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Neyer PJ, Kaboré B, Nakas CT, Hartmann B, Post A, Diallo S, Tinto H, Hammerer-Lercher A, Largiadèr CR, van der Ven AJ, Huber AR. Exploring the host factors affecting asymptomatic Plasmodium falciparum infection: insights from a rural Burkina Faso study. Malar J 2023; 22:252. [PMID: 37658365 PMCID: PMC10474782 DOI: 10.1186/s12936-023-04686-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Asymptomatic Plasmodium falciparum parasitaemia forms a reservoir for the transmission of malaria disease in West Africa. Certain haemoglobin variants are known to protect against severe malaria infection. However, data on the potential roles of haemoglobin variants and nongenetic factors in asymptomatic malaria infection is scarce and controversial. Therefore, this study investigated the associations of iron homeostasis, inflammation, nutrition, and haemoglobin mutations with parasitaemia in an asymptomatic cohort from a P. falciparum-endemic region during the high transmission season. METHODS A sub-study population of 688 asymptomatic individuals (predominantly children and adolescents under 15 years, n = 516) from rural Burkina Faso previously recruited by the NOVAC trial (NCT03176719) between June and October 2017 was analysed. Parasitaemia was quantified with conventional haemocytometry. The haemoglobin genotype was determined by reverse hybridization assays targeting a selection of 21 HBA and 22 HBB mutations. Demographics, inflammatory markers (interleukins 6 and 10, hepcidin), nutritional status (mid upper-arm circumference and body mass index), and anaemia (total haemoglobin, ferritin, soluble transferrin receptor) were assessed as potential predictors through logistic regression. RESULTS Malaria parasites were detected in 56% of subjects. Parasitaemia was associated most strongly with malnutrition. The effect size increased with malnutrition severity (OR = 6.26, CI95: 2.45-19.4, p < 0.001). Furthermore, statistically significant associations (p < 0.05) with age, cytokines, hepcidin and heterozygous haemoglobin S were observed. CONCLUSIONS According to these findings, asymptomatic parasitaemia is attenuated by haemoglobin S, but not by any of the other detected genotypes. Aside from evidence for slight iron imbalance, overall undernutrition was found to predict parasitaemia; thus, further investigations are required to elucidate causality and inform strategies for interventions.
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Affiliation(s)
- Peter J Neyer
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland.
- Graduate School for Cellular & Biomedical Sciences, University of Bern, Bern, Switzerland.
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Bérenger Kaboré
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Christos T Nakas
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Laboratory of Biometry, Department of Agriculture Crop, Production and Rural Environment, University of Thessaly, Volos, Greece
| | - Britta Hartmann
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Annelies Post
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Salou Diallo
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Halidou Tinto
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | | | - Carlo R Largiadèr
- Graduate School for Cellular & Biomedical Sciences, University of Bern, Bern, Switzerland
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andre J van der Ven
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andreas R Huber
- Private University in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
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2
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Archer NM, Inusa B, Makani J, Nkya S, Tshilolo L, Tubman VN, McGann PT, Ambrose EE, Henrich N, Spector J, Ohene-Frempong K. Enablers and barriers to newborn screening for sickle cell disease in Africa: results from a qualitative study involving programmes in six countries. BMJ Open 2022; 12:e057623. [PMID: 35264367 PMCID: PMC8915265 DOI: 10.1136/bmjopen-2021-057623] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Given the fundamental role of newborn bloodspot screening (NBS) to enable prompt diagnosis and optimal clinical management of individuals with sickle cell disease (SCD), we sought to systematically assess enablers and barriers to implementation of NBS programmes for SCD in Africa using established qualitative research methods. SETTING Childbirth centres and NBS laboratories from six countries in East, West and Southern Africa. PARTICIPANTS Eight programme leaders involved with establishing and operating NBS programmes for SCD in Angola, Democratic Republic of Congo, Ghana, Liberia, Nigeria and Tanzania. PRIMARY AND SECONDARY OUTCOME MEASURES Data obtained through a structured, phased interview approach were analysed using a combination of inductive and deductive codes and used to determine primary themes related to the implementation and sustainability of SCD NBS programmes. RESULTS Four primary themes emerged from the analysis relating to governance (eg, pragmatic considerations when deploying overcommitted clinical staff to perform NBS), technical (eg, design and execution of operational processes), cultural (eg, variability of knowledge and perceptions of community-based staff) and financial (eg, issues that can arise when external funding may effectively preclude government inputs) aspects. Key learnings included perceived factors that contribute to long-term NBS programme sustainability. CONCLUSIONS The establishment of enduring NBS programmes is a proven approach to improving the health of populations with SCD. Organising such programmes in Africa is feasible, but initial implementation does not assure sustainability. Our analysis suggests that future programmes should prioritise government partner participation and funding from the earliest stages of programme development.
