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Implementing newborn screening for sickle cell disease in Korle Bu Teaching Hospital, Accra: Results and lessons
Catherine I Segbefia1,2, Bamenla Goka1,2, Jennifer Welbeck1,2
1University of Ghana Medical School, College of Health Sciences, Accra, Ghana.
Insights
Newborn screening for sickle cell disease (SCD) in Ghana identified 1.8% of babies with presumptive SCD. Challenges like staffing and supplies impacted screening, but coverage improved to 83.7% in phase one.
Area of Science:
- Global Health
- Pediatrics
- Public Health
Background:
- Sub-Saharan Africa faces the highest burden of sickle cell disease (SCD).
- Universal newborn screening (NBS) for SCD is lacking in sub-Saharan Africa due to limited institutional capacity.
- Ghana's largest public hospital, Korle Bu Teaching Hospital (KBTH), was assessed for NBS implementation feasibility.
Purpose of the Study:
- To determine the feasibility of implementing NBS for SCD in Ghana.
- To identify challenges encountered during NBS implementation in a resource-limited setting.
- To inform strategies for establishing sustainable NBS programs in sub-Saharan Africa.
Main Methods:
- A multiyear partnership between KBTH and SickKids Center for Global Child Health, Toronto, guided the NBS program implementation in phases.
- Staff training in dried blood spot sampling was conducted.
- Screening coverage and identification of presumptive SCD (P-SCD) cases were monitored.
Main Results:
- 115 healthcare professionals were trained in NBS procedures.
- During the demonstration phase, 44.3% of 9990 newborns were screened, identifying 79 (1.8%) with P-SCD.
- Key challenges included inadequate nursing staff, supply shortages, and delayed results; phase one saw screening coverage increase to 83.7%.
Conclusions:
- Implementing NBS for SCD in KBTH revealed significant challenges impacting universal screening efforts in Ghana and sub-Saharan Africa.
- Addressing these challenges comprehensively is crucial for building upon initial successes.
- Sustainable national NBS programs require targeted strategies to overcome identified barriers.
Background:
Early diagnosis of sickle cell disease (SCD) through newborn screening (NBS) is a cost-effective intervention, which reduces morbidity and mortality. In sub-Saharan Africa (SSA) where disease burden is greatest, there are no universal NBS programs and few institutions have the capacity to conduct NBS. We determined the feasibility and challenges of implementing NBS for SCD in Ghana's largest public hospital.
Procedure:
The SCD NBS program at Korle Bu Teaching Hospital (KBTH) is a multiyear partnership between the hospital and the SickKids Center for Global Child Health, Toronto, being implemented in phases. The 13-month demonstration phase (June 2017-July 2018) and phase one (November 2018-December 2019) focused on staff training and the feasibility of universal screening of babies born in KBTH.
Results:
During the demonstration phase, 115 public health nurses and midwives acquired competency in heel stick for dried blood spot sampling. Out of 9990 newborns, 4427 babies (44.3%) were screened, of which 79 (1.8%) were identified with presumptive SCD (P-SCD). Major challenges identified included inadequate nursing staff to perform screening, shortage of screening supplies, and delays in receiving screening results. Strategies to overcome some of the challenges were incorporated into phase one, resulting in increased screening coverage to 83.7%.
Conclusions:
Implementing NBS for SCD in KBTH presented challenges with implications on achieving and sustaining universal NBS in KBTH and other settings in SSA. Specific steps addressing these challenges comprehensively will help build on the modest initial gains, moving closer toward a sustainable national NBS program.
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