Obeagu Emmanuel Ifeanyi, Olateju Olaitan Ruth-Thelca
Department of Biomedical and Laboratory Science, Africa University, Mutare, Zimbabwe.
Department of Human Anatomy, Faculty of Medicine and Pharmaceutical Sciences, Kampala International University in Tanzania, Dar es Salam, Tanzania.
Ann Med Surg (Lond). 2025 Aug 11;87(9):5918-5924. doi: 10.1097/MS9.0000000000003713. eCollection 2025 Sep.
Sickle cell disease (SCD) poses a significant public health challenge in Uganda, affecting approximately 1.6 million individuals and contributing to high morbidity and mortality rates. Current SCD management is often fragmented, with care primarily concentrated in specialized centers, leading to disparities in access and delayed interventions. The integration of SCD care into the primary healthcare (PHC) system has been proposed as a strategy to address these challenges. This narrative review explores the current gaps in SCD care within Uganda's healthcare system and examines the potential benefits of integrating SCD management into PHC settings to improve outcomes. A comprehensive literature review was conducted to assess existing SCD management practices, barriers within PHC systems, and outcomes from integration pilot programs. Data on healthcare provider confidence, access to diagnostic tools, and patient outcomes were analyzed to understand the current landscape and opportunities for improvement. Only 35% of healthcare providers in PHC settings reported confidence in managing SCD patients (OR: 0.45, 95% CI: 0.35-0.55). Limited access to diagnostic tools and inadequate resources further hinders timely diagnosis and treatment, contributing to preventable complications and higher healthcare costs. However, a pilot program integrating SCD care into PHC clinics demonstrated a 50% reduction in hospital admissions for pain crises among participants (OR: 2.0, 95% CI: 1.5-2.7). Integrating SCD care into Uganda's PHC framework offers significant potential to enhance early diagnosis, improve treatment adherence, and reduce hospital admissions. Coordinated care approaches could alleviate the disease burden, improve patient outcomes, and lower healthcare costs.
镰状细胞病（SCD）给乌干达带来了重大的公共卫生挑战，影响了约160万人，并导致了高发病率和死亡率。目前的SCD管理往往分散，护理主要集中在专科中心，导致获得医疗服务的差距和干预延迟。将SCD护理纳入初级卫生保健（PHC）系统已被提议作为应对这些挑战的一项策略。本叙述性综述探讨了乌干达医疗系统中SCD护理目前存在的差距，并研究了将SCD管理纳入初级卫生保健环境以改善结果的潜在益处。进行了全面的文献综述，以评估现有的SCD管理实践、初级卫生保健系统中的障碍以及整合试点项目的结果。分析了关于医疗服务提供者信心、诊断工具的可及性和患者结果的数据，以了解当前的情况和改进机会。初级卫生保健环境中只有35%的医疗服务提供者表示有信心管理SCD患者（比值比：0.45，95%置信区间：0.35 - 0.55）。诊断工具的可及性有限和资源不足进一步阻碍了及时诊断和治疗，导致可预防的并发症和更高的医疗成本。然而，一项将SCD护理纳入初级卫生保健诊所的试点项目表明，参与者因疼痛危机而住院的人数减少了50%（比值比：2.0，95%置信区间：1.5 - 2.7）。将SCD护理纳入乌干达的初级卫生保健框架具有显著潜力，可加强早期诊断、提高治疗依从性并减少住院人数。协调的护理方法可以减轻疾病负担、改善患者结果并降低医疗成本。
