Outcomes of Hydroxyurea Accessed via Various Means and Barriers Affecting Its Usage Among Children with Sickle Cell Anaemia in North-Western Tanzania.
Outcomes of Hydroxyurea Accessed via Various Means and Barriers Affecting Its Usage Among Children with Sickle Cell Anaemia in North-Western Tanzania.
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DOI：
10.2147/jbm.s380901
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发表时间：
2023
影响因子：
2
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为评估在坦桑尼亚西北部，通过多种获取途径获得羟基脲的临床和血液学效果，并揭示镰状细胞贫血（SCA）患儿使用羟基脲的障碍。
2020年10月至2021年4月，在布甘多医疗中心（BMC）开展了一项回顾性研究，通过查阅病历，比较SCA患儿在基线时以及在回顾性随访至少一年使用羟基脲（通过现金、保险和项目获取）后的临床和血液学效果。随后，对患儿父母及照顾者进行了一项横断面调查，以确定通过各种途径获取羟基脲的障碍。P值<0.05被认为具有统计学意义。
我们确定了87名使用羟基脲至少一年的SCA患儿。基线（使用羟基脲前）时的中位年龄为99[78 - 151]个月，其中52/87（59.8%）为男性。与基线相比，报告血管闭塞危象、住院和输血的患者比例显著降低，血红蛋白和平均红细胞体积显著增加，相反，通过保险和项目获取羟基脲的参与者，其绝对中性粒细胞和网织红细胞显著减少。通过现金获取羟基脲的患者，这些参数大多无显著变化。此外，共有24/87（27.6%）的参与者报告了获取羟基脲的不同障碍，其中10/24（41.7%）称羟基脲非常昂贵，10/24（41.7%）报告存在保险方面的问题，4/21（16.6%）称药物缺货。
通过保险和项目而非现金获取并使用羟基脲的儿科患者，在临床和血液学方面有显著改善。研究观察到获取羟基脲存在若干障碍，这些障碍似乎影响了治疗效果。这些研究结果呼吁各方共同努力，改善所有SCA患者对羟基脲的可持续获取。
To assess clinical and haematological outcomes of Hydroxyurea accessed via various access means and uncover the barriers to its utilization in children with Sickle cell anaemia (SCA), North-western Tanzania. A retrospective study was conducted between October 2020 and April 2021 at Bugando Medical Centre (BMC) through review of medical files to compare the clinical and haematological outcomes among children with SCA at baseline and followed up retrospectively for at least one year of hydroxyurea utilization, accessed via cash, insurance and projects. Subsequently, a cross-sectional survey was conducted among parents and caregivers to ascertain the barriers to access of hydroxyurea via the various means. The p-values <0.05 were considered statistically significant. We identified 87 children with SCA who were on hydroxyurea for at least one year. The median age at baseline (before hydroxyurea) was 99 [78–151] months, and 52/87 (59.8%) were male. Compared to baseline, there was a significant reduction in proportion of patients reporting vaso-occlusive crisis, admissions and blood transfusions, a significant increase in Haemoglobin and mean corpuscular volume, conversely a significant reduction in absolute neutrophil and reticulocytes to both insurance and project participants. There was no significant change in most of these parameters among patients who accessed hydroxyurea via cash. Further, a total of 24/87 (27.6%) participants reported different barriers to access of hydroxyurea, where 10/24 (41.7%) reported hydroxyurea to be very expensive, 10/24 (41.7%) reported insurance challenges, and 4/21 (16.6%) reported unavailability of the drug. The paediatric patients utilizing hydroxyurea accessed via insurance and projects, but not cash, experienced significant improvement in the clinical and haematological outcomes. Several barriers for access to hydroxyurea were observed which appeared to impact these outcomes. These findings call for concerted efforts to improve the sustainable access to hydroxyurea among all patients with SCA.