Sickle Cell Anaemia among Tharu Population Visiting the Outpatient Department of General Medicine in a Secondary Care Centre: A Descriptive Cross-sectional Study

INTRODUCTION

Sickle cell anaemia is a global health issue in which a mutation of the β-globin gene changes normal haemoglobin in sickle-shaped red blood cells. The objective of this study was to find out the prevalence of sickle cell anaemia among the Tharu population visiting the outpatient Department of General Medicine in a secondary care centre.

METHODS

A descriptive cross-sectional study was conducted among the Tharu population in the Department of General Medicine of a secondary care centre from 10 January 2020 to 10 June 2022. Ethical approval was taken from the Institutional Review Committee of the same institute (Reference number: 590/2076-077). A convenience sampling technique was used. Point estimate and 95% Confidence Interval were calculated.

RESULTS

Out of 409 patients, 60 (14.67%) (11.24-18.10, 95% Confidence Interval) had sickle cell anaemia. Among them, 45 (75%) patients had sickle cell trait and 15 (25%) patients had sickle cell disease.

CONCLUSIONS

The prevalence of sickle cell anaemia was higher when compared to other studies conducted in similar settings. The government needs to emphasise more effort in diagnosing cases as well as increasing the testing centre.

The Assessment and Sustainable Management of Sickle Cell Disease in the Indigenous Tharu Population of Nepal

Sickle cell disease is an inherited hemoglobinopathy associated with significant morbidity and mortality. Reports suggest a high sickle cell disease burden among the indigenous Tharu population of Nepal, who for centuries have inhabited regions where malaria is endemic. Unfortunately, health care resources are limited and often inaccessible for Tharu individuals suffering from sickle cell disease. We conducted a large-scale screening effort to estimate the prevalence of Hb S (HBB: c.20A>T) among the Tharu population and delivered community-based education sessions to increase sickle cell disease awareness. A total of 2899 Tharu individuals aged 6 months to 40 years in the rural district of Dang in Western Nepal were screened using a sickling test, of whom, 271 [9.3%; 95% confidence interval (95% CI): 8.3-10.4%] screened positive for Hb S. Those who screened positive were offered diagnostic gel electrophoresis testing. Of the 133 individuals who underwent diagnostic testing, 75.9% (n = 101) were confirmed to be Hb AS heterozygotes, 4.5% (n = 6) were confirmed to be Hb SS homozygotes and 19.5% (n = 26) were false positives. These findings support a large burden of sickle cell disease among the Tharu population and highlight the importance of appropriate resource allocation and management. With a positive predictive value of 80.0% (95% CI: 73.0-87.0%), the sickling test in conjunction with raising local sickle cell disease awareness may be a simple and sustainable way to promote access to health resources.