Prevalence and associated factors for vaso occlusive episode in children with sickle cell anaemia at Mulago National Referral Hospital

Abstract

Background: Sickle cell Anaemia (SCA) is characterized by a number of complications of which pain or vaso-occlusive crisis is most common and severe often requiring Emergency department (ED) visists for pain management. The frequencies of Vaso occlusive crisis (VOC) in our setting is however unknown. Identification of factors associated with Vaso occlusive crisis helps strengthen the preventive measures to the crisis, hence reduce time and resources spent in the management of the crisis, prevent the crisis and improve quality of life of these patients. This study set out to determine the prevalence and associated factors for vaso-occlusive episodes among children with sickle cell anaemia aged 6 months to 15 years at Mulago National Referral Hospital. Method. A crossectional study design was employed, data was collected using structured questionnaire. Descriptive analysis was conducted to determine the prevalence of VOC. Bivariate analysis of outcome variables (VOC yes/no) was done for each factor using the fisher’s exact test. Significant factors at bivariate level were analyzed at multivariate level using multiple regression techniques.Results: A total of 406 children were recruited, the majority of whom were 6-11yrs (44.8%) age range. The prevalence of VOC was 74.38% (95% CI: 70.36 – 79.82). Prevalence was highest among age groups12-15yrs (82.6%). Children aged under 6yrs had a lower chance of getting the crisis than older children (aOR 0.67 (95%CI: 0.23-0.89, p < .05)), while children on Hydroxyurea and those that received Phenoxymethylpenicilline prohylaxis were lesslikely to experience VOC (aOR 0.54, 0.33- 0.86 CI, p< 0.001) and (aOR 0.31, % CI 0.177- 0.45, P < 0.05) respectively. Children whose care takers gave adequate oral fluids had less chance of getting VOC than their counter parts (aOR 0.90, 95% CI: 0.17 – 0.98, P< 0.05). Conclusion: We found a high prevlance of VOC among children with SCA aged 6 months to 15 years attending the Acute Care Unit at Mulago, higher prevalence observed in those aged 6 years and above. Receiving prophylactic medications and adequate fluid intake were noted to be protective. Recommendations: There is need to emphasize on adequate hydration and adherence to prophylactic drugs (Hydroxyurea and Phenoxymethylpenicilline) especially in children above 6 yrs with sicklecell anaemia.