Integrating sickle cell disease care into primary healthcare in Uganda: a narrative review

Sickle cell disease (SCD) poses a significant public health challenge in Uganda, affecting approximately 1.6 million individuals and contributing to high morbidity and mortality rates. Current SCD management is often fragmented, with care primarily concentrated in specialized centers, leading to disparities in access and delayed interventions. The integration of SCD care into the primary healthcare (PHC) system has been proposed as a strategy to address these challenges. This narrative review explores the current gaps in SCD care within Uganda's healthcare system and examines the potential benefits of integrating SCD management into PHC settings to improve outcomes. A comprehensive literature review was conducted to assess existing SCD management practices, barriers within PHC systems, and outcomes from integration pilot programs. Data on healthcare provider confidence, access to diagnostic tools, and patient outcomes were analyzed to understand the current landscape and opportunities for improvement. Only 35% of healthcare providers in PHC settings reported confidence in managing SCD patients (OR: 0.45, 95% CI: 0.35-0.55). Limited access to diagnostic tools and inadequate resources further hinders timely diagnosis and treatment, contributing to preventable complications and higher healthcare costs. However, a pilot program integrating SCD care into PHC clinics demonstrated a 50% reduction in hospital admissions for pain crises among participants (OR: 2.0, 95% CI: 1.5-2.7). Integrating SCD care into Uganda's PHC framework offers significant potential to enhance early diagnosis, improve treatment adherence, and reduce hospital admissions. Coordinated care approaches could alleviate the disease burden, improve patient outcomes, and lower healthcare costs.