Population Survey on Contributing Factors to Sustained Prevalence of Sickle Cell Disease in Nigeria

According to the World Health Organization, about 5% of the world's population has the abnormal haemoglobin gene with Nigeria having the highest burden of sickle cell disease (SCD). Concerted efforts should target the reduction of SCD prevalence.

This study aimed to determine the various factors that contribute to the non-dwindling prevalence of SCD in Nigeria.

A community-based cross-sectional survey was carried out on 883 respondents aged 18 years and above between February 2021 and March 2023 in Enugu State, Nigeria. Interviewer-administered questionnaires were used to obtain relevant socio-demographic data, family history of SCD, knowledge of their haemoglobin phenotype, and information on any previous misdiagnosis of their haemoglobin phenotype. Statistical Package for the Social Sciences (SPSS) software program, version 26.0 (Chicago, Illinois) was used for data analysis. A value of P < 0.05 was considered statistically significant.

Median age was 43 years with a range of 18-88 years. Seven hundred and forty-three (743/883, 81.1%) have done the test to ascertain their haemoglobin phenotype. On the other hand, 140 respondents (15.9%) have never done the test due to: lack of awareness (35/140, 25%); financial difficulties (53/140, 37.8%); religious reasons (35/140, 25%); discordant results (301/743, 40.5%) and not knowing where to go for the test (17/140, 12.1%). The distributions of the haemoglobin phenotypes were: HbAA (519/743, 69.9%); HbAS (196/743, 26.4%) and HbSS (28/743, 3.8%).

Over one-tenth (15.9%) of the study population do not know their haemoglobin phenotype status and their reasons for non-testing are varied. The population prevalence of SCD (3.8%) is higher than the previously reported national prevalence range of 1 - 3%. Addressing the identified barriers to non-testing might help in checking the increasing prevalence of SCD in Nigeria.