Overview of current progress and challenges in diagnosis, and management of pediatric sickle cell disease in Democratic Republic of the Congo

Hemodynamic profile of cerebral arteries using transcranial Doppler in children with sickle cell disease compared to children without sickle cell disease: Prospective analytical study

BACKGROUND

Cerebral vasculopathy is a frequent and serious complication of major sickle cell disease syndromes. Transcerebral Doppler (TCD) can detect stenosis of the main arteries at the base of the skull before stroke occurs, and initiate therapy to avoid complications. The objective of the study is to evaluate and compare the hemodynamic profile of the middle cerebral artery using TCD in children with sickle cell disease compared to children without sickle cell disease.

METHOD

Prospective analytical study extended over a 6-month period from July 04, 2023 to December 28, 2023. The study population consisted of subjects followed for homozygous sickle cell disease SS and non-sickle cell subjects received at the above-mentioned centers, of all sexes, aged 2 to 16 years at most.

RESULTS

We recruited 182 children (52.2% male and 47.8% female) divided into 70 children with sickle cell disease and 112 children without sickle cell disease. The mean of Maximum systolic velocity (MSV) on the left was 85.0 ± 49.5 cm/s in sickle cell patients and 84.5 ± 17.8 cm/s in non-sickle cell patients. The mean of telediastolic velocity (TDV) was 40.9 ± 31.2 cm/s in sickle cell patients and 44.0 ± 15.8 cm/s in non-sickle cell patients. The mean maximum velocity (MMV) was 53.22 ± 39.0 cm/s in sickle cell patients and 57.5 ± 16.3 cm/s in non-sickle cell patients.

CONCLUSION

The mean velocity of children with sickle cell disease was lower than that of non-sickle cell patients, and the peak systolic velocity of children with sickle cell disease was slightly higher than those of children without sickle cell disease.

Assessment of healthcare workers' knowledge and availability of resources for sickle cell disease management in Bukavu, Democratic Republic of the Congo

INTRODUCTION

Sickle cell disease (SCD) is a global public health priority due to its high morbidity and mortality. In the Democratic Republic of the Congo (DRC), effective care for this disease depends on the availability of resources and the level of knowledge of healthcare workers (HCWs). However, in Bukavu, there is limited data available on these two crucial aspects, which are vital for enhancing the care of patients with SCD. This study aims to assess the availability of SCD services and the level of knowledge of HCWs in Bukavu, DRC.

METHODS

A cross-sectional study based on healthcare facilities (HCFs) was carried out between March and May 2024 among 501 nurses and clinicians from 58 HCFs in Bukavu. Data were collected using a structured questionnaire with 13 knowledge questions (score >7 corresponding to good knowledge) and a checklist of available resources. Pearson's χ2 test was used to assess the association between knowledge level and participant characteristics. Multivariate logistic regression was performed to determine the factors influencing knowledge.

RESULTS

Of the 501 participants, only 16.4% demonstrated good knowledge of SCD. Physicians were 8.4 times more likely to possess good knowledge compared to nurses (adjusted OR = 8.4; 95% CI: 4.5 - 15.9; p<0.0001). Age, clinical experience, type of HCF, attendance of SCD training, and previous management of SCD patients did not show a significant association with knowledge after adjusting for other variables (p>0.05). Regarding resources, 55.2% of HCFs had a falciform test, but none had advanced technologies such as isoelectrofocusing or high-performance liquid chromatography.

CONCLUSION

This study reveals a general lack of knowledge among HCWs about SCD in Bukavu, as well as limited availability of resources for diagnosis and treatment. It is essential to improve the training of HCWs and to strengthen HCFs in order to optimize the management of SCD patients in Bukavu.

