Operational analysis of the national sickle cell screening programme in the Republic of Uganda

Background: Sickle cell anaemia is a common global life-threatening haematological disorder. Most affected births occur in sub-Saharan Africa where children usually go undiagnosed and die early in life. Uganda's national sickle cell screening programme was developed in response to a 2014 sickle cell surveillance study that documented a high disease prevalence. Objective: This study describes the temporal and financial aspects of Uganda's 2014­2019 sickle cell screening programme. Methods: National sickle cell screening data from Uganda's Central Public Health Laboratories were used to calculate turn-around times (TATs) from sample collection to delivery, testing, and result reporting for blood samples collected from February 2014 to March 2019. The parameters affecting specific TATs were assessed. The exact programme expenditures were analysed to determine cost per test and per positive sickle cell disease case detected. Results: A total of 278 651 samples were analysed. The median TAT from sample collection to laboratory receipt was 8 days (interquartile range [IQR]: 6­12), receipt to testing was 3 days (IQR: 1­7), and testing to result reporting was 6 days (IQR: 3­12). Altogether, the sample continuum averaged 16 days (IQR: 11­24). Lower level healthcare facilities were associated with longer sample delivery TATs. Calendar months (January and December) and larger sample volumes impacted testing and result reporting TATs. The cost per test was $4.46 (United States dollars [USD]) and $483.74 USD per positive case detected. Conclusion: Uganda's sickle cell screening programme is efficient and cost-effective. Universal newborn screening is the best strategy for detecting sickle cell anaemia in Uganda.

Apport de la saturométrie dans le dépistage des cardiopathies congénitales cyanogènes chez les nouveau-nés au CNHU-HKM Cotonou, faisabilité et résultats préliminaires en 2019 / NA

Introduction : Les cardiopathies congénitales critiques représentant 25% des cardiopathies congénitales et s'accompagnent souvent de désaturation, d'où l'intérêt de l'utilisation de la saturation pulsée en oxygène pour favoriser leur détection chez tous les nouveau-nés avant la sortie de maternité et un traitement adéquat. Au Bénin la saturométrie de dépistage est encore peu utilisée. Cette étude avait pour objectif d'étudier l'apport de la saturométrie dans le dépistage des cardiopathies congénitales cyanogènes au CNHU-HKM de Cotonou en 2019. Méthodes : Il s'agissait d'une étude transversale, descriptive et analytique qui s'est déroulée du 15 mai au 13 novembre 2019 et ayant inclus les nouveau-nés, nés au CNHU- HKM. Tous les enfants ont bénéficié d'un examen clinique et d'un test de saturométrie. L'échographie Döppler cardiaque a été réalisée chez tous les patients et utilisée comme gold standard pour déterminer les performances diagnostiques de la saturométrie pour le dépistage des cardiopathies congénitales cyanogènes. Résultats : un total de 379 nouveau-nés ont été inclus. L'acceptabilité parentale était de 72,64%. La saturométrie a permis de détecter 4 cas d'hypertension artérielle pulmonaire persistante du nouveau-né (HTAPP) associée à un foramen ovale shuntant droite-gauche. La saturométrie de dépistage avait une sensibilité de 100%, une spécificité de 94,93% et une valeur prédictive positive à 17,4%. Malgré son faible caractère discriminant pour les autres causes de désaturation, la valeur prédictive négative était de 100%. L'examen clinique améliore les performances diagnostiques de la saturométrie pour le dépistage des cardiopathies congénitales cyanogènes. Conclusion : La saturométrie est un test de dépistage aisément utilisable dans nos conditions de travail et avec une bonne acceptabilité parentale. Malgré son faible caractère discriminant, ses performances diagnostiques sont excellentes pour le dépistage des cardiopathies congénitales cyanogènes.

ABSTRACT Introduction: Critical congenital heart disease represented 25% of congenital heart disease and are often accompanied by desaturation, hence the interest to use pulse oximeter in order to detect all newborns who have congenital heart disease before discharge after birth. In Benin, pulse oximetry screening is rarely used. This study aimed to study the contribution of s pulse oximetry screening in the detection of cyanotic congenital heart disease at the CNHU-HKM in Cotonou in 2019. Results: 379 newborns were included. The parental acceptability was 72.64%. Pulse oximetry detected 4 cases of newborn pulmonary hypertension with a permeable foramen oval and right to left shunt. Pulse oximetry screening had a sensitivity of 100% and a specificity of 94.93%, a positive predictive value of 17.4%. Despite its low discriminating character for the other causes of desaturation, its negative predictive value was 100%. Clinical examination improves results of pulse oximetry to detect cyanotic congenital heart disease. Conclusion: Pulse oximetry is a screening test easily used in our condition with a good parental acceptability. Despite its low discriminating character, it has an excellent accuracy to detect cyanotic congenital heart disease.

