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Sumedha D, Anita K. Prevalence of beta thalassemia carriers in India: a systematic review and meta-analysis. J Community Genet 2023; 14:527-541. [PMID: 37861936 PMCID: PMC10725409 DOI: 10.1007/s12687-023-00683-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
A large number of studies have reported that the prevalence of beta thalassemia carriers in India varies by ethnic groups. The objective of this study was to conduct a systematic review of the published studies and conduct a meta-analysis to determine the prevalence of beta thalassaemia carriers in India. A PubMed database search using keywords "beta thalassaemia AND India" identified 1088 articles of which 69 articles were included in the review. Studies using diagnostic tests and methods recommended by the International Council for Standardization in Haematology were used for calculation of pooled prevalence. Pooled prevalence was calculated using a random effects model using Review Manager version 5.3. Studies had screened five categories of populations, that is, the general population; tribal groups, communities not belonging to tribal groups, persons with anemia, and persons referred with a suspicion of hemoglobinopathy. This heterogeneity contributed to a high pooled prevalence of beta thalassemia carriers of 8.23% (95% CI 7.36-9.10). Sub-group analysis however yielded 3.74% (95% CI 2.52-4.97) pooled prevalence of beta thalassemia carriers in the general population. It was 4.6% (95% CI 3.2-6.2) among tribal groups. Quality of prevalence studies was limited by methodological issues including non-random sampling methods, heterogeneity of population types screened, and lack of use of recommended diagnostic cut-offs. Prevalence of beta thalassemia carriers was similar in tribal populations and the general population, indicating the need to further investigate the prevalence of beta thalassemia carriers in tribal groups.
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Affiliation(s)
- Dharmarajan Sumedha
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University (University of Pune), Pune, 411007, India
| | - Kar Anita
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University (University of Pune), Pune, 411007, India.
- Birth Defects Research Foundation, Pune, 411020, India.
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Colombatti R, Hegemann I, Medici M, Birkegård C. Systematic Literature Review Shows Gaps in Data on Global Prevalence and Birth Prevalence of Sickle Cell Disease and Sickle Cell Trait: Call for Action to Scale Up and Harmonize Data Collection. J Clin Med 2023; 12:5538. [PMID: 37685604 PMCID: PMC10488271 DOI: 10.3390/jcm12175538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited monogenic disorder with high prevalence throughout sub-Saharan Africa, the Mediterranean basin, the Middle East, and India. Sources of SCD epidemiology remain scarce and fragmented. A systematic literature review (SLR) to identify peer-reviewed studies on SCD epidemiology was performed, with a search of bibliographic databases and key conference proceedings from 1 January 2010 to 25 March 2022 (congress abstracts after 2018). The SLR followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Meta-analyses, using a binomial normal random-effects model, were performed to estimate global and regional prevalence and birth prevalence. Of 1770 journal articles and 468 abstracts screened, 115 publications met the inclusion criteria. Prevalence was highest in Africa (~800/100,000), followed by the Middle East (~200/100,000) and India (~100/100,000), in contrast to ~30/100,000 in Europe. Birth prevalence was highest in Africa (~1000/100,000) and lowest in North America (~50/100,000) and Europe (~30/100,000). This SLR confirmed that sub-Saharan and North-East Africa, India, the Middle East, and the Caribbean islands are global SCD hotspots. Publications including mortality data were sparse, and no conclusions could be drawn about mortality. The identified data were limited due to gaps in the published literature for large parts of the world population; the inconsistent reporting of SCD genotypes, diagnostic criteria, and settings; and a sparsity of peer-reviewed publications from countries with assumed high prevalence. This SLR demonstrated a lack of systematic knowledge and a need to provide uniform data collection on SCD prevalence and mortality.
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Affiliation(s)
- Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Department of Child and Maternal Health, Azienda Ospedaliera, University of Padova, 35122 Padua, Italy
| | | | - Morten Medici
- Novo Nordisk A/S, 2860 Søborg, Denmark; (M.M.); (C.B.)
