Hydroxyurea therapy in sickle cell disease: knowledge and prescription patterns among care providers in a low-and...

Hydroxyurea is a safe, effective, and well-tolerated disease-modifying therapy for patients with sickle cell disease (SCD), leading to reduced morbidity, mortality, and an improved quality of life. However, its underutilization, driven by inadequate knowledge and variability in use among SCD care providers, may limit its benefits. This study assessed the knowledge and prescription patterns of hydroxyurea among SCD care providers in Jos, Nigeria.

A cross-sectional survey of 132 physicians managing SCD was conducted to collect data on socio-demographics, hydroxyurea knowledge, and prescription patterns using a proforma. Knowledge was assessed using 17 questions (maximum score: 17). Scores above 12 (50th percentile) were classified as "good," while scores of 12 or below were categorized as "poor." Prescription patterns were evaluated against the National Institutes of Health (2014) and British Society for Haematology (2018) guidelines. Data were analyzed using descriptive and inferential statistics.

Sixty-seven (50.8%) of the 132 physicians had inadequate knowledge of hydroxyurea's clinical benefits and safety. Only 35 (26.5%) were aware of available treatment guidelines, and 32 (24.2%) had ever prescribed hydroxyurea. Among prescribers, nine (28.1%) used inappropriate criteria to initiate treatment and six (18.8%) prescribed below recommended doses. The median maximum daily prescribed dose was 750mg, whereas five (15.6%) physicians did not exceed 200mg, irrespective of patient weight. Treatment guidelines were not followed by 25 (78.1%) of prescribers.

This study revealed a high prevalence of inadequate knowledge and inconsistent hydroxyurea prescription practices among SCD care providers. Targeted training is essential to enhance hydroxyurea utilization and ensure adherence to standardized treatment guidelines, ultimately improving patient outcomes.