Abstract
BackgroundMalaria is among the leading cause of infection in individuals with sickle cell disease (SCD) living in sub-Saharan Africa, including Tanzania. However, after 2005 the standard treatment guidelines (STGs) on malaria chemoprevention for SCD patients were non-existent, and at present no medicine is recommended for SCD patients. Since several anti-malarials have been approved for the treatment of malaria in Tanzania, it is important to establish if there is a continued use of chemoprevention against malaria among SCD children.MethodsA cross-sectional, hospital-based study was conducted between January and June 2019 at tertiary hospitals in Dar es Salaam. Data were collected using a semi-questionnaire and analysed using SPSS software version 25. The descriptive statistics were summarized using proportions, while factors associated with the use of chemoprophylaxis were analysed using multivariate logistic regression. Statistical significance of p < 0.05 was accepted.ResultsA total of 270 SCD children were involved. The median age of SCD children was 6 years (interquartile range (IQR): 3–11 years). Of 270 SCD children, 77% (number (n) = 218) of children with SCD had not been diagnosed with malaria in the previous year, whereas 12.6% (n = 34) of children were admitted because of malaria in the previous year. Regarding the use of chemoprophylaxis in SCD children, 32.6% (n = 88) of parents were aware that, chemoprophylaxis against malaria is recommended in SCD children. Of the 270 participants, 17% (n = 46) were using malaria chemoprophylaxis. A majority used artemisinin combination therapy (ACT), 56.8% (n = 26). Of 223 parents who did not give chemoprophylaxis, the majority (n = 142, 63.7%) indicated unavailability at clinics as the reason. Children whose parents were primary level educated were 9.9 times more likely to not use chemoprophylaxis (adjusted odds ratio (AOR); 9.9, 95% CI 1.8–56.5, P = 0.01) compared to those whose parents had tertiary education.ConclusionDespite the lack of STGs, a small proportion of children with SCD were using malaria chemoprophylaxis where the majority used ACT, i.e., dihydroartemisinin-piperaquine.
Highlights
Malaria is among the leading cause of infection in individuals with sickle cell disease (SCD) living in sub-Saharan Africa, including Tanzania
Awareness of the use of chemoprophylaxis against malaria Most of the parents (n = 234, 86.7%) of SCD children who participated in this survey reported that malaria was not a common infection in their children
This study found a small proportion of children with SCD were using malaria chemoprophylaxis
Summary
Malaria is among the leading cause of infection in individuals with sickle cell disease (SCD) living in sub-Saharan Africa, including Tanzania. Since several anti-malarials have been approved for the treatment of malaria in Tanzania, it is important to establish if there is a continued use of chemoprevention against malaria among SCD children. Under 5 years old [1], including children with sickle cell disease (SCD) [2], are the groups mostly affected with malaria. About 75% of 300,000 births of affected children globally live in sub-Saharan Africa; Tanzania holds fifth position in Africa with a high prevalence of children born with SCD [4]. Of the reported infections in a SCD population, malaria is among the leading causes of death in those who die before adulthood [5]. Use of malaria chemoprophylaxis has been reported to reduce the number of crises, hospitalizations and episodes of anaemia [9]
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