Caring for Africa's sickle cell children: will we rise to the challenge?
Caring for Africa's sickle cell children: will we rise to the challenge?
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DOI：
10.1186/s12916-020-01557-2
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发表时间：
2020-04-28
期刊：
影响因子：
9.3
通讯作者：
Nnodu, Obiageli E.
中科院分区：
文献类型：
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作者：
Oron, Assaf P.;Chao, Dennis L.;Nnodu, Obiageli E.
世界上大多数镰状细胞病（SCD）负担在非洲，它是儿童发病率和死亡率的主要贡献者。尽管许多预防性SCD干预措施成本较低，但分配的资源不足，减轻SCD负担的进展落后于非洲其他公共卫生工作。最近宣布为治疗性SCD疗法的研究提供大量新资金，从长远来看是令人鼓舞的，但在未来几十年内，这不太可能对非洲的SCD儿童有实质性的帮助。进展的一个主要障碍是缺乏大规模的早期生命筛查。在非洲，大多数SCD死亡可能发生在病例被诊断之前。在过去几年中，新型廉价的SCD即时检测试剂盒已广泛使用，并已成功部署在非洲的实地环境中。这些试剂盒可能使普遍的早期SCD筛查成为可能。最近的其他发展是肺炎球菌结合疫苗的扩大，接近普遍覆盖，以及整个非洲大陆已证明的安全性，有效性以及越来越多的可用性和可负担性。在西方已经证明有效的SCD儿童标准医疗保健的大多数要素现在可以而且应该在非洲大规模实施。非洲国家和大陆的SCD研究和护理网络也取得了重大进展，汇集了护理指南，并使SCD公共卫生系统的部署和扩大成为可能。在后勤、文化和认识方面仍然存在巨大的障碍，但只要有足够的财政和政治意愿，在非洲控制其他疾病的努力中已经克服了类似的障碍。结论和建议尽管仍然存在挑战，但一些严重的SCD负担的非洲国家具有迅速实施和扩大全面的SCD儿童保育方案的政治意愿和基础设施。全球资助的努力从这些国家开始，扩展到非洲其他地方和包括印度在内的其他高负担国家，可以改变世界各地SCD儿童的生活，并帮助各国实现可持续发展目标。这一奋进还需要持续的研究，重点关注SCD患者的独特需求和挑战，特别是在高发地区的儿童。
Background Most of the world's sickle cell disease (SCD) burden is in Africa, where it is a major contributor to child morbidity and mortality. Despite the low cost of many preventive SCD interventions, insufficient resources have been allocated, and progress in alleviating the SCD burden has lagged behind other public-health efforts in Africa. The recent announcement of massive new funding for research into curative SCD therapies is encouraging in the long term, but over the next few decades, it is unlikely to help Africa's SCD children substantially. Main discussion A major barrier to progress has been the absence of large-scale early-life screening. Most SCD deaths in Africa probably occur before cases are even diagnosed. In the last few years, novel inexpensive SCD point-of-care test kits have become widely available and have been deployed successfully in African field settings. These kits could potentially enable universal early SCD screening. Other recent developments are the expansion of the pneumococcal conjugate vaccine towards near-universal coverage, and the demonstrated safety, efficacy, and increasing availability and affordability of hydroxyurea across the continent. Most elements of standard healthcare for SCD children that are already proven to work in the West, could and should now be implemented at scale in Africa. National and continental SCD research and care networks in Africa have also made substantial progress, assembling care guidelines and enabling the deployment and scale-up of SCD public-health systems. Substantial logistical, cultural, and awareness barriers remain, but with sufficient financial and political will, similar barriers have already been overcome in efforts to control other diseases in Africa. Conclusion and recommendations Despite remaining challenges, several high-SCD-burden African countries have the political will and infrastructure for the rapid implementation and scale-up of comprehensive SCD childcare programs. A globally funded effort starting with these countries and expanding elsewhere in Africa and to other high-burden countries, including India, could transform the lives of SCD children worldwide and help countries to attain their Sustainable Development Goals. This endeavor would also require ongoing research focused on the unique needs and challenges of SCD patients, and children in particular, in regions of high prevalence.