Mgasa Felician Paschal, Oh Singeun, Mgasa Avelina, Kang Sunjoo, Mbugi Erasto, Kim Ju Yeong
Department of Global Health and Disease Control, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea.
Department of Curative Services, National Public Health Laboratory, Ministry of Health, Dar es Salaam 9083, Tanzania.
Parasites Hosts Dis. 2025 May;63(2):147-156. doi: 10.3347/PHD.25018. Epub 2025 May 26.
Sickle cell disease (SCD), a genetic hemoglobin disorder, is a major public health challenge in sub-Saharan Africa, particularly in Tanzania, due to its association with high morbidity and mortality from infections. The disease is the leading cause of complications, emphasizing the urgent need for effective preventive strategies and diagnostic protocols. We evaluated the implementation and effectiveness of infection prevention measures and laboratory diagnostic compliance at Nyamagana District Hospital, emphasizing their effects on patient outcomes and survival rates. This retrospective observational study analyzed the medical records of 157 patients with SCD admitted to Nyamagana District Hospital for infection treatment between January 2022 and 2024. The infection profiles, utilization of preventive interventions (recommended drugs, vaccinations, and chemoprophylaxis), and diagnostic laboratory compliance were assessed. Of the 157 participants, 90.4% had at least one infection during their hospital stay, suggesting the vulnerability of this population to infections. Furthermore, malaria emerged as the most prevalent type of infection (40.1%), which is consistent with its endemic status in Tanzania. Other significant infections included unspecified diarrhea (12.5%) and upper respiratory tract infections (10.8%). Despite the high coverage rates of penicillin V prophylaxis (72%) and pneumococcal vaccination (100%), the utilization of malaria chemoprophylaxis and hydroxyurea was low (only 10.8% and 16.6%, respectively). The diagnostic laboratory test compliance, essential for accurate infection management, was moderate at 63.1%, with significant deficiencies in the blood, urine, and stool cultures and antibiotic susceptibility testing. The administration of hydroxyurea significantly reduced malaria prevalence (P=0.005), fewer vaso-occlusive crises (P<0.001), and severe anemia incidence (P=0.034). Thus, enhancing access to preventive measures and improving diagnostic laboratory compliance are crucial steps for reducing infection-related complications among patients with SCD in Nyamagana.
镰状细胞病（SCD）是一种遗传性血红蛋白疾病，由于其与感染导致的高发病率和死亡率相关，在撒哈拉以南非洲，尤其是坦桑尼亚，是一项重大的公共卫生挑战。该疾病是并发症的主要原因，凸显了对有效预防策略和诊断方案的迫切需求。我们评估了尼亚马加纳区医院感染预防措施的实施情况和有效性以及实验室诊断的依从性，强调了它们对患者结局和生存率的影响。这项回顾性观察研究分析了2022年1月至2024年期间因感染治疗而入住尼亚马加纳区医院的157例SCD患者的病历。评估了感染情况、预防干预措施（推荐药物、疫苗接种和化学预防）的使用情况以及诊断实验室的依从性。在157名参与者中，90.4%在住院期间至少发生过一次感染，这表明该人群易受感染。此外，疟疾成为最常见的感染类型（40.1%），这与其在坦桑尼亚的地方病状况一致。其他重要感染包括未明确的腹泻（12.5%）和上呼吸道感染（10.8%）。尽管青霉素V预防（72%）和肺炎球菌疫苗接种（100%）的覆盖率很高，但疟疾化学预防和羟基脲的使用率很低（分别仅为10.8%和16.6%）。对于准确的感染管理至关重要的诊断实验室检测依从性为中等水平，为63.1%，在血液、尿液和粪便培养以及抗生素敏感性检测方面存在明显不足。羟基脲的使用显著降低了疟疾患病率（P=0.005）、血管闭塞性危象的发生率（P<0.001）和严重贫血的发生率（P=0.034）。因此，增加预防措施的可及性并提高诊断实验室的依从性是减少尼亚马加纳SCD患者感染相关并发症的关键步骤。
