Abstract
Purpose: Sub-Saharan Africa has the world’s largest burden of Sickle Cell Disease (SCD), but due to poor care of SCD in childhood most do not reach reproductive ages. Consequently, due to sporadic cases of SCD in pregnancy, there has been little research attention to the problem in this sub region. This is one of the largest study series of SCD deliveries in Sub-Saharan Africa that aimed to establish the incidence and determinants of adverse pregnancy outcomes. Methods: Data of all deliveries from 1999 to 2011 at Muhimbili National Hospital (MNH) in Tanzania were analyzed. Deliveries of SCD were obtained and categorized according to presence or absence of adverse pregnancy outcomes based on set composite criteria. Using IBM SPSS statistics version 19, bivariate and multivariate logistic regression analyses were done to determine factors that were independently associated with adverse pregnancy outcomes. Statistics with p-value
Highlights
Since about a hundred years ago when SCD was formerly reported, there has been very marked progress in terms of screening, diagnosis and care [1]
After adjusting for confounding factors, the odds of adverse outcomes were independently increased with referred compared to non-referred women (OR = 4.4; 95% CI: 1.2 - 16.8) and among Cesarean section deliveries compared to vaginal deliveries (OR = 4.2; 95% CI: 1.2 - 14.6)
The incidence of adverse pregnancy outcomes in SCD is unacceptably high mainly contributed by poor management and prematurity
Summary
Since about a hundred years ago when SCD was formerly reported, there has been very marked progress in terms of screening, diagnosis and care [1]. Sub-Saharan Africa is the most affected with more than two thirds of all the 300,000 annual SCD deliveries happening [1,2] Despite of this burden, the management of SCD during childhood has lagged behind such that an estimated 50% - 80% of SCD children in Sub-Saharan Africa die before cerebrating their fifth birthday. The management of SCD during childhood has lagged behind such that an estimated 50% - 80% of SCD children in Sub-Saharan Africa die before cerebrating their fifth birthday This situation is in sharp contrast to what is happening in countries with good standard of care where on average the life expectancy of SCD is at least the mid-50s [3,4]. Most studies seem to agree on increased adverse fetal outcomes but there is a wide discrepancy on the occurrence of maternal compli-
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