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Affiliation(s)
- Natasha M Archer
- Division of Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Baba Inusa
- Evelina London Children's Hospital, London, UK
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Siana Nkya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Léon Tshilolo
- Institut de Recherche Biomédicale/CEFA and Centre Hospitalier Mère-Enfant Monkole, Kinshasa, Congo
| | - Venee N Tubman
- Texas Children's Cancer and Hematology Centers, Houston, Texas, USA
| | - Patrick T McGann
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Natalie Henrich
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jonathan Spector
- Department of Global Health, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts, USA
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3
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Hernandez AG, Kiyaga C, Howard TA, Ssewanyana I, Ndeezi G, Aceng JR, Ware RE. Trends in sickle cell trait and disease screening in the Republic of Uganda, 2014-2019. Trop Med Int Health 2020; 26:23-32. [PMID: 33151598 DOI: 10.1111/tmi.13506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Arielle G Hernandez
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, TX, USA
| | - Charles Kiyaga
- Central Public Health Laboratories, Ministry of Health, Republic of Uganda, Kampala, Uganda
| | - Thad A Howard
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Isaac Ssewanyana
- Central Public Health Laboratories, Ministry of Health, Republic of Uganda, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jane R Aceng
- Ministry of Health, Republic of Uganda, Kampala, Uganda
| | - Russell E Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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4
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Therrell BL, Lloyd-Puryear MA, Ohene-Frempong K, Ware RE, Padilla CD, Ambrose EE, Barkat A, Ghazal H, Kiyaga C, Mvalo T, Nnodu O, Ouldim K, Rahimy MC, Santos B, Tshilolo L, Yusuf C, Zarbalian G, Watson MS. Empowering newborn screening programs in African countries through establishment of an international collaborative effort. J Community Genet 2020; 11:253-268. [PMID: 32415570 PMCID: PMC7295888 DOI: 10.1007/s12687-020-00463-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/02/2020] [Indexed: 02/02/2023] Open
Abstract
In an effort to explore new knowledge and to develop meaningful collaborations for improving child health, the First Pan African Workshop on Newborn Screening was convened in June 2019 in Rabat, Morocco. Participants included an informal network of newborn screening stakeholders from across Africa and global experts in newborn screening and sickle cell disease. Over 150 attendees, representing 20 countries, were present including 11 African countries. The agenda focused on newborn screening rationale, techniques, system development, implementation barriers, ongoing research, and collaborations both globally and across Africa. We provide an overview of the workshop and a description of the newborn screening activities in the 11 African countries represented at the workshop, with a focus on sickle cell disease.
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Affiliation(s)
- Bradford L Therrell
- National Newborn Screening and Global Resource Center, University of Texas Health Science Center at San Antonio, Austin, TX, USA.
| | | | - Kwaku Ohene-Frempong
- Sickle Cell Foundation of Ghana, National Newborn Screening Program for Sickle Cell Disease, Accra, Ghana
| | - Russell E Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Emmanuela E Ambrose
- Bugando Medical Centre and Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Amina Barkat
- Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Hassan Ghazal
- National Center for Scientific and Technological Research, Rabat, Morocco
| | - Charles Kiyaga
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Obiageli Nnodu
- Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Karim Ouldim
- Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Abdellah, Fes, Morocco
| | - Mohamed Chérif Rahimy
- National Sickle Cell Disease Center, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Brígida Santos
- Centro de Apoio ao Doente Anémico, Hospital Pediátrico David Bernardino, Luanda, Angola
| | - Léon Tshilolo
- Centre Hospitalier Monkole, Kinshasa, Democratic Republic of the Congo
| | - Careema Yusuf
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Guisou Zarbalian
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Michael S Watson
- American College of Medical Genetics and Genomics, Bethesda, MD, USA
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5
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Prevalence of hemoglobin abnormalities in an apparently healthy population in Benin. Hematol Transfus Cell Ther 2019; 42:145-149. [PMID: 31523029 PMCID: PMC7248501 DOI: 10.1016/j.htct.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/01/2019] [Accepted: 06/07/2019] [Indexed: 12/22/2022] Open
Abstract
Background Sickle cell disease is the most common monogenic disorder in humans and is a major public health concern in sub-Saharan Africa. In Benin, the prevalence of sickle cell disease is estimated to be 4.8%. Our study aimed to describe the prevalence of hemoglobin abnormalities in an apparently healthy Benin population. Methods One thousand four hundred and eighty-three men and women, apparently in good health after medical screening, were tested for hemoglobin abnormalities by hemoglobin electrophoresis and the Emmel test. Subjects who were found to have homozygous or double heterozygous hemoglobin abnormalities, were re-sampled and a confirmation hemogram and hemoglobin electrophoresis test by capillary electrophoresis was performed. Results Our study population was predominantly male (97.7%) with an average age of 21.3 years. 1390 subjects reported that they did not know their hemoglobin electrophoresis status. Hemoglobin electrophoresis profiles found were as follows: 1077 (72.6%) AA (normal), 238 (16.1%) AS, 161 (10.9%) AC, 3 (0.2%) SC, 4 (0.2%) CC and 0 (0%) SS. The 406 subjects with abnormal hemoglobin had balanced somatic growth, with general physical examination results showing no abnormalities. In the seven subjects with major sickle cell syndrome or hemoglobinosis (SC and CC), their values of various hemogram parameters were normal apart from the discreet presence of microcytic anemia. Conclusion Our study highlights the need for increased routine testing of hemoglobin abnormalities and newborn screening for sickle cell disease in order to enhance early disease detection, prevention and comprehensive care.