Acceptabilité du dépistage néonatal de la drépanocytose au cours de la pandémie au COVID-19 à Kisangani, en République Démocratique du Congo

Introduction: l´implémentation du dépistage néonatal de la drépanocytose pendant la pandémie se coronavirus (COVID-19) représente un défi majeur en République Démocratique du Congo (RDC). La présente étude vise à déterminer si des facteurs socio-économiques sont associés à l´acceptabilité du dépistage néonatal de la drépanocytose pendant la COVID-19 à Kisangani, en RDC. Méthodes: étude observationnelle conduite dans les maternités de Kisangani du 21 mars au 30 juin 2020 chez les mères sensibilisées au dépistage néonatal de la drépanocytose de leurs nouveau-nés à l´hemotypeSCTM (HT401RUO-USA). Les données recueillies étaient la parité, le niveau d´étude, l´âge, le niveau socio-économique, la profession, la notion de sensibilisation et le motif du refus du dépistage. Résultats: sur 55,5% (273/492) des mères sensibilisées, 107 (39,19 %) ont accepté et 166 (60,80 %) ont refusé le dépistage néonatal de la drépanocytose chez leur nouveau né. Les motifs du refus étaient l´absence d´information (67,5%;IC 95% [59,8-74,5]), le manque d´argent dû au confinement (66,3%;IC 95% [58,5-73,4]), la prise de sang pour tentative du vaccin anti-COVID-19 (63,2%; IC 95% = [55,4-70,6]). Les Facteurs associés à l´acceptabilité du dépistage étaient l´âge > 35 ans (p = 0,0009; ORa = 3,04; IC 95% = 1,57-5,87) et le bas niveau socio-économique (p = 0,0016; ORa = 2,29; IC à 95% = 1,37-3,85). Conclusion: l´acceptabilité du dépistage néonatal de la drépanocytose pendant la COVID-19 reste faible à Kisangani. Le gouvernement devrait identifier les canaux de communication efficaces afin de promouvoir les initiatives dans le secteur de la Santé

Feasibility of Pulse Oximetry Pre-discharge Screening Implementation for Detecting Critical Congenital Heart Lesions in Newborns in a Secondary Level Maternity Hospital in the Western Cape; South Africa: The 'POPSICLe' Study

Background. Early detection of critical congenital heart disease (CCHD) through newborn pulse oximetry (POx) screening is an effective strategy for reducing paediatric morbidity and mortality rates and has been adopted by much of the developed world.Objectives. To document the feasibility of implementing pre-discharge POx screening in well babies born at Mowbray Maternity Hospital; a busy government hospital in Cape Town; South Africa. Parent and staff acceptance was assessed.Methods. We conducted a prospective study of predischarge POx screening in one postnatal ward; following informed parental consent.Results. During the 4-month study period; 1 017 of 2 256 babies discharged (45.1%) were offered POx screening and 1 001 were screened; 94.0% of tests took 3 minutes to perform; 4.3% 3 - 5 minutes and 1.7% 5 minutes. Eighteen patients needed second screens and three required third screens. Only 3.1% protocol errors were made; all without consequence. The vast majority (91.6%) of nursing staff reported insufficient time to perform the study screening in addition to their daily tasks; but ~75% felt that with a full nursing staff complement and if done routinely (not part of a study); pre-discharge POx screening could be successfully instituted at our facility. Over 98% of the mothers had positive comments. Two babies failed screening and required echocardiograms; one was diagnosed with CCHD and the other with neonatal sepsis. The sensitivity and specificity were 50% (95% confidence interval (CI) 1.3 - 98.7%) and 99.9% (95% CI 99.4 - 100%); respectively; with a percentage correct of 99.8%.Conclusions. POx screening was supported and accepted by staff and parents. If there are no nursing staff shortages and if it is done routinely before discharge; not as part of a study; we conclude that POx screening could be implemented successfully without excessive false positives or errors; or any additional burden to cardiology services

