Sickle cell disease management in Nigeria: Understanding the challenges from the physicians' perspectives

Abstract

Introduction: Nigeria has the greatest burden of sickle cell disease (SCD) in sub-Saharan Africa. The disorder is usually associated with a huge psychological and financial toll on families and individuals in developing countries. However, SCD diagnosis and management are still largely rudimentary especially in Africa. This study therefore aims to explore the views of physicians about challenges facing SCD management in Nigeria as well as the health system responses to these challenges. Methods: This qualitative cross-sectional study was conducted in 2015. A total of ten in-depth interviews (IDIs) were conducted among purposively selected resident doctors at the Hematology Department of the University College Hospital (UCH), Ibadan, Southwest Nigeria. Data from the IDIs were transcribed and analyzed with the aid of the NVIVO (version 10) software using the thematic framework approach to qualitative data analysis. Results: In the opinion of the study participants, many of the SCD patients, cannot access up-to-date medical care because of poor health financing and poverty, inadequate health infrastructure s and medical facilities including obsolete blood transfusion services and medical equipment. There were myriads of medical challenges facing individuals with SCD in Nigeria: frequent illnesses and crises which may comprise bone pains, recurrent anemia, malaria, chronic leg ulcer and even risk of HIV and Hepatitis B from frequent blood transfusion. Similarly, SCD patients may experience psychological challenges, according to the respondents, due to the frequent illnesses, discrimination suffered as well as somatization. Some respondents submitted that there is still significant ignorance about the disease and its pathophysiology among the patients themselves, their caregivers and the general population thereby feeding a lot of superstitious beliefs. Some health systems challenges highlighted in SCD management include inadequate financial support as well as poor infrastructures for diagnosis and treatment.