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Paediatric sickle cell disease at a tertiary hospital in Malawi: a retrospective cross-sectional study
INTRODUCTION: Sickle cell disease (SCD) remains a major cause of childhood mortality and morbidity in Malawi. However, literature to comprehensively describe the disease in the paediatric population is lacking. METHODS: A retrospective review of clinical files of children with SCD was conducted. Des...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8438882/ https://www.ncbi.nlm.nih.gov/pubmed/34568588 http://dx.doi.org/10.1136/bmjpo-2021-001097 |
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author | Chimbatata, Chikondi Sharon Chisale, Master RO Kayira, Alfred Bornwell Sinyiza, Frank Watson Mbakaya, Balwani Chingatichifwe Kaseka, Paul Uchizi Kamudumuli, Pocha Wu, Tsung-Shu Joseph |
author_facet | Chimbatata, Chikondi Sharon Chisale, Master RO Kayira, Alfred Bornwell Sinyiza, Frank Watson Mbakaya, Balwani Chingatichifwe Kaseka, Paul Uchizi Kamudumuli, Pocha Wu, Tsung-Shu Joseph |
author_sort | Chimbatata, Chikondi Sharon |
collection | PubMed |
description | INTRODUCTION: Sickle cell disease (SCD) remains a major cause of childhood mortality and morbidity in Malawi. However, literature to comprehensively describe the disease in the paediatric population is lacking. METHODS: A retrospective review of clinical files of children with SCD was conducted. Descriptive statistics were performed to summarise the data. χ(2) or Fisher’s exact test was used to look for significant associations between predictor variables and outcome variables (case fatality and length of hospital stay). Predictor variables that were significantly associated with outcome variables (p≤0.05) in a χ(2) or Fisher’s exact test were carried forward for analysis in a binary logistic regression. A multivariable binary logistic regression was used to identify covariates that independently predicted length of hospital stay. RESULTS: There were 16 333 paediatric hospitalisations during the study period. Of these, 512 were patients with SCD representing 3.1% (95% CI: 2.9%- 3.4%). Sixty-eight of the 512 children (13.3%; 95% CI: 10.5% - 16.5%) were newly diagnosed cases. Of these, only 13.2% (95% CI: 6.2% - 23.6%) were diagnosed in infancy. Anaemia (94.1%), sepsis (79.5%) and painful crisis (54.3%) were the most recorded clinical features. The mean values of haematological parameters were as follows: haemoglobin (g/dL) 6.4 (SD=1.9), platelets (×10(9)/L) 358.8 (SD=200.9) while median value for white cell count (×10(9)/L) was 23.5 (IQR: 18.0–31.2). Case fatality was 1.4% (95% CI: 0.6% - 2.8%)and 15.2% (95% CI: 12.2% -18.6%) of the children had a prolonged hospital stay (>5 days). Patients with painful crisis were 1.7 (95% CI: 1.02 - 2.86) times more likely to have prolonged hospital stay than those without the complication. CONCLUSION: Anaemia, sepsis and painful crisis were the most common clinical features paediatric patients with SCD presented with. Patients with painful crisis were more likely to have prolonged hospital stay. Delayed diagnosis of SCD is a problem that needs immediate attention in this setting. Although somewhat encouraging, the relatively low in-hospital mortality among SCD children may under-report the true mortality from the disease considering community deaths and deaths occurring before SCD diagnosis is made. |
format | Online Article Text |
id | pubmed-8438882 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-84388822021-09-24 Paediatric sickle cell disease at a tertiary hospital in Malawi: a retrospective cross-sectional study Chimbatata, Chikondi Sharon Chisale, Master RO Kayira, Alfred Bornwell Sinyiza, Frank Watson Mbakaya, Balwani Chingatichifwe Kaseka, Paul Uchizi Kamudumuli, Pocha Wu, Tsung-Shu Joseph BMJ Paediatr Open Haematology INTRODUCTION: Sickle cell disease (SCD) remains a major cause of childhood mortality and morbidity in Malawi. However, literature to comprehensively describe the disease in the paediatric population is lacking. METHODS: A retrospective review of clinical files of children with SCD was conducted. Descriptive statistics were performed to summarise the data. χ(2) or Fisher’s exact test was used to look for significant associations between predictor variables and outcome variables (case fatality and length of hospital stay). Predictor variables that were significantly associated with outcome variables (p≤0.05) in a χ(2) or Fisher’s exact test were carried forward for analysis in a binary logistic regression. A multivariable binary logistic regression was used to identify covariates that independently predicted length of hospital stay. RESULTS: There were 16 333 paediatric hospitalisations during the study period. Of these, 512 were patients with SCD representing 3.1% (95% CI: 2.9%- 3.4%). Sixty-eight of the 512 children (13.3%; 95% CI: 10.5% - 16.5%) were newly diagnosed cases. Of these, only 13.2% (95% CI: 6.2% - 23.6%) were diagnosed in infancy. Anaemia (94.1%), sepsis (79.5%) and painful crisis (54.3%) were the most recorded clinical features. The mean values of haematological parameters were as follows: haemoglobin (g/dL) 6.4 (SD=1.9), platelets (×10(9)/L) 358.8 (SD=200.9) while median value for white cell count (×10(9)/L) was 23.5 (IQR: 18.0–31.2). Case fatality was 1.4% (95% CI: 0.6% - 2.8%)and 15.2% (95% CI: 12.2% -18.6%) of the children had a prolonged hospital stay (>5 days). Patients with painful crisis were 1.7 (95% CI: 1.02 - 2.86) times more likely to have prolonged hospital stay than those without the complication. CONCLUSION: Anaemia, sepsis and painful crisis were the most common clinical features paediatric patients with SCD presented with. Patients with painful crisis were more likely to have prolonged hospital stay. Delayed diagnosis of SCD is a problem that needs immediate attention in this setting. Although somewhat encouraging, the relatively low in-hospital mortality among SCD children may under-report the true mortality from the disease considering community deaths and deaths occurring before SCD diagnosis is made. BMJ Publishing Group 2021-09-08 /pmc/articles/PMC8438882/ /pubmed/34568588 http://dx.doi.org/10.1136/bmjpo-2021-001097 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Haematology Chimbatata, Chikondi Sharon Chisale, Master RO Kayira, Alfred Bornwell Sinyiza, Frank Watson Mbakaya, Balwani Chingatichifwe Kaseka, Paul Uchizi Kamudumuli, Pocha Wu, Tsung-Shu Joseph Paediatric sickle cell disease at a tertiary hospital in Malawi: a retrospective cross-sectional study |
title | Paediatric sickle cell disease at a tertiary hospital in Malawi: a retrospective cross-sectional study |
title_full | Paediatric sickle cell disease at a tertiary hospital in Malawi: a retrospective cross-sectional study |
title_fullStr | Paediatric sickle cell disease at a tertiary hospital in Malawi: a retrospective cross-sectional study |
title_full_unstemmed | Paediatric sickle cell disease at a tertiary hospital in Malawi: a retrospective cross-sectional study |
title_short | Paediatric sickle cell disease at a tertiary hospital in Malawi: a retrospective cross-sectional study |
title_sort | paediatric sickle cell disease at a tertiary hospital in malawi: a retrospective cross-sectional study |
topic | Haematology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8438882/ https://www.ncbi.nlm.nih.gov/pubmed/34568588 http://dx.doi.org/10.1136/bmjpo-2021-001097 |
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