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Hsu L, Nnodu OE, Brown BJ, Tluway F, King S, Dogara LG, Patil C, Shevkoplyas SS, Lettre G, Cooper RS, Gordeuk VR, Tayo BO. White Paper: Pathways to Progress in Newborn Screening for Sickle Cell Disease in Sub-Saharan Africa. JOURNAL OF TROPICAL DISEASES & PUBLIC HEALTH 2018; 6:260. [PMID: 30505949 PMCID: PMC6261323 DOI: 10.4172/2329-891x.1000260] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sickle Cell Disease (SCD) is among the most common single-gene diseases in the world but evidence-based comprehensive health care has not been implemented where the highest prevalence of SCD occurs, in sub-Saharan Africa (SSA). It represents an urgent health burden, both in terms of mortality and morbidity with an estimated mortality of 8-16% in children under 5 years in SSA. Addressing the high mortality of SCD in SSA and for effective management of SCD, newborn screening (NBS) should be incorporated with prevention of infections (including pneumococcal septicaemia and malaria), parental education and support at all levels of healthcare provision to enable timely recognition. The NBS working group of the Africa Sickle Cell Research Network (AfroSickleNet) collaboration surveyed current projects in NBS in SSA, and current conditions that hinder more widespread implementation of NBS for SCD. Solutions based on new point-of-care testing technology to disseminate education, and implementation science approaches that leverage existing resources are proposed.
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Affiliation(s)
- Lewis Hsu
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
| | - Obiageli E. Nnodu
- Department of Hematology and Blood Transfusion, University of Abuja, Abuja, Nigeria
- Centre of Excellence for Sickle Cell Disease Research & Training, University of Abuja, Abuja, Nigeria
| | - Biobele J. Brown
- Department of Pediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Furahini Tluway
- Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dares Salaam, Tanzania
| | - Shonda King
- Department of Health Social Work, University of Illinois Hospital and Health Sciences Systems, Chicago, IL, USA
| | - Livingstone G. Dogara
- Department of Hematology and Blood Transfusion, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Crystal Patil
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, College of Nursing, Chicago, IL, USA
| | | | | | - Richard S. Cooper
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Victor R. Gordeuk
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Bamidele O. Tayo
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
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7
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Abstract
Sickle cell disease (SCD) is a group of inherited disorders caused by mutations in HBB, which encodes haemoglobin subunit β. The incidence is estimated to be between 300,000 and 400,000 neonates globally each year, the majority in sub-Saharan Africa. Haemoglobin molecules that include mutant sickle β-globin subunits can polymerize; erythrocytes that contain mostly haemoglobin polymers assume a sickled form and are prone to haemolysis. Other pathophysiological mechanisms that contribute to the SCD phenotype are vaso-occlusion and activation of the immune system. SCD is characterized by a remarkable phenotypic complexity. Common acute complications are acute pain events, acute chest syndrome and stroke; chronic complications (including chronic kidney disease) can damage all organs. Hydroxycarbamide, blood transfusions and haematopoietic stem cell transplantation can reduce the severity of the disease. Early diagnosis is crucial to improve survival, and universal newborn screening programmes have been implemented in some countries but are challenging in low-income, high-burden settings.
