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.

HIV/AIDS in Children

It is estimated that 3 million children under the age of 15 years have been infected with HIV world wide. The prevalence of HIV infection in Uganda ranges between 5and 10and the infection in children accounts for about 10of all infections. Mother to child transmission (MTCT) of the virus i.e. during pregnancy; delivery or breast-feeding is responsible for more than 90of HIV infection in children. Of those infants infectes through MTCT; it is beleived that about two - thirds are infected during pregnancy and around the time of delivery; and about one-third are infected through breastfeeding. MTCT rates vary considerably. In the developed countries; the risk of an infant acquiring HIV from an infected mother ranges from 15-25comapred with 25 - 45in developing countries. The differences in breast-feeding rates may account for much of this variation. The additional risk of infection when an infant is breast-fed is about 15