Level of utilization and provider-related barriers to the use of hydroxyurea in the treatment of sickle cell disease patients in Jos, North-Central Nigeria.

Akinyemi Od Ofakunrin,Atiene S Sagay,Nantok Dami,Edache S Okpe,Tolulope O Afolaranmi,Patience U Kanhu,Kehinde Adekola,Rasaq R Olaosebikan

doi:10.4314/ahs.v21i2.36

Akinyemi Od Ofakunrin, Atiene S Sagay + Show 6 more

Open Access

https://doi.org/10.4314/ahs.v21i2.36

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Abstract

Hydroxyurea is underutilized by sickle cell health-care providers in Nigeria despite available evidence of its effectiveness in reducing the manifestations and complications of sickle cell disease (SCD). To assess the level of utilization and provider-related barriers to the use of hydroxyurea in SCD therapy in Jos, Nigeria. A cross-sectional study conducted among 132 medical doctors providing care for SCD patients. Data on sociodemographics, utilization and barriers to hydroxyurea use were obtained. The barriers were fed cumulatively into the logistic regression model as predictors of utilization. Of the 132 care providers, 88 (67%) had been in medical practice for ≥6years. The level of utilization of hydroxyurea was 24.2%. The significant barriers that predicted the non-utilization of hydroxyurea included lack of expertise (OR=5.1; 95% CI=2.65-9.05), lack of clinical guidelines (OR=3.84; 95% CI=2.37-14.33), fear of side-effects (OR=0.50; 95% CI=0.22-0.68) and doubt about its effectiveness (OR=0.30; 95% CI=0.20-0.90). The level of utilization of hydroxyurea in the treatment of SCD among the care providers is sub-optimal with the lack of expertise in its use identified as the most prominent barrier. There is an urgent need for the training of sickle cell care-providers and the development of clinical guidelines on hydroxyurea use.

Highlights

25 million people are affected globally with the majority of them living in sub–Saharan Africa where Nigeria accounts for the highest burden of the disease. 4-5 Despite the huge burden of sickle cell disease (SCD) in Nigeria, its treatment has been mainly symptomatic with focus on pain relief, malaria prophylaxis and folic acid supplementation
The National Institute of Health (NIH) in 2014 and the British Society of Haematology in 2018 both recommended that all patients with the disorder and their family members should be educated about hydroxyurea therapy and all affected children from age nine months and above should be offered hydroxyurea regardless of clinical severity to reduce SCD-related complications and end organ failure.[12, 13]
Socio-Demographic Characteristics A total of 132 medical doctors who had been providing medical care for sickle cell disease patients participated in this study

Summary

Introduction

African Health Sciences, Vol 21 Issue 2, June, 2021 of the currently approved medications with the capability of modifying the disease process.[7] The National Institute of Health (NIH) in 2014 and the British Society of Haematology in 2018 both recommended that all patients with the disorder and their family members should be educated about hydroxyurea therapy and all affected children from age nine months and above should be offered hydroxyurea regardless of clinical severity to reduce SCD-related complications and end organ failure.[12, 13] In Nigeria, available reports suggest that the medication is underutilized by the sickle cell health-care providers while the barriers to its utilization in the treatment of SCD among the providers are yet to be elucidated.

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