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8
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Macharia AW, Mochamah G, Uyoga S, Ndila CM, Nyutu G, Makale J, Tendwa M, Nyatichi E, Ojal J, Shebe M, Awuondo KO, Mturi N, Peshu N, Tsofa B, Scott JAG, Maitland K, Williams TN. The clinical epidemiology of sickle cell anemia In Africa. Am J Hematol 2018; 93:363-370. [PMID: 29168218 PMCID: PMC6175377 DOI: 10.1002/ajh.24986] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 12/17/2022]
Abstract
Sickle cell anemia (SCA) is the commonest severe monogenic disorders of humans. The disease has been highly characterized in high‐income countries but not in sub‐Saharan Africa where SCA is most prevalent. We conducted a retrospective cohort study of all children 0–13 years admitted from within a defined study area to Kilifi County Hospital in Kenya over a five‐year period. Children were genotyped for SCA retrospectively and incidence rates calculated with reference to population data. Overall, 576 of 18,873 (3.1%) admissions had SCA of whom the majority (399; 69.3%) were previously undiagnosed. The incidence of all‐cause hospital admission was 57.2/100 person years of observation (PYO; 95%CI 52.6–62.1) in children with SCA and 3.7/100 PYO (95%CI 3.7–3.8) in those without SCA (IRR 15.3; 95%CI 14.1–16.6). Rates were higher for the majority of syndromic diagnoses at all ages beyond the neonatal period, being especially high for severe anemia (hemoglobin <50 g/L; IRR 58.8; 95%CI 50.3–68.7), stroke (IRR 486; 95%CI 68.4–3,450), bacteremia (IRR 23.4; 95%CI 17.4–31.4), and for bone (IRR 607; 95%CI 284–1,300), and joint (IRR 80.9; 95%CI 18.1–362) infections. The use of an algorithm based on just five clinical features would have identified approximately half of all SCA cases among hospital‐admitted children with a number needed to test to identify each affected patient of only fourteen. Our study illustrates the clinical epidemiology of SCA in a malaria‐endemic environment without specific interventions. The targeted testing of hospital‐admitted children using the Kilifi Algorithm provides a pragmatic approach to early diagnosis in high‐prevalence countries where newborn screening is unavailable.
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Affiliation(s)
| | | | - Sophie Uyoga
- KEMRI/Wellcome Trust Research Programme, Kilifi; Kenya
| | | | - Gideon Nyutu
- KEMRI/Wellcome Trust Research Programme, Kilifi; Kenya
| | | | | | | | - John Ojal
- KEMRI/Wellcome Trust Research Programme, Kilifi; Kenya
| | | | | | - Neema Mturi
- KEMRI/Wellcome Trust Research Programme, Kilifi; Kenya
| | - Norbert Peshu
- KEMRI/Wellcome Trust Research Programme, Kilifi; Kenya
| | | | - J. Anthony G. Scott
- KEMRI/Wellcome Trust Research Programme, Kilifi; Kenya
- London School of Hygiene and Tropical Medicine; London WC1E 7HT United Kingdom
- INDEPTH Network; Accra Ghana
| | - Kathryn Maitland
- KEMRI/Wellcome Trust Research Programme, Kilifi; Kenya
- Faculty of Medicine; Imperial College, St Mary's Hospital; London W21NY United Kingdom
| | - Thomas N. Williams
- KEMRI/Wellcome Trust Research Programme, Kilifi; Kenya
- INDEPTH Network; Accra Ghana
- Faculty of Medicine; Imperial College, St Mary's Hospital; London W21NY United Kingdom
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9
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Tubman VN, Makani J. Turf wars: exploring splenomegaly in sickle cell disease in malaria-endemic regions. Br J Haematol 2017; 177:938-946. [PMID: 28493472 DOI: 10.1111/bjh.14592] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Sickle cell disease (SCD) is a group of recessively inherited disorders of erythrocyte function that presents an ongoing threat to reducing childhood and adult morbidity and mortality around the world. While decades of research have led to improved survival for SCD patients in wealthy countries, survival remains dismal in low- and middle-income countries. Much of the early mortality associated with SCD is attributed to increased risk of infections due to early loss of splenic function. In the West, bacterial infections with encapsulated organisms are a primary concern. In sub-Saharan Africa, where the majority of infants with SCD are born, the same is true. However malaria presents an additional threat to survival. The search for factors that define variability in sickle cell phenotypes should include environmental modifiers, such as malaria. Further exploration of this relationship could lead to novel strategies to reduce morbidity and mortality attributable to infections. In this review, we explore the interactions between SCD, malaria and the spleen to better understand how splenomegaly and splenic (dys)function may co-exist in patients with SCD living in malaria-endemic areas.
