Neonatal prevalence of the sickle cell gene at mulago hospital.

Abstract

BACKGROUND: Sickle cell anaemia is a public health problem in Uganda. It contributes significantly to childhood deaths most of which occur during the first year of life. Uganda has one of the highest adult frequencies of sickle cell trait in the world and a very high mortality due to sickle cell anaemia during infancy. Neonatal diagnosis coupled with parental education and comprehensive care has been shown to reduce morbidity and mortality markedly in non-malarias areas. Neonatal diagnosis of sickle cell disease is not offered in Uganda. There is no information on the prevalence of sickle cell anaemia in newborns in Uganda. Information on the prevalence of sickle cell anaemia is essential to support the introduction of universal screening of sickle cell anaemia in new born babies. OBJECTIVE: To determine the prevalence of the sickle cell gene in newborns in mulago national referral hospital. METHODS: A Descriptive cross-section study was carried out in mulago national referral hospital between November and December 2007. Cord blood of 384 newborn babies was tested for the sickle haemoglobin using acetate electrophoresis at alkaline PH (8.4-8.6). RESULTS: Babies who had the sickle cell gene were 14.6% (56). Babies with sickle cell anaemia (FS) were 3.9% (15) {95% C1 (2.3-6.5%)} and those with sickle cell trait (FAS) were 10.7% (41) {95%C1(7.9-14.3%)}. Three (0.8%) babies had haemoglobin C gene {95%C1 (0.2-2.5%)}. Within the Baganda ethnic group, 14.8% of the babies had the sickle cell gene. Babies with the sickle cell gene within the Basoga and Banyankole ethnic groups were 28.6% and 16.7% respectively. Other ethnic groups had very low representation in this study. CONCLUSIONS: Fifty six children with sickle cell gene, 15 of whom had sickle cell anaemia were indentified. This would translate to 80 children born with sickle cell anaemia out of the 2000 births which occur in mulago hospital in a month. There was ethnic variation of the sickle cell gene. RECOMMENDATIONS: A policy on universal screening of newborns at mulago hospital should be considered as a priority, and the frequency of sickle cell gene should be determined in other parts of the country in order to consider extending this policy to include similar settings.