Kibone Winnie, Muzoora Conrad, Bongomin Felix, Namiiro Margaret Amelia, Ssenkungu Samuel, Ochola Emmanuel, Kasirye Phillip, Hamer D
Department of Medical Microbiology and Immunology, Gulu University, Gulu, Uganda
Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
BMJ Open. 2025 Aug 8;15(8):e104303. doi: 10.1136/bmjopen-2025-104303.
Sickle cell disease (SCD) is associated with significant mortality and morbidity, especially in low- and middle-income countries.
We determined the indications for hospitalisation and predictors of 30-day re-admission among patients with SCD in Northern and Central Uganda.
Retrospective chart review.
Mulago National Referral Hospital in Kampala, St. Mary's Hospital Lacor in Gulu and Gulu Regional Referral Hospital in Gulu, Uganda.
Patients with confirmed SCD admitted between January 2020 and January 2025 were included.
Primary outcome: indication for hospitalisation.
rate and predictors of 30-day hospital re-admission. Socio-demographic, clinical history and hospitalisation data were extracted using a pretested data extraction tool.
We enrolled 505 patients, accounting for 714 hospital admissions, with a mean age of 8.1±6.2 years. Most participants (n=489, 96.8%) had less than four admissions per year, with a median of 1 admission (IQR: 0-2). The most common indications for hospitalisation were infection (n=375, 52.5%), painful crisis (n=366, 51.3%) and anaemia (n=186, 26.1%). Malaria was the most prevalent infection (n=244, 65%). The median length of hospital stay was 4 days (IQR: 3-6), with a 30-day re-admission rate of 6.9% (n=49). Admission with painful crisis (adjusted OR (AOR): 0.45, 95% CI: 0.23 to 0.89, p=0.021), receiving a blood product (AOR: 0.32, 95% CI: 0.16 to 0.66, p=0.002) and having four or more admissions per year (AOR: 0.84, 95% CI: 0.04 to 0.17, p<0.001) were inversely associated with re-admission within 30 days of last admission.
Infections, especially malaria, and painful crises were the leading causes of hospitalisation among Ugandan patients with SCD. Frequent admissions, painful crises and blood transfusions were associated with lower 30-day re-admission risk. There is an urgent need to strengthen malaria prevention strategies and optimise access to disease-modifying therapy, such as hydroxyurea, to improve patient outcomes.
镰状细胞病（SCD）与显著的死亡率和发病率相关，尤其是在低收入和中等收入国家。
我们确定了乌干达北部和中部SCD患者的住院指征及30天再入院的预测因素。
回顾性病历审查。
乌干达坎帕拉的穆拉戈国家转诊医院、古卢的圣玛丽医院拉科尔以及古卢地区转诊医院。
纳入2020年1月至2025年1月期间确诊为SCD的住院患者。
主要结果：住院指征。
30天再入院率及预测因素。使用经过预测试的数据提取工具提取社会人口统计学、临床病史和住院数据。
我们纳入了505例患者，共714次住院，平均年龄为8.1±6.2岁。大多数参与者（n = 489，96.8%）每年住院次数少于4次，中位数为1次（四分位间距：0 - 2）。最常见的住院指征是感染（n = 375，52.5%）、疼痛性危象（n = 366，51.3%）和贫血（n = 186，26.1%）。疟疾是最常见的感染（n = 244，65%）。住院中位时长为4天（四分位间距：3 - 6），30天再入院率为6.9%（n = 49）。因疼痛性危象入院（调整后比值比（AOR）：0.45，95%置信区间：0.23至0.89，p = 0.021）、接受血液制品（AOR：0.32，95%置信区间：0.16至0.66，p = 0.002）以及每年住院4次或更多次（AOR：0.84，95%置信区间：0.04至0.17，p < 0.001）与上次入院后30天内再入院呈负相关。
感染，尤其是疟疾，以及疼痛性危象是乌干达SCD患者住院的主要原因。频繁住院、疼痛性危象和输血与较低的30天再入院风险相关。迫切需要加强疟疾预防策略，并优化获得如羟基脲等疾病修饰疗法的途径，以改善患者预后。