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Scott S, Lahiri A, Sethi V, de Wagt A, Menon P, Yadav K, Varghese M, Joe W, Vir SC, Nguyen PH. Anaemia in Indians aged 10–19 years: Prevalence, burden and associated factors at national and regional levels. MATERNAL & CHILD NUTRITION 2022; 18:e13391. [PMID: 35719126 PMCID: PMC9480897 DOI: 10.1111/mcn.13391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Samuel Scott
- International Food Policy Research Institute New Delhi India
| | - Anwesha Lahiri
- MRC Epidemiology Unit, Institute of Metabolic Science University of Cambridge School of Clinical Medicine Cambridge UK
- Population Research Centre, Institute of Economic Growth New Delhi India
| | - Vani Sethi
- Nutrition Division, UNICEF New Delhi India
| | | | - Purnima Menon
- International Food Policy Research Institute New Delhi India
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences New Delhi India
| | | | - William Joe
- Population Research Centre, Institute of Economic Growth New Delhi India
| | - Sheila C. Vir
- Public Health Nutrition and Development Centre New Delhi India
| | - Phuong Hong Nguyen
- International Food Policy Research Institute Washington District of Columbia USA
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Abstract
India bears a huge burden of hemoglobinopathies, and the most prevalent is thalassemia. The different types of thalassemia include minor, major and intermedia, based on the α/β-globin chain inequality. This review aimed to understand the current prevalence of thalassemia in different regions of India and communities affected by it, along with the management of β-thalassemia major (β-TM) and β-thalassemia (β-thal) minor patients. A comprehensive electronic search for relevant articles was conducted using two databases, i.e. PubMed and Science Direct. Articles published in English from India between January 2009 and September 2021 were included. Studies from other countries, genetic and molecular characterization studies, and articles published in other languages were excluded. The prevalence of β-thal trait in Central India ranged between 1.4 and 3.4%, while 0.94% β-TM was reported among the patients with anemia. In South India, the prevalence of β-thal trait was between 8.50 and 37.90% and β-TM was reported to be between 2.30 and 7.47%. Northern and Western Indian states had a higher thalassemic burden. In Eastern India, tribal populations had a higher prevalence of β-thal trait (0.00-30.50%), β-TM (0.36-13.20%) and other hemoglobinopathies [Hb E (HBB: c.79G>A)/β-thal] (0.04-15.45%) than nontribal populations. Additionally, scheduled castes, scheduled tribes and other backward classes of low socioeconomic status and low literacy rates were affected by β-thal. Almost all Indian states reported β-thal; however, it is mostly concentrated in eastern and western parts of the country. Well-integrated strategies and effective implementation are needed at State and National levels to minimize the burden of β-thal.
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Affiliation(s)
- Surabhi S Yadav
- Nutrition and Dietetics Programme, Symbiosis Institute of Health Sciences (SIHS), Symbiosis International (Deemed University), Pune, India
| | - Pooja Panchal
- Nutrition and Dietetics Programme, Symbiosis Institute of Health Sciences (SIHS), Symbiosis International (Deemed University), Pune, India
| | - Kavitha C Menon
- Nutrition and Dietetics Programme, Symbiosis Institute of Health Sciences (SIHS), Symbiosis International (Deemed University), Pune, India
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Dharmarajan S, Pawar A, Bhide P, Kar A. Undiagnosed haemoglobinopathies among pregnant women attending antenatal care clinics in Pune, India. J Community Genet 2021; 12:337-344. [PMID: 33486692 PMCID: PMC8241948 DOI: 10.1007/s12687-021-00505-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022] Open
Abstract
Pregnant women with iron deficiency and those who are carriers of haemoglobinopathies present with anaemia of varying severity. There is no antenatal screening for haemoglobinopathies in India. The objective of this study was to determine the prevalence of undiagnosed haemoglobinopathy carriers in a random sample of pregnant women attending antenatal care clinics in Pune city, India. Biobanked DNA of 360 randomly selected pregnant women was genotyped for six common mutations and two common haemoglobin variants, HbS and HbE. Odds ratios (OR) with 95% confidence intervals were computed to determine association of carrier status with socio-demographic, haematological and clinical characteristics. The prevalence of undiagnosed haemoglobinopathy carriers was 6.3% (95% CI 4.2-9.4%) of which 3.3% (95% CI 1.9-5.7%) were beta thalassaemia carriers. There was an increased odds that beta thalassaemia carriers had moderate anaemia (OR 10.59, 95% CI 1.15-96.90). This study reveals the high prevalence of undiagnosed haemoglobinopathy carriers among pregnant women, indicating the need to immediately implement carrier screening and genetic counselling services across the country.
