Frequency and Factors Associated With Hospitalisation of Children With Sickle Cell Anaemia in Kenyatta National Hospital and Gertrude’s Children’s Hospital

Abstract

Background: Sickle cell disease (SCD) is common in Sub-Saharan Africa in areas where plasmodium falciparum malaria is endemic and affects 3% of births. SCD is a disorders of red blood cells which sickle when deoxygenated. Majority of the patients with sickle cell anaemia are frequently admitted in a year, while some of the patients do stay a whole year without being admitted. A study to determine the frequency and the key factors associated with hospitalization of patients with sickle cell disease may inform strategies to improve care and therefore improve health outcome and quality of life. Objective: The study’s main objective was to determine the frequency of hospitalization among under 18-year-old children in one year with SCA at Kenyatta National Hospital and Gertrude’s Children Hospital. The study also aimed to determine the factors associated with frequency of hospitalization of patients with SCA at KNH and GGCH. Participants and Methods: A cross-sectional study design was employed to determine frequency of hospitalization in one year and factors associated with frequent hospitalization. The participants in the study were children less or equal to 18 years old with a diagnosis of sickle cell anemia confirmed by serum Hb electrophoresis and attending clinic and admitted in the wards at the Kenyatta National Hospital and Gertrude’s Children Hospital. An interviewee administered questionnaire was used to collect data which was analyzed to find frequency of hospitalization and factors associated with frequent hospitalization. Descriptive analysis was done to explain summary values and characteristics of participants using means and medians for continuous variables and proportions for categorical data. Binary logistic regression analysis was done to determine caregiver quality of health factors and child factors associated with increased risk of hospitalization. All variables with an association with the outcome variable with p value ≤ 0.05 were included in multivariate analysis. Odds ratio with 95 % CI and p-values were used to decide whether the independent variables included in the multivariate analysis were statistically significant or not in relation with outcome variable (number of hospitalizations in the past 1 year). Results: A total of 161 children participated in the study with a mean age of 7.7(SD 4.4) There was high rate of hospitalization with 76% of the children with SCA having at least an episode in the last one year. Risk factors that were statistically significant with frequent ix hospitalization were age at hydroxyurea use, children in post primary level of education, being female and lack of follow up. Conclusion: This study shows there is high frequency of hospitalization in children with sickle cell anemia between 0 years and 18 years. Follow up remains an important aspect in the care of children with SCA. Children in post primary level of education need more attention.