Experts have observed that Sickle Cell Disorder, SCD, remains one of the main causes of premature death among children under the age of five in various African countries. Ekekwu Joy writes that this is the reason for intense campaign to increase public awareness of the disease.
According to medical experts, the Sickle Cell Disorder, SCD, otherwise known as Sickle Cell Anemia, SCA, is an inherited blood disorder that affects red blood cells of individual carriers.
It is a condition in which there aren’t enough healthy red blood cells to carry adequate oxygen throughout your body.
Scientifically, a person’s red blood cells are flexible and round, moving easily through the blood vessels but in SCA patients, the red blood cells become rigid and sticky and are shaped like sickles or crescent moons. These irregularly shaped cells can get stuck in small blood vessels, which can slow or block blood flow and oxygen to parts of the body.
Recently, it was reported that at least 100,000 infants die from sickle cell genetic disorder in Nigeria every year.
A professor of Radiology at the University of Lagos, Rasheed Ajani Arogundade, during his July inaugural lecture of the university, said that the country still had the highest number of sickle cell cases in Africa.
He said that the World Health Organisation, WHO, indices showed that Nigeria accounts for 75 per cent of SCA cases in Africa and that advances in computer technology have made it possible for radiologists to utilise an array of imaging modalities with the use of modern facilities such as Ultrasound,US, Computerised Tomography,CT, and Magnetic Resonance Imaging,MRI, among others for diagnosis and treatment of the disease.
Arogundade therefore, advocated for investment in radiology equipment in the country through the Public-Private Partnership, PPP.
He said, “we live in a constantly changing technological environment and Nigeria cannot afford to persistently remain behind the rest of the world. Radiology is particularly technology driven and capital intensive. Equipment investment through the PPP remains the current solution and best option.
“Availability of essential diagnostic imaging equipment will also obviate the need for unnecessary medical tourism and conservation of our natural resources, while teaching hospitals in the country must acquire and maintain appropriate imagining equipment to improve radiology practice, training and research.
“Only acquisition of equipment with locally available engineering maintenance backup will guarantee durable functionality and uninterrupted training of medical students and residents doctors, as well as good quality materials for internationally acceptable research,” Arogundade maintained.
According to the Sickle Cell Foundation Nigeria, SCD was the most common inherited type of sickness in the world with about three quarters of the cases in Africa.
Experts also stress that Nigeria needs to take active part in the awareness campaign, going by the statistics from the WHO that the country has higher percentage of sickle cell carriers.
A consultant in blood disorders and children’s medicine, Dr Baba Inusa, in a Lagos Hospital, in collaboration observed that Nigeria has the largest population of people with SCD in the world with about 150,000 babies born with it every year.
“It is estimated that only 50 per cent of children with SCD live past the age of 10 in Nigeria, compared to over 96 per cent surviving into adulthood in the UK and U.S,’’ he said.
He, nonetheless, admitted that SCD also affected millions of people around the world, including adults and children.
Inusa agreed that SCD was a disorder of the blood caused by inherited abnormal hemoglobin, the oxygen-carrying protein within the red blood cells.
According to him, the abnormal cells are unable to move around as easily as normal shaped cells and can block blood vessels, resulting in severe pain.
Similarly, the Director, Clinical Services of Sickle Cell Foundation, Dr Ajibola Sanda, explained that the trouble was that people with sickle cell trait are often unconscious of the condition if they had not been tested.
He explained that the best management of the disorder was when the diagnosis was carried out at early stage. “Early detection is very important in the management of a child with the disorder because it has been found that people who tested early are better prepared.
“Parents who know that their children have SCD early enough should quickly begin a regime of drugs, adapt their lifestyles and get the prescribed vaccines,’’ Sanda said.
He insisted that adequate knowledge and information of the disease and its impending risks could prepare a family for the challenges ahead.
“Such a family can prevent illness by developing a meal plan that aids health, sleeping under mosquito nets and by taking steps to prevent dehydration.’’
Also, the Head of Laboratory Department of the foundation, Mr Olayemi Onijala said that the prevalence of the disorder in Nigeria was declining due to some level of awareness and information.
“More than 40 million Nigerians are healthy carriers of the sickle
cell gene, while more than 150,000 babies are born each year with SCD; this figure shows a decrease.
“This is the largest burden of the disorder in the world and most of these children die in childhood because of ignorance and lack of access to correct diagnosis and proper care,’’ he noted.