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Affiliation(s)
- Sumedha Dharmarajan
- School of Health Sciences, Savitribai Phule Pune University (University of Pune), Pune, 411007, India
| | - Ameya Pawar
- Department of Microbiology, Modern College of Arts, Science & Commerce, Pune, India
| | - Prajkta Bhide
- School of Health Sciences, Savitribai Phule Pune University (University of Pune), Pune, 411007, India
| | - Anita Kar
- School of Health Sciences, Savitribai Phule Pune University (University of Pune), Pune, 411007, India.
- Birth Defects and Childhood Disability Research Centre, Pune, 411020, India.
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Abstract
Sickle-cell anaemia (SCA) is a neglected chronic disorder of increasing global health importance, with India estimated to have the second highest burden of the disease. In the country, SCA is particularly prevalent in scheduled populations, which comprise the most socioeconomically disadvantaged communities. We compiled a geodatabase of a substantial number of SCA surveys carried out in India over the last decade. Using generalised additive models and bootstrapping methods, we generated the first India-specific model-based map of sickle-cell allele frequency which accounts for the district-level distribution of scheduled and non-scheduled populations. Where possible, we derived state- and district-level estimates of the number of SCA newborns in 2020 in the two groups. Through the inclusion of an additional 158 data points and 1.3 million individuals, we considerably increased the amount of data in our mapping evidence-base compared to previous studies. Highest predicted frequencies of up to 10% spanned central India, whilst a hotspot of ~12% was observed in Jammu and Kashmir. Evidence was heavily biased towards scheduled populations and remained limited for non-scheduled populations, which can lead to considerable uncertainties in newborn estimates at national and state level. This has important implications for health policy and planning. By taking population composition into account, we have generated maps and estimates that better reflect the complex epidemiology of SCA in India and in turn provide more reliable estimates of its burden in the vast country. This work was supported by European Union’s Seventh Framework Programme (FP7//2007–2013)/European Research Council [268904 – DIVERSITY]; and the Newton-Bhabha Fund [227756052 to CH]
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Saxena D, Yasobant S, Golechha M. Situational Analysis of Sickle Cell Disease in Gujarat, India. Indian J Community Med 2017; 42:218-221. [PMID: 29184322 PMCID: PMC5682721 DOI: 10.4103/ijcm.ijcm_284_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Sickle cell disease (SCD) is a major public health concern in tribal community not only in Gujarat but also globally. Gujarat, a western state of India, has 89.12 lakh tribal populations and is expected to have at least 9,00,000 sickle cell trait and 70,000 SCD patients. The aim of the present review is to document the prevalence of SCD in various communities and various screening methods adapted. Methodology: An in-depth literature review was carried out using available search engines such as Cochrane Library, PubMed, Scopus etc. and published articles, and government reports/policy documents with reference to SCD were gathered. Results: A total of 17 original research articles and 2 policy/program documents are included in this review. The review suggests a prevalence of 0.6%–35% studies conducted among medical students, tribal schoolchildren, and tribal adolescents, with diverse screening methodologies. Conclusion: A diverse prevalence is observed in this review. Various screening methods such as dithionite turbidity test/hemoglobin/high-performance liquid chromatography methods were used to estimate the prevalence, citing the need for standardization. It was also found that not only tribal population, but also nontribal population have the risk of getting SCD that needs to be further investigated properly. Qualitative studies with SCD patients are required to understand the quality of life and morbidity pattern.
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Affiliation(s)
- Deepak Saxena
- Department of Epidemiology, Indian Institute of Public Health Gandhinagar, Gujarat, India
| | - Sandul Yasobant
- Center for Development Research (ZEF), University of Bonn, Germany
| | - Mahaveer Golechha
- Department of Epidemiology, Indian Institute of Public Health Gandhinagar, Gujarat, India
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Gomez S, Diawara A, Gbeha E, Awadalla P, Sanni A, Idaghdour Y, Rahimy MC. Comparative Analysis of Iron Homeostasis in Sub-Saharan African Children with Sickle Cell Disease and Their Unaffected Siblings. Front Pediatr 2016; 4:8. [PMID: 26942167 PMCID: PMC4762986 DOI: 10.3389/fped.2016.00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/01/2016] [Indexed: 01/19/2023] Open
Abstract
Iron is an essential trace element subject to tight regulation to ensure adequate running of biological processes. In sub-Saharan Africa where hemoglobinopathies are common, iron homeostasis is likely to be impaired by these conditions. Here, we assessed and compared key serum proteins associated with iron metabolism between sub-Saharan African children with sickle cell disease (SCD) and their unaffected siblings. Complete blood counts and serum concentrations of four key proteins involved in iron regulation (ferritin, transferrin, sTfR, and hepcidin) were measured for 73 children with SCD and 68 healthy siblings in Benin, West Africa. We found significant differences in concentration of transferrin, sTfR, and ferritin between the two groups. Hepcidin concentrations were found at unusually high concentrations but did not differ among the two groups. We found a significant negative correlation between hepcidin levels and both MCH and MCV in the SCD group and report that sTfR concentrations show a correlation with MCV and MHC in opposite directions in the two groups. These results highlight the unusually high levels of hepcidin in the Beninese population and the patterns of differential iron homeostasis taking place under SCD status. These results lay the foundation for a systematic evaluation of the underlying mechanisms deregulating iron homeostasis in populations with SCD or high prevalence of iron deficiency.