Evaluation of universal newborn hearing screening in South African primary care

Background: Universal Newborn Hearing Screening (UNHC) is the gold standard toward early hearing detection and intervention; hence the importance of its deliberation within the South African context. Aim: To determine the feasibility of screening in low-risk neonates, using Otoacoustic Emissions (OAEs), within the Midwife Obstetric Unit (MOU) three-day assessment clinic at a Community Health Centre (CHC); at various test times following birth.Method: Within a quantitative, prospective design, 272 neonates were included. Case history interviews, otoscopic examinations and Distortion Product OAEs (DPOAEs) screening were conducted at two sessions (within six hours and approximately three days after birth). Data were analysed via descriptive statistics. Results: Based on current staffing profile and practice, efficient and comprehensive screening is not successful within hours of birth, but is more so at the MOU three-day assessment clinic. Significantly higher numbers of infants were screened at session 2; with significantly less false-positive results. At session 1, only 38.1% of the neonates were screened; as opposed to more than 100% at session 2. Session 1 yielded an 82.1% rate of false positive findings, a rate that not only has important implications for the emotional well-being of the parents; but also for resource-stricken environments where expenditure has to be accounted for carefully. Conclusion: Current findings highlight the importance of studying methodologies to ensure effective reach for hearing screening within the South African context. These findings argue for UNHS initiatives to include the MOU three-day assessment to ensure that a higher number of neonates are reached and confounding variables such as vernix have been eliminated

Evaluating the Knowledge of Sickle Cell Disease and Hemoglobin Electrophoretic Pattern among People Living in Sekondi-Takoradi Metropolis; Ghana

Background: Sickle cell disease (SCD) is an inherited lifelong hemolytic disorder affecting many children in sub-Saharan Africa; especially in West and Central Africa. There is a limited public health education on SCD in Ghana with only two information centers in Accra and Kumasi; respectively.Methodology: This cross-sectional study evaluated the knowledge of SCD among people living in Sekondi-Takoradi metropolis. Churches; saloons; internet cafes and bus stations were randomly selected in the center of the city with proximity to the central market.Results: A total of 621 individuals were recruited; 52.5 (326) had knowledge of their hemoglobin (Hb) electrophoretic pattern while 47.5 (295) had none. In addition; 93.4 individuals had knowledge of SCD while 6.6 had no knowledge of SCD. Older individuals exhibited better knowledge of their Hb electrophoretic pattern than the younger ones (P = 0.019). Individuals with tertiary education and married couples exhibited higher knowledge of SCD when compared to their counterparts (P 0.001).Conclusion: Despite the relatively high knowledge of SCD and Hb electrophoretic pattern observed in this study; it is very important to increase neonatal screenings and health care services to the region. In addition; more emphasis is needed to increase public awareness of SCD especially in schools; churches; hospitals and the media

How Effective is the 2012 Maternal; Newborn and Child Health Week (MNCHW) in River State?

Nigeria is one of the countries noted to have made insufficient progress towards the attainment of the health-related MDGs. Experience has however shown that a few cost-effective interventions that can be delivered in resource poor settings; through family/community-level action and schedulable population-oriented services; are able to rapidly attain these goals. This was the basis of the Maternal; Newborn and Child Health Week (MNCHW) in Nigeria; designed to achieve rapid population coverage of chosen interventions; within the one week period of the programme. This study assessed the effectiveness of the week held in Rivers State; in June 2012. of the LGAs; while iron and folate tablets were given to just 2.86Materials and Methods: The data for the assessment was collected through on-the- spot observations; three semi-structured questionnaires; and the final summaries of the week; provided by the State Ministry of Health. The questionnaires were administered in nine health centers; in three randomly selected LGAs. The first questionnaire was used to assess the extent of the social mobilization carried out for the week; the second was an exit interview of clients of the health facilities; and used to assess the success of the social mobilization campaign; while the third questionnaire was used to assess the availability of the intervention commodities; and the quality of care given to the clients.Results: The social mobilization campaign for the week was poorly funded and did not have much effect; as only 28.57 of the clients of the health facilities were aware of the week. Most of the commodities for the week; except the NPI vaccines and vitamin A; were not available in the required quantities. Long Lasting Insecticide-treated Nets (LLINs) and Sulphadoxine-Pyrimethamine (SP) were not available in 65.22 of the LGAs; family planning commodities were not available in 30.43 of the LGAs; family planning commodities were not available in 30.43 of the LGAs; while iron and folate tablets were given to just 2.86 of the LGAs; while iron and folate tablets were given to just 2.86 of the targeted total. The coverage rate of the vaccines ranged from 1.29 recorded with the measles vaccine; to the 14.85; for the DPT vaccine. The coverage with vitamin A of 43.41; for the DPT vaccine. The coverage with vitamin A of 43.41 was the highest of all the interventions; while the 0.36 coverage for family planning commodities was the least.Conclusions: The MNCHW in Rivers State did not meet the stated objectives. Efforts should be made to leverage on the political will of the current government of the State for health programmes