Haematology day care service for adult sickle cell disease patients

Abstract

Background: Non communicable diseases have overtaken infectious diseases as a cause of death in resource poor countries, making it necessary to introduce interventions and management policies in their control. Sickle Cell Disease (SCD) is a prevalent disorder in this category. This survey evaluated the use of a day care facility in the care of SCD patients in Nigeria. Methods: This is a questionnaire based, cross-sectional survey carried out in tertiary hospitals in Nigeria. Information obtained included number of patients per week with vaso-occlussive crises (VOC), blood transfusion and hospital admissions through the hematology day care unit (HDCU) or Emergency Room (ER). Also obtained were the number of sickle cell deaths in the preceding year and the use of hydroxyurea by the patients. Results: Eight (61.5%) of the thirteen hospitals have HDCU and such hospitals were less likely to transfuse patients in the ER OR=0.5). Admissions through the ER also differ between hospitals with and without HDCU 1.75 vs 2.4 respectively (p=0.2). Sickle cell deaths did not differ between the two groups (X2: =3.6; p-0.46). Experience per consultant year differed between teaching and non-teaching hospitals (p=0.02), teaching and state hospitals (p=0.09). Conclusions: This survey showed that hospitals without HDCU are more likely to use the ER for the care of SCD patients where care for the patients may not be optimal. It is important for countries with a high disease burden to consider HDCU as a suitable intervention in optimizing SCD care.