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Halim-Fikri BH, Lederer CW, Baig AA, Mat-Ghani SNA, Syed-Hassan SNRK, Yusof W, Abdul Rashid D, Azman NF, Fucharoen S, Panigoro R, Silao CLT, Viprakasit V, Jalil N, Mohd Yasin N, Bahar R, Selvaratnam V, Mohamad N, Nik Hassan NN, Esa E, Krause A, Robinson H, Hasler J, Stephanou C, Raja-Sabudin RZA, Elion J, El-Kamah G, Coviello D, Yusoff N, Abdul Latiff Z, Arnold C, Burn J, Kountouris P, Kleanthous M, Ramesar R, Zilfalil BA. Global Globin Network Consensus Paper: Classification and Stratified Roadmaps for Improved Thalassaemia Care and Prevention in 32 Countries. J Pers Med 2022; 12:jpm12040552. [PMID: 35455667 PMCID: PMC9032232 DOI: 10.3390/jpm12040552] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/06/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
The Global Globin Network (GGN) is a project-wide initiative of the Human Variome/Global Variome Project (HVP) focusing on haemoglobinopathies to build the capacity for genomic diagnosis, clinical services, and research in low- and middle-income countries. At present, there is no framework to evaluate the improvement of care, treatment, and prevention of thalassaemia and other haemoglobinopathies globally, despite thalassaemia being one of the most common monogenic diseases worldwide. Here, we propose a universally applicable system for evaluating and grouping countries based on qualitative indicators according to the quality of care, treatment, and prevention of haemoglobinopathies. We also apply this system to GGN countries as proof of principle. To this end, qualitative indicators were extracted from the IthaMaps database of the ITHANET portal, which allowed four groups of countries (A, B, C, and D) to be defined based on major qualitative indicators, supported by minor qualitative indicators for countries with limited resource settings and by the overall haemoglobinopathy carrier frequency for the target countries of immigration. The proposed rubrics and accumulative scores will help analyse the performance and improvement of care, treatment, and prevention of haemoglobinopathies in the GGN and beyond. Our proposed criteria complement future data collection from GGN countries to help monitor the quality of services for haemoglobinopathies, provide ongoing estimates for services and epidemiology in GGN countries, and note the contribution of the GGN to a local and global reduction of disease burden.
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Affiliation(s)
- Bin Hashim Halim-Fikri
- Malaysian Node of the Human Variome Project Secretariat, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (B.H.H.-F.); (S.-N.R.-K.S.-H.); (W.Y.)
| | - Carsten W. Lederer
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, Ayios Dometios, Nicosia 2371, Cyprus; (C.W.L.); (C.S.); (P.K.); (M.K.)
| | - Atif Amin Baig
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu 20400, Terengganu, Malaysia;
| | - Siti Nor Assyuhada Mat-Ghani
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (S.N.A.M.-G.); (N.N.N.H.)
| | - Sharifah-Nany Rahayu-Karmilla Syed-Hassan
- Malaysian Node of the Human Variome Project Secretariat, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (B.H.H.-F.); (S.-N.R.-K.S.-H.); (W.Y.)
| | - Wardah Yusof
- Malaysian Node of the Human Variome Project Secretariat, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (B.H.H.-F.); (S.-N.R.-K.S.-H.); (W.Y.)
| | - Diana Abdul Rashid
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (D.A.R.); (N.F.A.); (N.M.)
| | - Nurul Fatihah Azman
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (D.A.R.); (N.F.A.); (N.M.)
| | - Suthat Fucharoen
- Thalassemia Research Centre, Institute of Molecular Biosciences, Mahidol University, Nakhom Pathom 73170, Thailand;
| | - Ramdan Panigoro
- Department of Biomedical Sciences, Medical Genetics Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia;
| | - Catherine Lynn T. Silao
- Institute of Human Genetics, National Institutes of Health, University of the Philippines, Manila 1000, Philippines;
- Department of Pediatrics, College of Medicine, University of the Philippines, Manila 1000, Philippines
| | - Vip Viprakasit
- Department of Paediatrics & Thalassaemia Centre, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Norunaluwar Jalil
- UKM Specialist Children’s Hospital, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia;
| | - Norafiza Mohd Yasin
- Haematology Unit, Cancer Research Centre, Institute for Medical Research, National Institutes of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, Shah Alam 40170, Selangor Darul Ehsan, Malaysia; (N.M.Y.); (E.E.)
| | - Rosnah Bahar
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Veena Selvaratnam
- Hospital Ampang, Jalan Mewah Utara, Taman Pandan Mewah, Ampang Jaya 68000, Selangor, Malaysia;
| | - Norsarwany Mohamad
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (D.A.R.); (N.F.A.); (N.M.)
| | - Nik Norliza Nik Hassan
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia; (S.N.A.M.-G.); (N.N.N.H.)
