Abstract
BackgroundSickle cell anaemia is a common global life-threatening haematological disorder. Most affected births occur in sub-Saharan Africa where children usually go undiagnosed and die early in life. Uganda’s national sickle cell screening programme was developed in response to a 2014 sickle cell surveillance study that documented a high disease prevalence.ObjectiveThis study describes the temporal and financial aspects of Uganda’s 2014–2019 sickle cell screening programme.MethodsNational sickle cell screening data from Uganda’s Central Public Health Laboratories were used to calculate turn-around times (TATs) from sample collection to delivery, testing, and result reporting for blood samples collected from February 2014 to March 2019. The parameters affecting specific TATs were assessed. The exact programme expenditures were analysed to determine cost per test and per positive sickle cell disease case detected.ResultsA total of 278 651 samples were analysed. The median TAT from sample collection to laboratory receipt was 8 days (interquartile range [IQR]: 6–12), receipt to testing was 3 days (IQR: 1–7), and testing to result reporting was 6 days (IQR: 3–12). Altogether, the sample continuum averaged 16 days (IQR: 11–24). Lower level healthcare facilities were associated with longer sample delivery TATs. Calendar months (January and December) and larger sample volumes impacted testing and result reporting TATs. The cost per test was $4.46 (United States dollars [USD]) and $483.74 USD per positive case detected.ConclusionUganda’s sickle cell screening programme is efficient and cost-effective. Universal newborn screening is the best strategy for detecting sickle cell anaemia in Uganda.
Highlights
Sickle cell anaemia is a monogenic haematological disorder that manifests as a devastating systemic disease with high morbidity and early mortality
Samples were excluded from analysis if they were outside the study date range, beyond 24 months of age, or collected and tested outside of routine sickle cell screening
We found that turn-around times (TATs) for sickle cell screening was shorter in all inbound phases compared to what was previously reported for Uganda’s Early Infant HIV Detection programme, and exhibited overall improved time efficiency for the entire Central Public Health Laboratories (CPHL) sample continuum
Summary
Sickle cell anaemia is a monogenic haematological disorder that manifests as a devastating systemic disease with high morbidity and early mortality. The pathophysiology begins in infancy with acute and life-threatening complications, which presents as increased susceptibility to infections, chronic haemolytic anaemia, and painful vaso-occlusive events.[1,2] Sickle cell anaemia is the most prevalent haemoglobinopathy that impacts more than 20 million people worldwide, with an estimated 312 302 babies born with the disease each year.[3] Over 75% of the world’s annual sickle cell anaemia births occur in sub-Saharan Africa where resources for providing early detection and care are most constrained,[3] leading to the deaths of more than 500 affected children per day.[4]. Uganda’s national sickle cell screening programme was developed in response to a 2014 sickle cell surveillance study that documented a high disease prevalence
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