Zohoun I S, Mérault G, Reinette P, Rosa J
Service des maladies du sang et banque du sang, CNHU de Cotonou, Bénin.
Rev Prat. 1992 Oct 1;42(15):1873-7.
Issues of public health raised by sickle cell disease and available solutions vary greatly between countries. Two main variables lead the choices: the affordable health resources, and the distribution of the abnormal genes in the population. Three examples have been chosen to illustrate these challenges. 1. In continental France, the level of health resources is good but the distribution of sickle traits is very heterogeneous among the population. Health policies against sickle cell disease aim at organizing screening and care to reach populations at risk, and concentrate the efforts upon them. This task is made difficult by two usual characteristics of these minorities: their rather poor social condition, and their cultural isolation. 2. In Guadeloupe (French West Indies) available health resources are similar to those of France but the sickle trait is common and has a homogeneous distribution in the population (14% carriers). Sickle cell disease is a health priority. Such conditions have recently favoured the organization of an efficient program for prevention and care of the disease. 3. In Benin (West Africa) a very high prevalence of sickle trait (more than 30% individuals are carriers, and about 4% have the disease) comes along with quite precarious resources that have to be shared with several other health priorities. An efficient and sustained policy against sickle cell disease has not yet been developed, which impedes a rational use of the few available resources, and creates much distress for diseased individuals.
镰状细胞病引发的公共卫生问题以及可用的解决方案在不同国家之间存在很大差异。有两个主要变量影响着这些选择：可负担的卫生资源，以及异常基因在人群中的分布情况。我们选择了三个例子来说明这些挑战。1. 在法国本土，卫生资源水平良好，但镰状细胞性状在人群中的分布非常不均一。针对镰状细胞病的卫生政策旨在组织筛查和护理，以覆盖高危人群，并集中力量关注这些人群。这些少数群体的两个常见特征使得这项任务变得困难：他们的社会状况相当贫困，且在文化上处于孤立状态。2. 在瓜德罗普岛（法属西印度群岛），可用的卫生资源与法国相似，但镰状细胞性状很常见，且在人群中分布均匀（14%的携带者）。镰状细胞病是卫生工作的重点。这种情况最近有利于组织一项有效的疾病预防和护理计划。3. 在贝宁（西非），镰状细胞性状的患病率非常高（超过30%的个体为携带者，约4%患有该病），同时卫生资源相当匮乏，还必须与其他几个卫生重点事项共享这些资源。尚未制定出一项针对镰状细胞病的有效且持续的政策，这阻碍了对仅有的少量可用资源的合理利用，并给患病个体带来了极大的痛苦。