| | - Ezalia Esa
- Haematology Unit, Cancer Research Centre, Institute for Medical Research, National Institutes of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Bandar Setia Alam, Shah Alam 40170, Selangor Darul Ehsan, Malaysia; (N.M.Y.); (E.E.)
| | - Amanda Krause
- Division of Human Genetics, National Health Laboratory Service (NHLS) and School of Pathology, Faculty of Health Sciences, The University of the Witwatersrand, Watkins Pitchford Building, NHLS Braamfontein, Cnr Hospital and De Korte St, Hillbrow, P.O. Box 1038, Johannesburg 2000, South Africa;
| | - Helen Robinson
- Nossal Institute for Global Health, MDDHS, University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Julia Hasler
- Global Variome, Institute of Genetic Medicine, International Centre for Life, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK;
| | - Coralea Stephanou
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, Ayios Dometios, Nicosia 2371, Cyprus; (C.W.L.); (C.S.); (P.K.); (M.K.)
| | - Raja-Zahratul-Azma Raja-Sabudin
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia;
| | - Jacques Elion
- Medical School, Université Paris Diderot, 75018 Paris, France;
| | - Ghada El-Kamah
- Clinical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Cairo 12622, Egypt;
| | - Domenico Coviello
- Laboratorio di Genetica Umana, IRCCS Istituto Giannina Gaslini, Largo Gerolamo Gaslini 5, 16147 Genova, Italy;
| | - Narazah Yusoff
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Kepala Batas 13200, Pulau Pinang, Malaysia;
| | - Zarina Abdul Latiff
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Kuala Lumpur, Malaysia;
| | - Chris Arnold
- BioGrid Australia, Hodgson Associates, 4 Hodgson St., Kew, Melbourne, VIC 3101, Australia;
| | - John Burn
- Translational and Clinical Research Institute, International Centre for Life Times Square, Newcastle upon Tyne NE1 3BZ, UK;
| | - Petros Kountouris
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, Ayios Dometios, Nicosia 2371, Cyprus; (C.W.L.); (C.S.); (P.K.); (M.K.)
| | - Marina Kleanthous
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, Ayios Dometios, Nicosia 2371, Cyprus; (C.W.L.); (C.S.); (P.K.); (M.K.)
| | - Raj Ramesar
- Department of Pathology, University of Cape Town City of Cape Town, Cape Town 7925, South Africa;
| | - Bin Alwi Zilfalil
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: or ; Tel.: +60-9767-6531
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Jonathan A, Tutuba H, Lloyd W, Ndunguru J, Makani J, Ruggajo P, Minja IK, Balandya E. Healthcare Workers' Knowledge and Resource Availability for Care of Sickle Cell Disease in Dar es Salaam, Tanzania. Front Genet 2022; 12:773207. [PMID: 35222514 PMCID: PMC8873977 DOI: 10.3389/fgene.2021.773207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/29/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Sickle cell disease (SCD) is a global public health priority due to its high morbidity and mortality. In Tanzania, SCD accounts for 7% of under-five mortality. Cost-effective interventions such as early diagnosis and linkage to care have been shown to prevent 70% of deaths but require knowledge among healthcare workers and availability of resources at health facilities. In Tanzania, data on these critical determinants are currently lacking. Objective: To assess healthcare workers' knowledge and resource availability for care of SCD at health facilities in Dar es Salaam, Tanzania. Methodology: A facility-based cross-sectional study was conducted between December 2020 and February 2021 among 490 nurses and clinicians at Regional Referral Hospitals (Temeke, Amana, and Mwananyamala) and Muhimbili National Hospital in Dar es Salaam, Tanzania. Data were collected using a pre-tested structured questionnaire consisting of 13 knowledge questions (scored good knowledge if correct response in >7) and an inventory check list to record available resources. Pearson's χ2 was used to determine the association between level of knowledge and demographic factors. Multivariate logistic regression was used to ascertain the strength of associations. A two-tailed p-value <0.05 was considered to be statistically significant. Results: Of the 490 participants (median age 28 years [IQR = 26-35]), only 25.1% had good knowledge on SCD. The odds of good knowledge was 82% lower in nurses than clinicians (AOR = 0.177; 95% CI: 0.090, 0.349; p < 0.001); 95% lower in diploma than Master's degree holders (AOR = 0.049; 95% CI: 0.008, 0.300; p = 0.001) and 4.6 times higher in those with 5-9 years than ≥10 years of experience (AOR = 4.564; 95% CI: 1.341, 15.525; p = 0.015). The regional-level hospitals lacked diagnostic tests and hydroxyurea therapy. Conclusion: There was general lack of knowledge on SCD among healthcare workers and limited availability of critical resources for the diagnosis and care of SCD, especially at regional-level hospitals. Efforts are needed for their improvement to enhance care to patients, thus reducing the morbidity and mortality due to SCD in Tanzania.
