Division of Socio-Behavioural & Health Systems Research, 28604Indian Council of Medical Research, New Delhi, India.
Department of Biotechnology, 468678Indira Gandhi National Tribal University, Amarkantak, India.
J Med Screen. 2023 Mar;30(1):28-35. doi: 10.1177/09691413221123131. Epub 2022 Aug 28.
To describe the development and implementation of a population-based screening programme for sickle cell disease (SCD) implemented in 12 SCD-endemic and tribal-dominated primary/community health centres (PHCs/CHCs) across six districts of India.
India reports a huge burden of SCD, especially among indigenous (tribal) communities. However, there is no state-led SCD programme in many places, and systematic screening is absent. This situation necessitates developing a model of population screening.
This programme was meant to screen all people and was carried out in three tiers. The first tier was a symptomatic survey carried out by community health workers. Regular health workers then screened those referred by sickle cell solubility test at sub-health centres as the second tier. The third tier was confirmation by haemoglobin electrophoresis at PHCs/CHCs. Communities were mobilised and prepared to accept the screening. Capacity building of health facilities was ensured through training and supply of equipment and material.
Initial observation based on six months' data revealed that out of the 110,754 tribal population of 12 PHCs/CHCs, 8418 (7.6%) were identified in the symptomatic survey. Subsequently, 9416 people, including the above 8418, underwent the solubility test, and 2607 (27.7%) were found to be positive. Of these, 1978 (78.9%) underwent electrophoresis. About 64.2% were found to be positive for sickle haemoglobin (233 (18.4%) SCD and 1036 (81.6%) SCD trait).
The study demonstrates the feasibility of establishing a population-based screening programme in the primary health care system. It is easy to implement in tribal habitations as part of the proposed national SCD/haemoglobinopathies programme.
描述在印度六个地区的 12 个镰状细胞病（SCD）流行地区和部落主导的初级/社区卫生中心（PHC/CHC）实施的基于人群的 SCD 筛查计划的发展和实施情况。
印度报告 SCD 负担巨大，尤其是在土著（部落）社区中。然而，许多地方没有州政府主导的 SCD 计划，也没有系统的筛查。这种情况需要制定一种人群筛查模式。
该计划旨在筛查所有人群，分为三个层次进行。第一层是由社区卫生工作者进行的症状调查。然后，由基层卫生中心的镰状细胞溶解度试验转诊的人员进行第二层常规卫生工作者筛查。第三层是在 PHC/CHC 进行血红蛋白电泳确认。社区进行动员并准备接受筛查。通过培训和提供设备和材料来确保卫生设施的能力建设。
基于六个月的数据初步观察发现，在 12 个 PHC/CHC 的 110754 名部落人口中，有 8418 人（7.6%）在症状调查中被发现。随后，9416 人（包括上述 8418 人）接受了溶解度试验，其中 2607 人（27.7%）呈阳性。其中，1978 人（78.9%）接受了电泳。约 64.2%的人镰状血红蛋白阳性（233 人（18.4%）SCD 和 1036 人（81.6%）SCD 特征）。
该研究表明，在初级卫生保健系统中建立基于人群的筛查计划是可行的。作为拟议的全国 SCD/血红蛋白病计划的一部分，它很容易在部落居住地实施。
