基于证据的干预措施,以减少在撒哈拉以南非洲的状细胞疾病相关的发病率和死亡率:一个范围审查
Emmanuel Emenike Arji1, Ujunwa Justina Eze2, Gloria Oluchukwu Ezenwaka3
1School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK.
状细胞疾病的干预可以显著降低撒哈拉以南非洲的儿童死亡率. 关键的策略包括基尿素治疗和专科诊所,尽管资源限制带来了挑战.
科学领域:
- 全球健康 全球健康
- 血液学 血液学 血液学
- 儿科 儿科 儿科
背景情况:
- 状细胞病 (SCD) 是一个重大的全球卫生挑战,不成比例地影响撒哈拉以南非洲.
- 在撒哈拉以南非洲,大多数患有SCD的儿童不会活到成年,尽管高收入国家有有效的干预措施.
- 评估和实施基于证据的干预措施以减少该地区的SCD负担至关重要.
研究的目的:
- 审查和综合有关干预措施的证据,以减少撒哈拉以南非洲儿童SCD相关的发病率和死亡率.
- 在资源有限的环境中确定有效的SCD管理策略.
- 为改善撒哈拉以南非洲的SCD结果提供政策和实践信息.
主要方法:
- 使用乔安娜·布里格斯方法论框架进行范围审查.
- 包括36项研究 (18项RCT,11项观察性研究,5项前后研究,2项经济评估).
- 干预措施分为药物治疗,新生儿查,综合护理,疾病修饰剂,营养,全身治疗,支持剂和教育.
主要成果:
- 基于证据的干预措施有效地减少了诸如中风,血管封闭性危机,急性胸部综合征,严重贫血和疟疾等常见的SCD发病率.
- 干预措施明显提高了研究参与者的生存率.
- 基尿素疗法被证明可以增加血红蛋白和胎儿血红蛋白水平,这是面临输血挑战的关键发现.
结论:
- 定期低剂量氧尿素治疗,硫素-甲胺化学预防,L-氨酸和Omega-3脂肪酸补充剂显示出有前途.
- 建议建立专业的独立状细胞诊所.
- 实施可行性受到负担能力,可访问性和资源限制的阻碍.
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