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Affiliation(s)
- Agnes Jonathan
- Sickle Pan-African Research Consortium (SPARCO)-Tanzania, Dar es Salaam, Tanzania,Sickle Cell Program, Department of Hematology and Blood Transfusion, MUHAS, Dar es Salaam, Tanzania,*Correspondence: Agnes Jonathan,
| | - Hilda Tutuba
- Sickle Pan-African Research Consortium (SPARCO)-Tanzania, Dar es Salaam, Tanzania,Sickle Cell Program, Department of Hematology and Blood Transfusion, MUHAS, Dar es Salaam, Tanzania
| | - William Lloyd
- Sickle Cell Program, Department of Hematology and Blood Transfusion, MUHAS, Dar es Salaam, Tanzania
| | - Joyce Ndunguru
- Sickle Pan-African Research Consortium (SPARCO)-Tanzania, Dar es Salaam, Tanzania,Sickle Cell Program, Department of Hematology and Blood Transfusion, MUHAS, Dar es Salaam, Tanzania
| | - Julie Makani
- Sickle Pan-African Research Consortium (SPARCO)-Tanzania, Dar es Salaam, Tanzania,Sickle Cell Program, Department of Hematology and Blood Transfusion, MUHAS, Dar es Salaam, Tanzania
| | - Paschal Ruggajo
- Sickle Pan-African Research Consortium (SPARCO)-Tanzania, Dar es Salaam, Tanzania,Department of Internal Medicine, MUHAS, Dar es Salaam, Tanzania
| | - Irene K. Minja
- Sickle Pan-African Research Consortium (SPARCO)-Tanzania, Dar es Salaam, Tanzania,Department of Restorative Dentistry, MUHAS, Dar es Salaam, Tanzania
| | - Emmanuel Balandya
- Sickle Pan-African Research Consortium (SPARCO)-Tanzania, Dar es Salaam, Tanzania,Department of Physiology, MUHAS, Dar es Salaam, Tanzania
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Chimbatata CS, Chisale MR, Kayira AB, Sinyiza FW, Mbakaya BC, Kaseka PU, Kamudumuli P, Wu TSJ. Paediatric sickle cell disease at a tertiary hospital in Malawi: a retrospective cross-sectional study. BMJ Paediatr Open 2021; 5:e001097. [PMID: 34568588 PMCID: PMC8438882 DOI: 10.1136/bmjpo-2021-001097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) remains a major cause of childhood mortality and morbidity in Malawi. However, literature to comprehensively describe the disease in the paediatric population is lacking. METHODS A retrospective review of clinical files of children with SCD was conducted. Descriptive statistics were performed to summarise the data. χ2 or Fisher's exact test was used to look for significant associations between predictor variables and outcome variables (case fatality and length of hospital stay). Predictor variables that were significantly associated with outcome variables (p≤0.05) in a χ2 or Fisher's exact test were carried forward for analysis in a binary logistic regression. A multivariable binary logistic regression was used to identify covariates that independently predicted length of hospital stay. RESULTS There were 16 333 paediatric hospitalisations during the study period. Of these, 512 were patients with SCD representing 3.1% (95% CI: 2.9%- 3.4%). Sixty-eight of the 512 children (13.3%; 95% CI: 10.5% - 16.5%) were newly diagnosed cases. Of these, only 13.2% (95% CI: 6.2% - 23.6%) were diagnosed in infancy. Anaemia (94.1%), sepsis (79.5%) and painful crisis (54.3%) were the most recorded clinical features. The mean values of haematological parameters were as follows: haemoglobin (g/dL) 6.4 (SD=1.9), platelets (×109/L) 358.8 (SD=200.9) while median value for white cell count (×109/L) was 23.5 (IQR: 18.0-31.2). Case fatality was 1.4% (95% CI: 0.6% - 2.8%)and 15.2% (95% CI: 12.2% -18.6%) of the children had a prolonged hospital stay (>5 days). Patients with painful crisis were 1.7 (95% CI: 1.02 - 2.86) times more likely to have prolonged hospital stay than those without the complication. CONCLUSION Anaemia, sepsis and painful crisis were the most common clinical features paediatric patients with SCD presented with. Patients with painful crisis were more likely to have prolonged hospital stay. Delayed diagnosis of SCD is a problem that needs immediate attention in this setting. Although somewhat encouraging, the relatively low in-hospital mortality among SCD children may under-report the true mortality from the disease considering community deaths and deaths occurring before SCD diagnosis is made.
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Affiliation(s)
| | - Master Ro Chisale
- Biological Sciences, Mzuzu University Faculty of Health Sciences, Mzuzu, Northern Region, Malawi.,Laboratory, Mzuzu Central Hospital, Mzuzu, Northern Region, Malawi
| | | | | | | | | | - Pocha Kamudumuli
- University of Maryland Global Initiatives Corporation Baltimore, Lilongwe, Central Region, Malawi
| | - Tsung-Shu Joseph Wu
- Luke International, Mzuzu, Northern Region, Malawi.,Ping Tung Christian Hospital, Pingtung, Taiwan
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