He observed further that one in 14 children with SCD have high risk of developing stroke, saying that the stroke could be prevented by identifying it from onset.
“With modern ultrasound scanning machine at the foundation, we can identify and prevent stroke in these children”.
“Bone marrow or stem cell transplant is the most effective cure for SCD and it is most affordable. Stem cell transplant is aimed at introducing stem cells that will regenerate normal red blood cell progeny,’’ Onijala said.
He also called on the National Assembly to ensure speedy passage of the Sickle Cell Disease (Prevention, Control and Management) Bill.
“The bill seeks to provide a legal framework for the prevention, control and management of SCD.
“It aims at drawing the attention of the public to the health burden arising from the disorder in Nigeria,’’ he observed.
Buttressing on the burden of the disease, the National Coordinator, Non-Communicable Disease Division, Federal Ministry of Health, Dr Anthony Usaro, said SCD contributed to maternal, neo-natal and child mortality in Nigeria, not undermining the attainment of Millennium Development Goals.
He, however, said that the ministry had developed comprehensive national guidelines for the control and management of the disease.
“SCD affects all human systems; the clinical management of patients with the disease is multi-disciplinary.
“The guidelines would facilitate uniformity and standardisation of care across different disciplines,’’ Usaro, said.
He noted that in preventing the disease, the guidelines would focus on screening of new born, pre-marital counseling and registration of SCD patients.
He added that the ministry was collaborating with sickle cell support organisations to carry out research on effective and affordable treatment of the disease.
According to him, the ministry has established six SCD screening centres in Abakaliki, Lagos, Gombe, Keffi, Yenagoa and Birnin Kebbi for effective management of the disease. Usaro described SCD as “chronic and expensive’’ to treat, adding that it placed
socio-economic burden on the carrier, their family and the community.
In the same vein, WHO report states that the recurrent pain and
complications caused by SCD can interfere with many aspects of the patient’s life, including education, employment and psycho-social developments.
Furthermore, Medikka Journal of the University of Nigeria Medical Students, advises individuals to be tested for presence of the gene before pregnancy and marriage.
It states that if both partners are carriers, couples may seek genetic counseling to help them better understand SCD and how it will affect the children they may have.
Furthermore, a Professor of Haematology and Transfusion Medicine, Erhabor Osaro, warned that Nigeria is bound to witness an unimaginable increase in cases of blood related disorders like sickle cell in the nearest future if urgent measures are not taken by the federal government.
Osaro, speaking during his observation at the Third International Pre-Conference Workshop on Haematology and Blood Disorders, recently in Abuja, charged the government at all levels to strengthen diagnosis through adequate funding of the health sector, personnel development and equipment endowment.
“Laboratory capacity and research to diagnose blood disorders in Nigeria should be strengthened through adequate funding, personnel development, equipment endowment and having an all-inclusive and valued health teams.
“This can potentially lead to improved health outcomes among Nigerians living with blood disorders,” he explained.
Osaro regretted that blood disorders, including SCD, constitute serious health problems to the nation and the world at large.
Osaro, who is also the chairman Local Organizing Committee, LOC, of the same workshop, said “the conference was organised to empower participants to reduce the public health burden of blood disorders by sharing evidence-based best practices, aimed at fostering better understanding of blood disorders and their complications. To ensure that preventive programmes are developed, implemented and evaluated by all healthcare professionals involved in the diagnosis and management blood related diseases.
Speaking more on this development, the Vice Chancellor, Federal University Birni Kebbi, Prof Lawal Bilbis, disclosed that blood disorders affect one or more parts of the blood and prevent blood from carrying out its statutory responsibilities.
“This disorder may be acute or chronic among other platelet disorders, excessive clotting, bleeding problems, anaemia, leukaemia, myeloma and eosinophilic disorders. Many of them are inherited, while some are as a result of other diseases, side effects of drugs and lack of certain nutrients in the diet,” he said.
Also, the Vice Chancellor, University of Abuja, Prof Umale Adikwu, said the delivery of high quality laboratory services was essential in the nation’s health system, both for providing the foundation for clinical decisions and as an objective means to institute treatment.
He decried that the value of medical laboratory service was often under-estimated in spite of its vital contribution to the provision of cost-effective, quality and effective health care.
Stakeholders call for collective participation at annual SCD for increased awareness, and research into the disease.