Undercover illness: Interventions needed to detect and treat sickle-cell anemia in Africa

In resource-constrained settings like Kenya, “more than 90% of children with sickle-cell anaemia die before the diagnosis can be made,” most likely due to opportunistic bacterial diseases. Two of the most common infections, Streptococcus pneumoniae and Haemophilus influenzae, are preventable or treated readily in developed countries.

A recent study published in The Lancet underscores these health inequities suffered by children in sub-Saharan Africa. The report, “Bacteraemia in Kenyan children with sickle-cell anaemia: A retrospective cohort and case-control study,” examines retrospectively the prevalence, diagnosis, and treatment of bacterial illnesses associated with sickle-cell anemia in Kenya.

At the Kilifi District Hospital in Kenya, the researchers collected and studied blood cultures from approximately 38,000 children under 14 years of age who were admitted between August 1, 1998, and March 31, 2008. They identified approximately 2,000 cases of bacterial infection. Sickle-cell anemia was identified in over 100 of these cases, but three-quarters of these children did not receive this diagnosis until admission for a bacterial infection.

Although studies show that antibacterial prophylaxis and vaccination can improve the prognosis for people born with sickle-cell anemia in developed countries, few guidelines exist in Africa that would improve the detection and treatment of the disease and its related infections. According to the researchers, “few studies have described the bacteriology of sickle-cell anaemia in sub-Saharan Africa despite the fact that more than 200,000 African children are born with this disease every year.” The dearth of data, most likely due to underreporting, contributes to the stalled development of evidence-based guidelines that could save thousands of lives.

Vaccines against Streptococcus pneumoniae and Haemophilus influenzae, the most common causes of infection among children with sickle-cell anemia, are administered regularly in developed countries. The uptake of such preventative measures has been slow in Africa due to funding priorities for other pervasive diseases such as HIV and malaria. A Reuters article about the study mentions that the Global Alliance for Vaccines and Immunization (GAVI) currently provides an effective vaccine for Haemophilus influenzae type b (Hib) to 35 African nations and hopes to roll out an improved pneumococcal vaccine across Africa in the next few years.

The Lancet study results suggest that “bacterial infections are a major cause of morbidity and mortality in children with sickle-cell anaemia.” Unless greater attention is given to identifying and treating the disease in developing countries, sickle-cell anemia will continue to contribute to child mortality. Targeted interventions would save lives and lead one step closer to reaching the Millennium Development Goal of reducing mortality in children younger than 5 years old.