Ally Mwashungi, Kakoko Deodatus Conatus, Swai Calvin, Metta Emmy, Yonazi Mbonea, Makani Julie, Mmbaga Elia John, Leshabari Melkizedeck Thomas, Moen Kåre, Omsland Tone Kristen, Balandya Emmanuel
Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.
Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.
Pediatric Health Med Ther. 2024 Dec 27;15:385-395. doi: 10.2147/PHMT.S485842. eCollection 2024.
Tanzania is the fifth country with the highest sickle cell disease (SCD) prevalence globally. Although hydroxyurea (HU) is available, only 25% of persons with SCD are reported to use it in Tanzania. Perceived disease threat is associated with medication usage in patients with chronic diseases. We assessed the factors associated with caregivers' perceived threat of SCD complications and its relationship with HU use among children with SCD in Dar-es-Salaam.
We conducted a cross-sectional hospital-based study from May to August 2023. We enrolled 374 caregivers of health-insured children with SCD from 4 public SCD clinics. We adapted the modified original and revised Champion's Health Belief Model Scales to derive perceived threat scores. We used Mann-Whitney and Kruskal-Wallis tests to compare the outcomes across sociodemographic characteristics and regression analysis for factors associated with perceived SCD threat.
The median score (InterQuartile Range) for perceived threat of SCD complications was 559 (175, 598). Sixty-one percent of caregivers had a high SCD perceived threat. The caregivers of under-five children had 141 lower median SCD threat scores than those of children aged 13-17 years, value < 0.001. Participants from Regional Referral Hospitals (RRH) had lower median threat scores compared to participants attending Muhimbili National Hospital (MNH), 177 for Amana RRH, 325 Temeke RRH, 585 MNH Mloganzila, and 557 MNH Upanga, -value <0.001. Children of caregivers with high perceived SCD threat were 3.4 times more likely to use HU compared to those with low SCD threat perception (Incidence Rate Ratio 3.4, 95% CI: 2.7-4.5).
The perceived threat of SCD predicts the likelihood of SCD patients using HU in Dar-es-Salaam, Tanzania. We recommend health education to caregivers aiming to improve their SCD threat perception and thus improve the use of HU among children with SCD in similar settings.
坦桑尼亚是全球镰状细胞病（SCD）患病率最高的五个国家之一。尽管有羟基脲（HU）可用，但据报道在坦桑尼亚只有25%的SCD患者使用它。慢性病患者对疾病的感知威胁与药物使用有关。我们评估了达累斯萨拉姆地区SCD患儿的照料者对SCD并发症的感知威胁相关因素及其与HU使用的关系。
我们于2023年5月至8月进行了一项基于医院的横断面研究。我们从4家公立SCD诊所招募了374名有医疗保险的SCD患儿的照料者。我们采用修改后的原始及修订版冠军健康信念模型量表来得出感知威胁分数。我们使用曼-惠特尼检验和克鲁斯卡尔-沃利斯检验来比较不同社会人口学特征的结果，并对与SCD感知威胁相关的因素进行回归分析。
SCD并发症感知威胁的中位数分数（四分位间距）为559（175，598）。61%的照料者有较高的SCD感知威胁。5岁以下儿童的照料者的SCD威胁中位数分数比13 - 17岁儿童的照料者低141分，P值<0.001。与在穆希姆比利国家医院（MNH）就诊的参与者相比，来自地区转诊医院（RRH）的参与者的威胁中位数分数较低，阿马纳RRH为177分，特梅克RRH为325分，MNH姆洛甘齐拉为585分，MNH乌潘加为557分，P值<0.001。与SCD威胁感知较低的照料者的孩子相比，SCD威胁感知较高的照料者的孩子使用HU的可能性高3.4倍（发病率比3.4，95%置信区间：2.7 - 4.5）。
在坦桑尼亚达累斯萨拉姆，SCD的感知威胁可预测SCD患者使用HU的可能性。我们建议对照料者进行健康教育，旨在提高他们对SCD的威胁感知，从而改善类似环境下SCD患儿对HU的使用情况。
