Knowledge, attitude and practices of health workers towards sickle cell screening in Tororo District, Uganda

Abstract

Introduction: Sickle cell is a genetic disease affecting millions of people worldwide. About 75% of children with sickle cell disease die within the first 5 years as a result of infections. The sickle cell trait is a key risk factor for development of sickle cell disease. In Tororo district, the prevalence of sickle cell trait is high (19.6%). The Ministry of Health rolled out a sickle cell screening programme (SCSP) for the newly born children in Tororo, where health workers were trained on screening, diagnosis and management of sickle cell disease. Objectives: To determine health workers’ knowledge, attitude and practice towards sickle cell screening in Tororo district following the roll out of the SCSP. Methods: A cross sectional survey was conducted in June, 2018 among health workers randomly selected from 38 health facilities in Tororo district. Health workers’ knowledge on sickle cell screening was obtained using a questionnaire. Health workers attitude and practice on sickle cell screening was obtained through interviews conducted with 10 key informants and 10 in-depth interviewees. For the outcome knowledge; participants were classified to have good knowledge if they had a score of 7 and above, as average if they had a score between 5 and 6 and considered to have low knowledge if they had a score less than 5. Knowledge was further categorised defining it based on the number of correct responses to a set of 10 items. Good knowledge was defined as scoring at least 6 items correctly and poor knowledge if they scored less to obtain a binary outcome. The main outcome; sickle cell screening practice was based on yes or no response to questions on sickle cell screening. Data from the quantitative tool were analysed using STATA 13.0 SE. A generalised linear model (glm) was used with the family of Poisson and a log link with robust standard error to provide prevalence ratio (PR) as a measure of association with corresponding 95% confidence intervals and p-values. Qualitative data were analysed using manual thematic analysis. xiii

Administrative clearance was obtained from the District Health Office of Tororo and ethical clearance and approval was by Higher Degrees Research and Ethics Committee of Makerere University School of Public Health. Results: A total of 180 health workers were interviewed (180/196, 91.8% response rate). Nearly half (49.4%, 81) were aged 30 to 39 years, around two-thirds (64.4%, 116) were female or resident in rural areas (64.9%, 113), and four-fifth (81.9%, 145) were married. Just over a half (52.8%, 95) of health workers were aware about sickle cell screening in their community. Knowledge about sick cells was low in (20%, 36); just over a quarter (27.2%, 49) had average knowledge and just over a half (52.8%, 95) had good knowledge. When re categorised for analysis, knowledge was poor in nearly a third (30.6%, 55), and just over two thirds had good knowledge (69.4%, 125). Only 62.2% (112) of the health workers reported screening for sickle cell, but from both quantitative and in-depth interviews, premarital counselling and awareness campaigns on sickle cell screening were rarely carried out. Factors associated with good knowledge about sickle cells was significantly higher in the urban (aPR=1.11, 95% CI; 1.03-1.19), health workers (HW) with higher income level (aPR= 1.30, 95% CI; 1.13-1.47) and those who were trained on sickle cell screening (aPR= 1.09, 95% CI; 1.01-1.20). Sickle cell screening practice was significantly higher among urban residents (aPR= 1.29, 95% CI; 1.02-1.64), or with above average knowledge about sickle cells (aPR=2.02, 95% CI; 1.40-2.92). Attitude towards sickle cell screening as reported by key informants was found to be positive; as health workers cared and supported clients to screen for sickle cell, considered screening fully as their responsibility, and believed that screening prevented transmission of sickle cell genes to others. However, health workers felt they lacked adequate supplies and equipment for sickle cell screening, and had limited knowledge and skills for sickle cell screening.