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Operational analysis of the national sickle cell screening programme in the Republic of Uganda
Arielle G Hernandez1,2,3, Charles Kiyaga4, Thad A Howard1,2
1Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
Insights
Uganda
Area of Science:
- Public Health
- Hematology
- Global Health
Background:
- Sickle cell anaemia is a major global health issue, particularly in sub-Saharan Africa.
- Uganda established a national sickle cell screening program due to high disease prevalence.
- Early diagnosis and intervention are critical for children with sickle cell anaemia.
Purpose of the Study:
- To evaluate the temporal efficiency of Uganda's national sickle cell screening program (2014-2019).
- To analyze the financial costs associated with the sickle cell screening program.
- To identify factors influencing screening program turnaround times.
Main Methods:
- Analysis of national sickle cell screening data from February 2014 to March 2019.
- Calculation of median turnaround times (TATs) for sample collection, testing, and result reporting.
- Assessment of program expenditures to determine cost per test and per positive case.
Main Results:
- Over 278,000 samples were analyzed, with an average TAT of 16 days.
- Longer TATs were linked to lower-level facilities, peak months, and high sample volumes.
- The cost per test was $4.46 USD, and per positive case detected was $483.74 USD.
Conclusions:
- Uganda's sickle cell screening program demonstrates efficiency and cost-effectiveness.
- Universal newborn screening is recommended as the optimal strategy for sickle cell anaemia detection in Uganda.
- The program's findings support the expansion of sickle cell screening initiatives.
Background:
Sickle 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.
Objective:
This study describes the temporal and financial aspects of Uganda's 2014-2019 sickle cell screening programme.
Methods:
National 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.
Results:
A 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.
Conclusion:
Uganda's sickle cell screening programme is efficient and cost-effective. Universal newborn screening is the best strategy for detecting sickle cell anaemia in Uganda.