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Affiliation(s)
- Venée N Tubman
- Texas Children's Cancer and Hematology Centers, Houston, TX, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Julie Makani
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
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10
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Hemoglobin variants identified in the Uganda Sickle Surveillance Study. Blood Adv 2016; 1:93-100. [PMID: 29296698 DOI: 10.1182/bloodadvances.2016000950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/28/2016] [Indexed: 11/20/2022] Open
Abstract
The Uganda Sickle Surveillance Study analyzed dried blood spots that were collected from almost 100 000 infants and young children from all 10 regions and 112 districts in the Republic of Uganda, with the primary objective of determining the prevalence of sickle cell trait and disease. An overall prevalence of 13.3% sickle cell trait and 0.7% sickle cell disease was recently reported. The isoelectric focusing electrophoresis technique coincidentally revealed numerous hemoglobin (Hb) variants (defined as an electrophoresis band that was not Hb A, Hb F, Hb S, or Hb C) with an overall country-wide prevalence of 0.5%, but with considerable geographic variability, being highest in the northwest regions and districts. To elucidate these Hb variants, the original isoelectric focusing (IEF) gels were reviewed to identify and locate the variant samples; corresponding dried blood spots were retrieved for further testing. Subsequent DNA-based investigation of 5 predominant isoelectric focusing patterns identified 2 α-globin variants (Hb Stanleyville II, Asn78Lys; Hb G-Pest, Asp74Asn), 1 β-globin variant (Hb O-Arab, Glu121Lys), and 2 fusion globin variants (Hb P-Nilotic, β31-δ50; Hb Kenya, Aγ81Leu-β86Ala). Compound heterozygotes containing an Hb variant plus Hb S were also identified, including both Hb S/O-Arab and HbS/Kenya. Regional differences in the types and prevalence of these hemoglobin variants likely reflect tribal ancestries and migration patterns. Algorithms are proposed to characterize these Hb variants, which will be helpful for emerging neonatal hemoglobinopathy screening programs that are under way in sub-Saharan Africa.
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11
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Anie KA, Treadwell MJ, Grant AM, Dennis-Antwi JA, Asafo MK, Lamptey ME, Ojodu J, Yusuf C, Otaigbe A, Ohene-Frempong K. Community engagement to inform the development of a sickle cell counselor training and certification program in Ghana. J Community Genet 2016; 7:195-202. [PMID: 27090687 DOI: 10.1007/s12687-016-0267-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/10/2016] [Indexed: 12/22/2022] Open
Abstract
Sickle cell disease (SCD) and sickle cell trait (SCT) are highly prevalent in Africa. Despite public health implications, there is limited understanding of community issues for implementing newborn screening and appropriate family counseling. We conducted a 3-day workshop in Kumasi, Ghana, with community leaders as lay program development advisors to assist the development and implementation of a Sickle Cell Counselor Training and Certification Program. We employed qualitative methods to understand cultural, religious, and psychosocial dimensions of SCD and SCT, including the advisors' attitudes and beliefs in relation to developing a culturally sensitive approach to family education and counseling that is maximally suited to diverse communities in Ghana. We collated advisors' discussions and observations in order to understand community issues and potential challenges and guide strategies for advocacy in SCD family education and counseling. Results from the workshop revealed that community leaders representing diverse communities in Ghana were engaged constructively in discussions about developing a culturally sensitive counselor training program. Key findings included the importance of improved knowledge about SCD among the public and youth in particular, the value of stakeholders such as elders and religious and traditional leaders, and government expectations of reduced SCD births. We submitted a report to the Ministry of Health in Ghana with recommendations for the next steps in developing a national sickle cell counselor training program. We named the program "Genetic Education and Counseling for Sickle Cell Conditions in Ghana" (GENECIS-Ghana). The first GENECIS-Ghana Training and Certification Program Workshop was conducted from June 8 to 12, 2015.
