Sickle cell disease in Cameroon: Taking out the "neglect" and highlighting key opportunities for sustainable control.

Sickle Cell Disease (SCD) is a serious genetic disorder with astounding regional differences in childhood survival. Alarmingly, over 90% of children with SCD in SSA die before their fifth birthday. In Cameroon, approximately 7,000 children are born with SCD annually; however, most of them go undiagnosed until their fourth birthday, resulting into untold pain and suffering. Despite this, little is known about the barriers to optimal care and treatment for SCD in Cameroon. Here, we assess these barriers, and consider opportunities that could be leveraged, for a sustainable control of SCD in Cameroon. We conducted a qualitative study, with documentary analysis of key national and international policy documents related to SCD management in Cameroon; semi-structured interviews; and focus group discussions, used for data collection. Key informants were selected purposively, and met at the central level of the health system (in Yaoundé) and the operational level (Mfou health district). These were policy makers, health workers, parents with SCD children and teenagers with SCD. Several critical gaps exist which hinder SCD control in Cameroon. These include lack of a national sickle cell disease strategy, no proportional allocation of funds for SCD in the national budget, and gaps in service delivery. These are translated into healthcare providers having little knowledge on SCD, absence of SCD-specific indicators in the health information system, challenges accessing essential medicines, and limited awareness raising in communities on SCD. Still, several opportunities exist which could be leveraged for improving SCD care in Cameroon. These include the possibility of integrating SCD screening and care into well-established primary healthcare services like vaccination, antenatal care, and non-communicable disease clinics. In the light of such limited resource settings, considering opportunities for integration in existing health programs could go a long way to reduce morbidities and mortalities from SCD over the coming years.