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Sickling and solubility tests and the peripheral blood film method for screening for sickle cell disease. [corrected]
Andrew Livex Okwi1, Michael Ocaido, Wilson Byarugaba
1Department of Pathology, Medical School, Makerere University, Kampala, Uganda. livexo@yahoo.co.uk
Insights
Screening infants for sickle-cell disease at Ugandan health centers is cost-effective. The sickling test at local centers with regional confirmation (B2) is recommended for being both cheap and sensitive.
Area of Science:
- Public Health
- Hematology
- Health Economics
Background:
- Sickle-cell disease (SCD) is a significant public health concern in many parts of Africa, including Uganda.
- Early diagnosis and management of SCD can improve patient outcomes.
- The cost-effectiveness of different screening strategies is crucial for resource-limited settings.
Purpose of the Study:
- To evaluate the cost-benefit of implementing sickle-cell disease screening for infants at district health centers in Uganda.
- To compare the cost-effectiveness of various screening methods: sickling, solubility tests, and peripheral blood film, in conjunction with confirmatory hemoglobin electrophoresis.
Main Methods:
- A cost-benefit analysis (CBA) was conducted comparing four scenarios for sickle-cell screening in Uganda.
- Scenarios included referral to tertiary or regional hospitals versus establishing screening services at district health centers with regional confirmation.
- Cost calculations were performed in Uganda shillings (USh).
Main Results:
- Initial screening costs were high across all scenarios but decreased over time.
- Referral-only scenarios (A1, A2) were highly sensitive but costly, with Scenario A1 being the most expensive.
- District-level screening with regional confirmation (Scenario B2) using the sickling test was found to be both sensitive and cost-effective.
Conclusions:
- Screening infants for sickle-cell disease at Mulago hospital using hemoglobin electrophoresis (A1) is highly sensitive but prohibitively expensive.
- A recommended strategy involves screening at district health centers using the sickling method, with positive cases confirmed at a regional hospital (B2).
- This approach (B2) offers a balance of sensitivity and cost-effectiveness for sickle-cell disease screening in Uganda.
Objective:
To determine the cost benefit of screening for sickle-cell disease among infants at district health centres in Uganda using sickling, solubility tests and the peripheral blood film method.
Methods:
Pilot screening services were established at district health centres. Cost benefit analysis (CBA) was performed in four scenarios: A1 - where there are no sickle-cell screening services at district health centres and all children are referred either to Mulago tertiary referral hospital or A2 - a regional hospital for haemoglobin (Hb) electrophoresis; B1 - when there are screening services at district health centres, only positive samples are taken either to Mulago Hospital or B2 - the regional hospital for confirmation using haemoglobin electrophoresis. Calculations were done in Uganda shillings (USh).
Results:
Initial operational costs were high for all scenarios but variably reduced in the subsequent years. Scenarios A1 and A2 were very sensitive compared with B1 and B2. Scenario A1 had the highest screening costs in the subsequent years, costing over 62 000 USh per test in both eastern and western Uganda. Scenario B2 was sensitive and cheaper when using the sickling test, but was expensive and insensitive when using the solubility test and more insensitive though cheaper when using the peripheral blood film method. CONCLUSIONS AND RECOMMENDATION: Screening children in Mulago hospital using haemoglobin electrophoresis (A1) was very expensive although it was sensitive. Screening the children at four health centres using the sickling method and confirming positive samples at a regional hospital (B2) was both cheap and sensitive and is therefore recommended.
