Prevalence and factors associated with splenomegaly among children aged 5 to 17 years with Sickle Cell Anemia attending Mulago Hospital, Kampala
Mwalimu, Mwende Catherine
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Background: The spleen is one of the main organs to be affected in Sickle cell anemia, this has been attributed to its complex anatomy and prominent reticuloendothelial functions. The spleen usually becomes palpably enlarged early in the life of a sickle cell anemia patient but then undergoes progressive atrophy due to repeated attacks of vaso occlusion and infarction leading to auto splenectomy. However, splenomegaly may persist later into childhood and in some even into adult life. Splenomegaly may predispose patients with SCA to acute splenic sequestration crisis, hypersplenism, increased susceptibility to infection and splenic abscess. Objective: The objective of this study was to determine the prevalence and factors associated with splenomegaly in children aged 5 to 17 years with sickle cell anemia at Mulago hospital. Methods: This was a cross sectional study to determine the prevalence of splenomegaly and the factors associated with splenomegaly among children with sickle cell anemia in Mulago National Referral Hospital, Kampala, Uganda. Systematic random sampling was used to enroll 212 children aged 5 to 17 years with SCA attending the sickle cell clinic at Mulago hospital whose parents had given informed consent. A detailed history was obtained and physical examination was performed to assess the current state of each patient. Blood samples were drawn for complete blood count, blood smear for malaria parasite and HIV antibody testing. The patients were later taken for abdominal ultrasound scan to help determine the actual size of the spleen. The main outcome/dependent variable was splenomegaly, which was expressed as a proportion while the independent variables assessed was analysed by logistic regression model. Data was entered using EPI data version 3.1 and analysed using STATA version 14.0. Ethical approval was obtained from the School of Medicine Research and Ethics Committee. Informed consent was sought from the parents or guardians and assent from children above 8 years. Results: Of the 212 children, 20 (9.4%) had splenomegaly. The mean age of the participants was 9.17 (± 3.14) years with a median age of 9 years and interquartile range of 4-12. The male to female ratio was 1:1. Most of the children with splenomegaly were aged 5 to 10 years. Significant associations were found between splenomegaly and being male (p value-0.034), the child having had an enlarged spleen detected on assessment (p value-0.004) and severe anemia (p value- 0.033). Conclusion: Approximately 1 in 10 children with sickle cell anemia aged 5 to 17 years have splenomegaly. Children with SCA who have splenomegaly are more likely to be male, to have had an enlarged spleen detected on assessment and to have severe anemia. SCA children with splenomegaly should have more frequent routine hospital visits for close monitoring and early detection of complications if therapy is to be effective.