Current Status of Newborn Bloodspot Screening Worldwide 2024: A Comprehensive Review of Recent Activities (2020-2023)

Newborn bloodspot screening (NBS) began in the early 1960s based on the work of Dr. Robert "Bob" Guthrie in Buffalo, NY, USA. His development of a screening test for phenylketonuria on blood absorbed onto a special filter paper and transported to a remote testing laboratory began it all. Expansion of NBS to large numbers of asymptomatic congenital conditions flourishes in many settings while it has not yet been realized in others. The need for NBS as an efficient and effective public health prevention strategy that contributes to lowered morbidity and mortality wherever it is sustained is well known in the medical field but not necessarily by political policy makers. Acknowledging the value of national NBS reports published in 2007, the authors collaborated to create a worldwide NBS update in 2015. In a continuing attempt to review the progress of NBS globally, and to move towards a more harmonized and equitable screening system, we have updated our 2015 report with information available at the beginning of 2024. Reports on sub-Saharan Africa and the Caribbean, missing in 2015, have been included. Tables popular in the previous report have been updated with an eye towards harmonized comparisons. To emphasize areas needing attention globally, we have used regional tables containing similar listings of conditions screened, numbers of screening laboratories, and time at which specimen collection is recommended. Discussions are limited to bloodspot screening.

Newborn screening for sickle cell disease in Kisangani, Democratic Republic of the Congo: an update

BACKGROUND

Neonatal screening is the first action necessary to identify children with sickle cell disease (SCD) and thus ensure their care. Using rapid tests to give an immediate result to families is a new resilient approach of great interest. These two aspects are essential for establishing an adequate health policy for this disease. This study was undertaken in Kisangani to update the current incidence of neonatal SCD.

METHODS

Heel prick blood samples of 1432 babies born from different racial groups of parents living in Kisangani were collected at birth and screened using a point of care test, i.e. the HemoTypeSC^TM.

RESULTS

The incidence at birth was 2.2% (n = 31; 95% CI: [1.5%-3.1%]) for HbSS homozygosity and 21% (n = 303; 95% CI: [19%-23%]) for HbAS heterozygosity. Compared to a previous study in 2010; the incidence at the birth of the HbSS form has doubled, while that of the heterozygous form HbAS remained almost unchanged. The inter-ethnic incidence of HbSS among the five top-represented ethnic groups was significant (<0.001).

CONCLUSION

The prevalence of homozygote form has doubled compared to the 0.96% reported in 2010. Setting up a neonatal screening program and an awareness unit is necessary to assess the need for care services correctly.

Pairing parents and offspring's HemoTypeSC Test to validate results and confirm sickle cell pedigree: a case study in Kisangani, the Democratic Republic of the Congo

OBJECTIVES

HemoTypeSC^TM is one of the immunoassay methods currently used for the early diagnosis of Sickle Cell Disease (SCD) in newborns. Earlier diagnosis remains the key strategy for early preventive care needs and parents' education about the child's future well-being throughout his life. Before considering these children as sick and aligning them for regular medical monitoring, it may be valuable to confirm the HemoTypeSC result with a secondary laboratory testing method. In resource-limited settings, where confirmatory methods are not always available, we propose testing the parents to validate the HemoTypeSC result.

METHODS

This study explored this approach in the city of Kisangani. It was a prospective diagnostic accuracy study using genotype biological parents to evaluate HemoTypeSC's performance in the newborn.

RESULTS

Fifty-eight children born to 46 known mothers, and 37 known fathers, have been tested. The phenotyping showed that 41 (70.7%) children were SS, whose 37 were born to a couple AS/AS and 4 to a couple AS/xx. Of the 41 SS children, 8 (19.5%) were newborns and 33 (80.4%) were children; 12 (20.6%) children were AS, one of whom was born to a couple SS/AA and 11 to a couple AA/SS; 5 (8.6%) children were AA. In this population, the probability of offspring born to AS/AS parents being SS rather than AS is high (odds, 1.25). No statistical difference was observed between girls and boys. The pedigree of all 58 children has been confirmed.

CONCLUSION

We demonstrated that testing biological parents with HemoTypeSC is a reliable confirmatory method for newborn screening but it presents some limitations discussed in the present article.