Trends in sickle cell trait and disease screening in the Republic of Uganda, 2014-2019
Trends in sickle cell trait and disease screening in the Republic of Uganda, 2014-2019
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DOI：
10.1111/tmi.13506
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发表时间：
2020-12-14
影响因子：
3.3
通讯作者：
Ware, Russell E.
中科院分区：
文献类型：
--
作者：
Hernandez, Arielle G.;Kiyaga, Charles;Ware, Russell E.
镰状细胞病是一个重要的公共卫生问题，越来越多地认识到它是撒哈拉以南非洲发病率和幼儿死亡率的一个重要因素。我们的目的是提供来自非洲大规模、长期镰状细胞筛查工作的信息。方法：我们使用来自乌干达中央公共卫生实验室数据库的具有全国代表性的数据来检查5年期间镰状细胞筛查的流行病学趋势，比较0-24个月儿童不同检测队列中患病率的年龄和地理调整，并计算高负担地区的筛查覆盖率。结果2014年2月至2019年3月共筛查324356例0-24月龄儿童镰状细胞特征和疾病。在与艾滋病毒联合检测的一组样本中，确认镰状细胞病的国家高负担（0.9%）。在专门用于镰状细胞检测的样本队列中，镰状细胞病的总体患病率为9.7%，在进行重点筛查的高负担地区尤其高。大多数儿童在4个月前接受筛查，但镰状病特异性队列在5-9个月之间接受检测的受影响儿童比例更大，与疾病体征和症状的发病时间一致。在几个高负担地区，镰状细胞病新生儿筛查覆盖率成功实现。结论：对乌干达国家镰状细胞筛查趋势的检查和分析表明，重点筛查战略的成功是迈向普遍筛查的重要一步。有了这一证据和增加的医疗保健提供者知识，乌干达可以在全国范围内优化镰状细胞的诊断和管理。
Objective Sickle cell disease is an important public health issue that is increasingly recognised as a substantial contributor to morbidity and early childhood mortality in sub-Saharan Africa. We aimed to provide information from large-scale, long-term sickle cell screening efforts in Africa.Methods We used nationally representative data from the centralised public health laboratory database in Uganda to examine epidemiological trends in sickle cell screening over a five-year period, comparing age and geographic adjustments to prevalence among different testing cohorts of children aged 0-24 months, and calculating screening coverage within high-burden districts.Results A total of 324 356 children aged 0-24 months were screened for sickle cell trait and disease from February 2014 to March 2019. A high national burden of sickle cell disease (0.9%) was confirmed among a cohort of samples co-tested with HIV. In the cohort of samples referred specifically for sickle cell testing, the overall prevalence of sickle cell disease was 9.7% and particularly elevated in high-burden districts where focused screening occurred. The majority of children were screened before age 4 months, but the sickle-specific cohort had a larger proportion of affected children tested between age 5-9 months, coincident with onset of disease signs and symptoms. Successful screening coverage of sickle cell disease births was achieved in several high-burden districts.Conclusions Examination and analysis of national sickle cell screening trends in Uganda documents the successes of focused screening strategies as an important step towards universal screening. With this evidence and increased healthcare provider knowledge, Uganda can optimise sickle cell diagnosis and management across the country.