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Affiliation(s)
- Selma Gomez
- Laboratoire de Biochimie et de Biologie Moléculaire, Faculté des Sciences et Techniques, University of Abomey-Calavi, Cotonou, Benin; Centre de Prise en charge Médicale Intégrée du Nourrisson et de la Femme Enceinte atteints de Drépanocytose, Faculté des Sciences de la Santé, University of Abomey-Calavi, Cotonou, Benin
| | - Aïssatou Diawara
- Biology Program, Division of Science and Mathematics, New York University Abu Dhabi , Abu Dhabi , United Arab Emirates
| | - Elias Gbeha
- Sainte-Justine Research Centre, Centre Hospitalier et Universitaire Sainte Justine , Montréal, QC , Canada
| | - Philip Awadalla
- Sainte-Justine Research Centre, Centre Hospitalier et Universitaire Sainte Justine , Montréal, QC , Canada
| | - Ambaliou Sanni
- Laboratoire de Biochimie et de Biologie Moléculaire, Faculté des Sciences et Techniques, University of Abomey-Calavi , Cotonou , Benin
| | - Youssef Idaghdour
- Biology Program, Division of Science and Mathematics, New York University Abu Dhabi , Abu Dhabi , United Arab Emirates
| | - M Cherif Rahimy
- Centre de Prise en charge Médicale Intégrée du Nourrisson et de la Femme Enceinte atteints de Drépanocytose, Faculté des Sciences de la Santé, University of Abomey-Calavi , Cotonou , Benin
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Abstract
The β-thalassemias and sickle cell disorders pose a major health burden in the large and diverse Indian population. Education programs for awareness generation are being done by National Institutions, non-governmental organizations and Thalassemia Societies in different states. Several extensive epidemiological studies have shown that there are many non-tribal and tribal communities where the prevalence of b-thalassemia carriers is much higher (5.3 to 17.0%) than the average of 3 to 4% projected for the entire country. These variations have also been shown within small geographic regions in some states, emphasizing the need for micro mapping to estimate the true burden of disease. There are 10 to 12 centers where prenatal diagnosis for hemoglobinopathies is done and the Indian Council of Medical Research is establishing additional regional centers in states where they are most needed. Sixtyeight b-thalassemia mutations have been described so far among Indians and the knowledge on their prevalence and regional distribution has helped to undertake prenatal diagnosis in a cost effective way.
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Tewari S, Rees D. Morbidity pattern of sickle cell disease in India: a single centre perspective. Indian J Med Res 2013; 138:288-90. [PMID: 24135171 PMCID: PMC3818589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sanjay Tewari
- Clinical Research Fellow in Paediatric Haematology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK,For correspondence:
| | - David Rees
- Professor of Paediatric Haematology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
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Molecular characterization of β-thalassemia in four communities in South Gujarat—codon 30 (G → A) a predominant mutation in the Kachhiya Patel community. Ann Hematol 2013; 92:1473-6. [DOI: 10.1007/s00277-013-1777-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 04/28/2013] [Indexed: 11/26/2022]
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Das R. Micro mapping the frequencies of beta thalassemia and sickle cell anemia in India: A way forward to plan control strategies. INDIAN JOURNAL OF HUMAN GENETICS 2012; 18:148-9. [PMID: 23162286 PMCID: PMC3491284 DOI: 10.4103/0971-6866.100748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Reena Das
- Department of Hematology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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