Sickle cell retinopathy among Ghanaian high school students: a school-based screening

Sickle cell disease (SCD) remains a significant health concern, particularly in Ghana and Sub-Saharan African countries. School-based ocular screenings provide a unique opportunity for early detection of sickle cell retinopathy (SCR).

Students from five major schools in the Kumasi Metropolitan District of Ghana were included. Research assistants educated students on SCD and type 1 diabetes (T1DM) during school-wide assemblies, emphasising destigmatisation and vision health. Students completed questionnaires to self-report SCD or T1DM. Those who self-reported underwent in-depth interviews and dilated fundus exams (DFE).

Of 17 987 total student population, 8168 students completed the survey (45.4% response rate) of which 2.4% of students were aware of their SCD status, while most 69.3% were unaware. No students reported having T1DM. 24 students identified as having SCD (14 haemoglobin SS and 10 HbSC) resulting in a prevalence of 0.07% and 0.05% for SS and SC, respectively. Among the SCD cohort, four had Proliferative SCR (PSCR). Of the students with stage 3 PSCR, one was 15 years old with SS genotype and bilateral stage 3 PSCR; another was 18 years old with SC disease, unilateral stage 3 PSCR. Only one SCD patient (SS genotype) had a history of previous DFE. 20.8% of SCD students were aware of SCD ocular complications and 75% felt uncomfortable sharing their SCD status.

We conclude (1) an alarmingly low rate of self-reporting SCD (11× and 24× lower than expected for SS and SC-SCD, respectively), (2) low health literacy given 0% of students with SC-SCD had previously undergone a DFE and (3) 17% of students had PSCR and 8% of students had treatment-warranted PSCR (stage 3). These findings highlight the need for universal SCD screening, improved health education on the ocular complications of SCD and routine school-based vision screenings for patients with SCD.