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Affiliation(s)
- Kofi A Anie
- Haematology and Sickle Cell Centre, London North West Healthcare NHS Trust, Central Middlesex Hospital, London, NW10 7NS, UK. .,Imperial College London, London, UK.
| | - Marsha J Treadwell
- University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Althea M Grant
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jemima A Dennis-Antwi
- International Confederation of Midwives Investing in Midwives Program, Accra, Ghana.,Sickle Cell Foundation of Ghana, Kumasi, Ghana
| | - Mabel K Asafo
- Ashanti Region Health Promotion Office, Kumasi, Ghana
| | - Mary E Lamptey
- Sickle Cell Foundation of Ghana, Kumasi, Ghana.,National Newborn Screening Program for Sickle Cell Disease, Accra, Ghana
| | - Jelili Ojodu
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Careema Yusuf
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Ayo Otaigbe
- Sickle Cell Foundation Nigeria, Lagos, Nigeria
| | - Kwaku Ohene-Frempong
- Sickle Cell Foundation of Ghana, Kumasi, Ghana.,National Newborn Screening Program for Sickle Cell Disease, Accra, Ghana.,Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Tubman VN, Marshall R, Jallah W, Guo D, Ma C, Ohene-Frempong K, London WB, Heeney MM. Newborn Screening for Sickle Cell Disease in Liberia: A Pilot Study. Pediatr Blood Cancer 2016; 63:671-6. [PMID: 26739520 PMCID: PMC4755789 DOI: 10.1002/pbc.25875] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/10/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND In malaria-endemic countries in West Africa, sickle cell disease (SCD) contributes to childhood mortality. Historically, Liberia had regions wherein hemoglobin S and beta-thalassemia trait were mutually exclusive. Data on hemoglobinopathies in the Monrovia, the capital, are outdated and do not reflect urban migration. Updating the epidemiology of SCD is necessary to plan a public health and clinical agenda. Neither newborn screening (NBS) nor screening tools were available in country. This pilot study aimed to determine the feasibility of NBS using a South-South partnership and define the incidence of sickle cell trait (SCT) and SCD in Monrovia. PROCEDURE This descriptive epidemiologic feasibility study collected dried blood spots from 2,785 consecutive newborns delivered at a hospital in Monrovia. Samples were analyzed by isoelectric focusing at a regional reference laboratory. Infants with SCD were referred for preventive care. RESULTS SCT occurred in 10.31% of infants screened. SCD occurred in 33 infants screened [1.19% (95% confidence interval [CI]: 0.79-1.59%)] (FS: 28/33, FSB: 2/33, FSA: 2/33, FSX: 1/33). There were no infants with FSC phenotype observed. Nonsickling hemoglobin phenotypes "FC" and "F" were each present in three infants screened. Seventy-six percent of infants with SCD were brought to care, demonstrating the feasibility of our approach. CONCLUSIONS The incidence of SCD and other hemoglobinopathies remains high in Liberia. Additional studies are needed to clarify sickle genotypes and identify the contribution of silent beta-thalassemia alleles. By developing regional partnerships, countries similar to Liberia can acquire current data to inform NBS as an important public health initiative toward improving child health.
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Affiliation(s)
- Venée N Tubman
- Dana-Farber / Boston Children’s Cancer and Blood Disorders Center, Boston, MA,Department of Pediatrics, Harvard Medical School
| | - Roseda Marshall
- John F. Kennedy Hospital, Monrovia, Liberia,Department of Pediatrics, A. M. Dogliotti College of Medicine
| | | | - Dongjing Guo
- Dana-Farber / Boston Children’s Cancer and Blood Disorders Center, Boston, MA
| | - Clement Ma
- Dana-Farber / Boston Children’s Cancer and Blood Disorders Center, Boston, MA
| | | | - Wendy B London
- Dana-Farber / Boston Children’s Cancer and Blood Disorders Center, Boston, MA,Department of Pediatrics, Harvard Medical School
| | - Matthew M Heeney
- Dana-Farber / Boston Children’s Cancer and Blood Disorders Center, Boston, MA,Department of Pediatrics, Harvard Medical School
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Abstract
In Africa, at least 240,000 children are born each year with sickle cell disease. Historically, in the absence of newborn screening and appropriate treatment, most such children died undiagnosed in early childhood. However, with increasing awareness of the condition and economic and epidemiologic transition, increasing numbers are surviving. Greater investments in basic and applied research in the African context, and increased sensitization or African ministries of health regarding the importance of this condition, could make a substantial difference to the lives and livelihoods of millions of people living with sickle cell disease on the continent and their families.
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Affiliation(s)
- Thomas N Williams
- Department of Medicine, Imperial College of Science, Technology and Medicine, St Mary's Hospital, Praed Street, London W21N, UK; Department of Epidemiology and Demography, KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi, Kenya.
