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乌干达降低镰状细胞病所致儿童死亡率的策略:叙述性综述

Strategies for reducing child mortality due to sickle cell disease in Uganda: a narrative review.

作者信息

Obeagu Emmanuel Ifeanyi

机构信息

Department of Biomedical and Laboratory Science, Africa University, Zimbabwe.

出版信息

Ann Med Surg (Lond). 2025 May 21;87(6):3279-3288. doi: 10.1097/MS9.0000000000002981. eCollection 2025 Jun.

Abstract

Sickle cell disease (SCD) remains a significant contributor to child mortality in Uganda, with an estimated 80% of children born with SCD dying before their fifth birthday, largely due to lack of early diagnosis and inadequate access to comprehensive care. Neonatal screening, although critical for early detection, is limited in Uganda, with coverage rates below 10%. This lack of early diagnosis often leads to delayed treatment and higher mortality rates. Data from recent studies highlight that implementing universal newborn screening could reduce SCD-related mortality by up to 50% if coupled with timely interventions such as prophylactic antibiotics, vaccination, and parental education. Comprehensive care, which includes regular health check-ups, preventive care, pain management, and access to blood transfusions, is essential for improving survival rates among children with SCD. However, in Uganda, only 30% of children with SCD receive regular follow-up care, and access to life-saving interventions like blood transfusions remains limited, especially in rural areas. A study conducted in Uganda found that children with SCD who received regular blood transfusions had a 70% lower risk of stroke and other severe complications compared to those who did not. Strengthening healthcare infrastructure and increasing access to these critical services are crucial to reducing mortality. Community engagement and education play a vital role in reducing SCD-related child mortality. Despite the high burden of SCD, awareness levels among Ugandan communities remain low, contributing to delayed healthcare-seeking behavior and high mortality rates.

摘要

镰状细胞病(SCD)仍是乌干达儿童死亡的一个重要原因,估计出生时患有SCD的儿童中有80%在五岁前死亡,主要原因是缺乏早期诊断以及获得全面护理的机会不足。新生儿筛查虽然对早期发现至关重要,但在乌干达受到限制,覆盖率低于10%。这种缺乏早期诊断的情况往往导致治疗延迟和死亡率上升。最近研究的数据表明,如果结合预防性抗生素、疫苗接种和家长教育等及时干预措施,实施普遍的新生儿筛查可将与SCD相关的死亡率降低多达50%。全面护理,包括定期健康检查、预防保健、疼痛管理和输血服务,对于提高SCD患儿的生存率至关重要。然而,在乌干达,只有30%的SCD患儿接受定期随访护理,获得输血等救命干预措施的机会仍然有限,特别是在农村地区。在乌干达进行的一项研究发现,与未接受定期输血的SCD患儿相比,接受定期输血的患儿中风和其他严重并发症的风险降低了70%。加强医疗基础设施并增加获得这些关键服务的机会对于降低死亡率至关重要。社区参与和教育在降低与SCD相关的儿童死亡率方面发挥着至关重要的作用。尽管SCD负担沉重,但乌干达社区的认识水平仍然很低,这导致了就医行为延迟和高死亡率。

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