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Updated: Oct 21, 2025
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Sickle cell disease in sub-Saharan Africa: transferable strategies for prevention and care
Kevin Esoh1, Edmond Wonkam-Tingang1, Ambroise Wonkam2
1Division of Human Genetics, Department of Pathology, University of Cape Town, Cape Town, South Africa.
Insights
Sickle cell disease (SCD) disproportionately affects children in sub-Saharan Africa, where mortality is high due to neglected care. International collaborations are now piloting interventions to improve SCD management and quality of life on the continent.
Area of Science:
- Hematology
- Public Health
- Global Health
Background:
- Sickle cell disease (SCD) is a major global health issue, particularly impacting over 300,000 newborns annually in sub-Saharan Africa.
- High-income countries have reduced SCD-related childhood mortality through early screening and care, yet Africa faces significant neglect in prevention and management.
- Without intervention, 50-90% of children with SCD in sub-Saharan Africa die before age five, highlighting a critical disparity in care.
Purpose of the Study:
- To describe the epidemiology, pathophysiology, clinicobiological profile, and psychosocial effects of SCD in sub-Saharan Africa.
- To highlight successful, transferable strategies for SCD management.
- To recommend key strategies for affordable and comprehensive SCD care tailored to the African continent.
Main Methods:
- Review and synthesis of existing literature on sickle cell disease in sub-Saharan Africa.
- Analysis of epidemiological data, clinical presentations, and psychosocial impacts.
- Examination of current and emerging intervention strategies, including international collaborations.
Main Results:
- SCD poses a severe threat in sub-Saharan Africa, with high mortality rates in children under five due to limited access to care and effective treatments like hydroxyurea (hydroxycarbamide).
- Emerging initiatives and international collaborations are beginning to pilot neonate screening and comprehensive care programs.
- Quality of life and increased life expectancy are becoming key targets as mortality rates show potential for decline.
Conclusions:
- Addressing the significant burden of sickle cell disease in sub-Saharan Africa requires urgent, tailored, and affordable interventions.
- International collaboration and the adaptation of successful management strategies are crucial for improving outcomes.
- Focusing on comprehensive care, including psychosocial support and accessible treatments, is essential to enhance the quality of life and life expectancy for individuals with SCD in Africa.
Abstract:
Sickle cell disease can be life-threatening or chronically debilitating for both children and adults. Worldwide, more than 300 000 children are born with sickle cell disease every year, over 75% of whom in sub-Saharan Africa. Increased awareness and early interventions, such as neonate screening and comprehensive care, have led to considerable reductions in mortality in children younger than 5 years in high-income countries. However, sickle cell disease prevention and care have largely been neglected in Africa. Without intervention, 50-90% of affected children in many sub-Saharan African countries die before their fifth birthday. Fortunately, increasing initiatives in sub-Saharan Africa are piloting interventions such as neonate screening and comprehensive care, and as mortality declines, quality of life and increased life expectancy become major targets for interventions. Hydroxyurea (hydroxycarbamide) and haematopoietic stem-cell transplantation have already been shown to be effective therapies in high-income countries, but are either not widely accessible or too expensive for most African populations. These challenges are being alleviated by numerous networks evolving through international collaborations that are positively changing the outlook of sickle cell disease management in sub-Saharan Africa. In this Series paper, we describe the epidemiology, pathophysiology, clinicobiological profile, and psychosocial effects of sickle cell disease in sub-Saharan Africa. We highlight transferable strategies already used for the successful management of the condition and key strategies and recommendations for affordable and comprehensive care on the continent. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.
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