stroke; Sub-Saharan Africa; Tanzania; Vaso-occlusive episode