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Frömmel C, Brose A, Klein J, Blankenstein O, Lobitz S. Newborn screening for sickle cell disease: technical and legal aspects of a German pilot study with 38,220 participants. BIOMED RESEARCH INTERNATIONAL 2014; 2014:695828. [PMID: 25147811 PMCID: PMC4132432 DOI: 10.1155/2014/695828] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/15/2014] [Accepted: 07/01/2014] [Indexed: 01/29/2023]
Abstract
Sickle cell disease (SCD) does not occur in the indigenous German population, but with the increasing number of immigrants from countries at high risk for hemoglobinopathies, the question emerges whether or not a newborn screening program (NBS) for SCD disease should be initiated in Germany anyhow. We have recently shown that in Berlin, a city with a very large immigrant population, the incidence of SCD is considerable, but our findings are insufficient to make a decision for the country as a whole. In this paper we will show that a large body of epidemiological data can be generated in a relatively short period of time, with a very high degree of precision and at relatively little expense--a result that might motivate other working groups to start such a pilot project locally. We examined previously collected dried blood cards that were up to six months old, using high performance liquid chromatography (HPLC) as first method and capillary electrophoresis (CE) as second method. A single, part-time laboratory technician processed 38,220 samples in a period of 162 working days. The total costs per sample including all incidentals (as well as labor costs) were EUR 1.44.
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Affiliation(s)
- Claudia Frömmel
- Labor Berlin-Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin, Germany
- INSTAND e.V., Gesellschaft zur Förderung der Qualitätssicherung in Medizinischen Laboratorien e.V., Ubierstraße 20, 40223 Düsseldorf, Germany
| | - Annemarie Brose
- Labor Berlin-Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin, Germany
| | - Jeannette Klein
- Newborn Screening Laboratory, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Oliver Blankenstein
- Newborn Screening Laboratory, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Stephan Lobitz
- Department of Pediatric Oncology/Hematology/BMT, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Dossche L, Noyez JF, Ouedraogo W, Kalmogho E. Establishment of a hip replacement project in a district hospital in Burkina Faso: analysis of technical problems and peri-operative complications. Bone Joint J 2014; 96-B:177-80. [PMID: 24493181 DOI: 10.1302/0301-620x.96b2.31304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Total hip replacement (THR) still is a rare intervention in many African countries. In Burkina Faso it is not performed on a regular basis. A visiting programme for THR was started in a district hospital with no previous relevant experience. In this paper we present an analysis of the surgical technical problems and peri-operative complications of 152 THRs in 136 patients and three bipolar hemiarthroplasties in three patients undertaken in this new programme with limited orthopaedic equipment. There were 86 male and 53 female patients with a mean age of 49 years (21 to 78). We identified 77 intra-operative technical problems in 51 operations. There were 24 peri-operative complications in 21 patients, 17 of which were bony in nature. So far, ten revision THRs have been performed in nine patients. Regular analysis of the technical problems and complications was used to improve quality, and we identified patient selection adapted to the local circumstances as important to avoid complications. Our reflections on the problems encountered in initiating such a programme may be of help to other teams planning similar projects.
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Affiliation(s)
- L Dossche
- Antwerp University Hospital, Department of Orthopaedic Surgery, Wilrijkstraat 10, 2650 Edegem, Belgium
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McGann PT, Ferris MG, Ramamurthy U, Santos B, de Oliveira V, Bernardino L, Ware RE. A prospective newborn screening and treatment program for sickle cell anemia in Luanda, Angola. Am J Hematol 2013; 88:984-9. [PMID: 24038490 DOI: 10.1002/ajh.23578] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 08/16/2013] [Accepted: 08/20/2013] [Indexed: 11/07/2022]
Abstract
Over 300,000 infants are born annually with sickle cell anemia (SCA) in sub-Saharan Africa, and >50% die young from infection or anemia, usually without diagnosis of SCA. Early identification by newborn screening (NBS), followed by simple interventions dramatically reduced the mortality of SCA in the United States, but this strategy is not yet established in Africa. We designed and implemented a proof-of-principle NBS and treatment program for SCA in Angola, with focus on capacity building and local ownership. Dried bloodspots from newborns were collected from five birthing centers. Hemoglobin identification was performed using isoelectric focusing; samples with abnormal hemoglobin patterns were analyzed by capillary electrophoresis. Infants with abnormal FS or FSC patterns were enrolled in a newborn clinic to initiate penicillin prophylaxis and receive education, pneumococcal immunization, and insecticide-treated bed nets. A total of 36,453 infants were screened with 77.31% FA, 21.03% FAS, 1.51% FS, and 0.019% FSC. A majority (54.3%) of affected infants were successfully contacted and brought to clinical care. Compliance in the newborn clinic was excellent (96.6%). Calculated first-year mortality rate for babies with SCA compares favorably to the national infant mortality rate (6.8 vs. 9.8%). The SCA burden is extremely high in Angola, but NBS is feasible. Capacity building and training provide local healthcare workers with skills needed for a functional screening program and clinic. Contact and retrieval of all affected SCA infants remains a challenge, but families are compliant with clinic appointments and treatment. Early mortality data suggest screening and early preventive care saves lives.
