5610785 THE EFFICACY OF HEALTH EDUCATION INTERVENTION AND MATERNAL SCREENING ON KNOWLEDGE AND INFANT SCREENING FOR SICKLE CELL DISEASE AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINICS IN DAR-ES-SALAAM, TANZANIA

Abstract

Background: Globally, Sickle cell disease (SCD) is one of the most common genetic disease with high childhood mortality 1. Early identification of babies with SCD through newborn screening (NBS) and linking them to care are among the recommended interventions 2. For these to be effective, it is important for pregnant women to have the right knowledge on SCD and motivation to screen their babies. Aim: To assess the efficacy of health education (HE) intervention and maternal screening for SCD on knowledge and the uptake of infant screening for SCD among pregnant women attending antenatal clinics (ANC) in Dar-Es-Salaam, Tanzania. Methods: This was a quasi-experimental study, involved pregnant women attending ANC at Buguruni health center, Mbagala hospital and Sinza hospital in Dar Es Salaam between August 2020 to April 2022. A structured questionnaire was used in data collection. Knowledge on SCD (poor if score <7; good if score 7-10) was assessed to all participants before and after two sessions of HE3, and participants in Buruguni and Mbagala were also screened for SCD using Sickle SCAN point-of-care test (BioMedomics Inc, USA). We computed effectiveness of HE intervention as the post-intervention minus baseline knowledge score. Two-sample test of proportions, univariate and multivariate logistic regression were used to analyze the efficacy of HE intervention and also predictors of infant diagnosis. Before enrollment, written informed consent was obtained from participants, parents/guardian of participants <18 years of age. Results: A total of 467 pregnant women completed two sessions of HE intervention where 221 (47.3 %) participants were screened for SCD; Out of 221 screened participants, 203 (91.9%) remembered their sickle cell status 3 to 4 months after screening. The proportion of participants with good knowledge on SCD had significantly increased from 12.4% at baseline to 85.9% following the education intervention p-value <0.0001. HE provided was effective to 85.3% of participants, and was 2.45 times higher among those who shared the received education with others than those who did not share (AOR = 2.45; 95% CI = 1.38 to 4.36). The uptake of infant diagnosis was 5.39 higher in infants whose mothers shared the received education than those who did not share (AOR = 5.39; 95% CI = 1.18 to 24.67). 5.4% of babies (26/170 babies) were screened post-delivery, and 3 of them had Hb SS. Mothers who were employed had 6.49 higher odds of screening their infants than housewives (AOR = 6.49; 95% CI =1.52 to 27.79). Maternal status was also seen to associate with infant diagnosis whereby those with hemoglobin S (AS or SS) had 13.28 times higher odds of screening their infants than those who did not know their SCD status (AOR = 13.28; 95% CI = 4.11 to 42.86). There was no difference in odds of the baby being screened for SCD between mothers who had Hemoglobin AA as compared to mothers who were not screened for SCD (AOR = 1.62; 95% CI = 0.56 to 4.84). Conclusion: This study has demonstrated that maternal HE and maternal screening for SCD are feasible and effective interventions in increasing knowledge as well as improving the uptake of infant screening for SCD. These interventions are strongly recommended to be included in the comprehensive care package for pregnant women attending antenatal clinics, particularly in areas with a high burden of SCD.