Shamira Nassiwa, Bosco Asiimwe John, Dick Nsimbe, Lwanga Charles
Department of Statistical Methods & Actuarial Sciences, School of Statistics & Planning, College of Business & Management Sciences, Makerere University, Kampala, Uganda.
Department of Planning, School of Statistics & Planning, College of Business & Management Sciences, Makerere University, Kampala, Uganda.
BMC Health Serv Res. 2025 Apr 21;25(1):571. doi: 10.1186/s12913-025-12753-2.
Sickle cell disease (SCD) is a chronic hematologic disease associated with increased morbidity and mortality. The study aims to investigate the suggested socio-economic and clinical factors and their contribution to the frequency of pain episodes among sickle cell patients in Uganda.
We used pre-existing secondary data from sickle cell clinic records at Mulago referral hospital collected in 2019, with a sample of 2532 sickle cell patients. In support of the outcome being count data, the Negative Binomial Regression model was utilized to estimate how the independent factors affected the frequency of pain episodes among the patients.
The frequency of pain episodes was different among age groups as age group (16/24) experienced the highest number of pain episodes on average (Incidence Rate Ratio = 1.39; 95% CI = 1.277-1.522; p = 0.000) compared to young children because as individuals age, pain management declines, and repeated episodes can lead to increased sensitivity, making them more prone to pain. While increased temperature (°C) (fever) increased the frequency of pain episodes by 24% (Incidence Rate Ratio = 1.243; 95% CI = 1.147-1.348; p = 0.000), infection by 27% (Incidence Rate Ratio = 1.27; 95% CI = 1.191-1.354; p < 0.000), other chronic diseases by 11% (Incidence Rate Ratio = 1.11; 95% CI = 1.038-1.188; p < 0.002), malaria by 38% (Incidence Rate Ratio = 1.38; 95% CI = 1.036-1.836; p < 0.027). The rate of hydroxyurea usage was very high at 90%. The intake of the drug reduced the frequency of pain episodes by 34% (Incidence Rate Ratio = 0.662; 95% CI = 0.584-0.750; p < 0.000). According to the observations, there is a high chance that hydroxyurea also had a strong protective against malaria in SCD patients. Nevertheless, there was no evidence that being a male or female would influence the frequency of pain episodes among sickle cell patients.
These findings are expected to add to the body of knowledge in the health sector, assist in advocacy programs, inform policy, and aid in tailored interventions.
镰状细胞病（SCD）是一种慢性血液疾病，与发病率和死亡率增加相关。本研究旨在调查乌干达镰状细胞病患者中社会经济和临床因素及其对疼痛发作频率的影响。
我们使用了2019年在穆拉戈转诊医院镰状细胞病门诊记录中已有的二手数据，样本为2532例镰状细胞病患者。为支持结果为计数数据，采用负二项回归模型来估计独立因素如何影响患者疼痛发作的频率。
各年龄组的疼痛发作频率不同，年龄组（16/24岁）平均经历的疼痛发作次数最多（发病率比=1.39；95%置信区间=1.277 - 1.522；p = 0.000），与幼儿相比，随着个体年龄增长，疼痛管理能力下降，反复发作会导致敏感性增加，使他们更容易疼痛。温度升高（摄氏度）（发热）使疼痛发作频率增加24%（发病率比=1.243；95%置信区间=1.147 - 1.348；p = 0.000），感染使发作频率增加27%（发病率比=1.27；95%置信区间=1.191 - 1.354；p < 0.000），其他慢性病使发作频率增加11%（发病率比=1.11；95%置信区间=1.038 - 1.188；p < 0.002），疟疾使发作频率增加38%（发病率比=1.38；95%置信区间=1.036 - 1.836；p < 0.027）。羟基脲的使用率非常高，为90%。服用该药物使疼痛发作频率降低34%（发病率比=0.662；95%置信区间=0.584 - 0.750；p < 0.000）。根据观察结果，羟基脲在镰状细胞病患者中很有可能对疟疾也有很强的保护作用。然而，没有证据表明性别会影响镰状细胞病患者的疼痛发作频率。
这些发现有望增加卫生部门的知识体系，有助于宣传项目，为政策提供信息，并有助于制定针对性的干预措施。
