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A predictive algorithm for identifying children with sickle cell anemia among children admitted to hospital with severe anemia in Africa

Title: A predictive algorithm for identifying children with sickle cell anemia among children admitted to hospital with severe anemia in Africa
Authors: Olupot-Olupot, P
Connon, R
Kiguli, S
Opoka, RO
Alaroker, F
Uyoga, S
Nakuya, M
Okiror, W
Nteziyaremye, J
Ssenyondo, T
Nabawanuka, E
Kayaga, J
Williams Mukisa, C
Amorut, D
Muhindo, R
Frost, G
Walsh, K
Macharia, AW
Gibb, DM
Walker, AS
George, EC
Maitland, K
Williams, TN
Williams, T
Item Type: Journal Article
Abstract: Sickle cell anemia (SCA) is common in sub-Saharan Africa where approximately 1% of births are affected. Severe anemia is a common cause for hospital admission within the region yet few studies have investigated the contribution made by SCA. The Transfusion and Treatment of severe anemia in African Children Trial (ISRCTN84086586) investigated various treatment strategies in 3983 children admitted with severe anemia (hemoglobin < 6.0 g/dl) based on two severity strata to four hospitals in Africa (three Uganda and one Malawi). Children with known-SCA were excluded from the uncomplicated stratum and capped at 25% in the complicated stratum. All participants were genotyped for SCA at trial completion. SCA was rare in Malawi (six patients overall), so here we focus on the participants recruited in Uganda. We present baseline characteristics by SCA status and propose an algorithm for identifying children with unknown-SCA. Overall, 430 (12%) and 608 (17%) of the 3483 Ugandan participants had known- or unknown-SCA, respectively. Children with SCA were less likely to be malaria-positive and more likely to have an affected sibling, have gross splenomegaly, or to have received a previous blood transfusion. Most outcomes, including mortality and readmission, were better in children with either known or unknown-SCA than non-SCA children. A simple algorithm based on seven admission criteria detected 73% of all children with unknown-SCA with a number needed to test to identify one new SCA case of only two. Our proposed algorithm offers an efficient and cost-effective approach to identifying children with unknown-SCA among all children admitted with severe anemia to African hospitals where screening is not widely available.
Issue Date: May-2022
Date of Acceptance: 29-Jan-2022
URI: http://hdl.handle.net/10044/1/95025
DOI: 10.1002/ajh.26492
ISSN: 0361-8609
Publisher: Wiley
Start Page: 527
End Page: 536
Journal / Book Title: American Journal of Hematology
Volume: 97
Issue: 5
Copyright Statement: © 2022 The Authors. American Journal of Hematology published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: Wellcome Trust
Wellcome Trust
Medical Research Council
Wellcome Trust
Medical Research Council (MRC)
Medical Research Council
Wellcome Trust
Funder's Grant Number: 091758/B/10/Z
202800/Z/16/Z
MR/JO12483
203077/C/16/Z
MR/J012483/1
MR/J012483/1
203077/C/16/Z
Keywords: Science & Technology
Life Sciences & Biomedicine
Hematology
DISEASE
OUTCOMES
MALARIA
BURDEN
Algorithms
Anemia, Sickle Cell
Child
Hospitals
Humans
Malawi
Uganda
Humans
Anemia, Sickle Cell
Algorithms
Child
Hospitals
Uganda
Malawi
1102 Cardiorespiratory Medicine and Haematology
Immunology
Publication Status: Published
Online Publication Date: 2022-02-11
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Department of Surgery and Cancer
Department of Infectious Diseases
Faculty of Medicine



This item is licensed under a Creative Commons License Creative Commons