As Nigeria loses 100,000 infants to sickle cell
It is a shame that Nigeria’s health-care delivery system is one of the worst in the world. It is doubly so when it is considered that avoidable or preventable conditions add to the burden and issues that have long been dealt with in saner climes still constitute immense challenges here. Sickle cell disease (SCD) is a genetic blood disorder affecting red blood cells, with high morbidity and mortality rates. While the United Nations estimates that there are between 20 and 25 million people worldwide living with SDC, 12–15 million live in Africa. Furthermore, it is estimated that 75–85% of children born with SCD are born in Africa, where mortality rates for those under age five range from 50% to 80%. Zeroing in on Sub-saharan Africa, available statistics show that 70% of the over 300,000 born with SCD annually in Africa occur in the sub-region while one out of four Nigerians has Sickle cell Trait (SCT). This may account for why Nigeria loses 100,000 infants to sickle cell annually. This is worrisome!
What is responsible for the high incidence of SCD in Africa? Research findings suggest that one factor associated with the high incidence of SCD in tropical Africa is the protection against Plasmodium malaria associated with having the SCT. However, that protection seems not to extend to people with SCD. Although, the theory that the SCT offers some immunity against the malaria parasite was found to be strong in tropical Africa, it could not be explained in other parts of the world. This is a thesis that must be allowed to diffuse, especially against the backdrop of the development that Nigeria is to witness more malaria cases as mosquitoes develop resistance to Long Lasting Insecticidal Nets (LLINs).
Furthermore, while there is high mortality rate in Nigeria due to SDC, which may be influenced by multiple factors including limited resources leading to poor access to care, and lack of comprehensive SCD management programmes, there have been significant improvements in the morbidity and mortality rates for children with SCD in high resource countries. Especially in the United States of America, due to early diagnosis through newborn screening programs, prophylactic therapy, comprehensive care programs, and bone marrow transplant.
Therefore, this alarm raised does not call for a defence or debate given the statistics that Nigeria has a high infant mortality rate as a result of SDC. Rather, Nigeria, government and people alike, should see the alarm as a wake-up call to reduce the incidence because this perennial decimator of human life, particularly in children can be prevented.
Since sickle cell anaemia is an inherited illness because both parents must be carriers of the sickle cell gene for a child to be affected, Nigerians should be sensitised on the existence of SDC, consequences, prevention and care. Also, while, treating the biological and physical manifestations of SCD such as crises and complications, there is the need for prevention by discouraging marriages between two people with SCT because of the near certainly of the couple having a child with SCD. As such, young people should be sensitised to know the genotype of their proposed spouses before they go deep into relationships. So, government, religious and community leaders should rise up to the occasion.
Intending couples should be counselled on the need to know the genotype of their proposed spouses before marriage; and religious leaders should encourage the intending couple to undergo a test. Backing this with legislation, just as the Kano State government, through the Hisbah Board, in collaboration with the Kano State Agency for the Control of AIDS (KSACA), recently proposed to come up with a law that would compel couples to undergo HIV screening before marriage a legislation to back up the need for genotype test will help in making the country SCD-free. Essentially, the prevention of SDC is better than managing it, In addition, many of the interventions in high resource countries can confer the same benefits to SCD patients in Africa. So, newborn screening for SCD, developing partnerships between high resource countries and other countries in Africa to support training of healthcare workers, research, and sharing of knowledge can help to reduce the SCD burden on Africa.