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Affiliation(s)
- Patrick T McGann
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Wolff F, Cotton F, Gulbis B. Screening for haemoglobinopathies on cord blood: laboratory and clinical experience. J Med Screen 2012; 19:116-22. [DOI: 10.1258/jms.2012.011107] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Blood from the umbilical cord (cord blood) is screened for haemoglobinopathies in several neonatal screening programmes, as well as before banking as a source of stem cells. We investigated the pre-analytical and analytical aspects of neonatal screening for haemoglobinopathies on liquid cord blood using the Sebia Haemoglobin kit. We give an interpretation of the results as well as a proposed scheme for reporting of the results. Methods A neonatal screening programme on liquid cord blood has been performed in all labour wards in Brussels since 1994. Using that material, the screening methods of isoelectric focusing and capillary zone electrophoresis were compared using 962 cord blood samples. From December 2008 to December 2010, 47,388 neonatal samples were analysed by capillary electrophoresis as the first-line method for neonatal screening. High-performance liquid chromatography was used as the second-line method. Results Capillary zone electrophoresis on liquid cord blood enabled the detection of all clinically significant haemoglobin variants, significant levels of Hb Bart's, and β-thalassaemia major. Among the 47,388 neonatal samples tested, 362 (0.7%) were suspected to be contaminated with maternal blood, but no diagnostic error was reported retrospectively for a major haemoglobinopathy. Recommendations for the interpretation and reporting of results of neonatal screening for haemoglobinopathies using the Sebia Haemoglobin kit are proposed. Conclusions A routine capillary electrophoresis kit adapted to neonatal screening and liquid cord blood is reliable for screening for haemoglobinopathies. It enables early detection and reporting of all major haemoglobinopathies and most minor ones. It also enables use of a simple scheme to report the results.
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Affiliation(s)
| | | | - Béatrice Gulbis
- Laboratory of Clinical Chemistry, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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First conference of the worldwide initiative on social studies of haemoglobinopathies: sickle cell over the next 100 years. Am J Prev Med 2011; 41:S413-6. [PMID: 22099366 DOI: 10.1016/j.amepre.2011.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 08/14/2011] [Accepted: 09/07/2011] [Indexed: 01/08/2023]
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Williams TN, Obaro SK. Sickle cell disease and malaria morbidity: a tale with two tails. Trends Parasitol 2011; 27:315-20. [PMID: 21429801 DOI: 10.1016/j.pt.2011.02.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 02/15/2011] [Accepted: 02/18/2011] [Indexed: 01/19/2023]
Abstract
More than 230,000 children are born in Africa with sickle cell disease (SCD) each year: approximately 85% of all affected births worldwide. Although malaria is commonly viewed as a major problem for African patients with this condition, questions still remain about its relative importance as a cause of ill heath and death. In the absence of definitive studies investigating the contribution of malaria to morbidity and mortality in African children with SCD, policy makers will continue to lack the evidence on which to base appropriate management guidelines.
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Affiliation(s)
- Thomas N Williams
- KEMRI Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.
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High mortality from Plasmodium falciparum malaria in children living with sickle cell anemia on the coast of Kenya. Blood 2010; 116:1663-8. [PMID: 20530796 DOI: 10.1182/blood-2010-01-265249] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although malaria is widely considered a major cause of death in young children born with sickle cell anemia (SCA) in sub-Saharan Africa, this is poorly quantified. We attempted to investigate this question through 4 large case-control analyses involving 7164 children living on the coast of Kenya. SCA was associated with an increased risk of admission to hospital both with nonmalaria diseases in general (odds ratio [OR] = 4.17; 95% confidence interval [CI], 1.95-8.92; P < .001) and with invasive bacterial diseases in particular (OR = 8.73; 95% CI, 4.51-16.89; P < .001). We found no evidence for a strongly increased risk of either uncomplicated malaria (OR = 0.43; 95% CI, 0.09-2.10; P = .30) or malaria complicated by a range of well-described clinical features of severity (OR = 0.80; 95% CI, 0.25-2.51; P = .70) overall; nevertheless, mortality was considerably higher among SCA than non-SCA children hospitalized with malaria. Our findings highlight both the central role that malaria plays in the high early mortality seen in African children with SCA and the urgent need for better quantitative data. Meanwhile, our study confirms the importance of providing all children living with SCA in malaria-endemic areas with effective prophylaxis.
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