|Year : 2014 | Volume
| Issue : 2 | Page : 56-60
Evaluating the knowledge of sickle cell disease and hemoglobin electrophoretic pattern among people living in Sekondi-Takoradi Metropolis, Ghana
Verner N Orish1, Onyekachi S Onyeabor2, Adekunle O Sanyaolu3, Nnaemeka C Iriemenam4
1 Department of Internal Medicine, Effia-Nkwanta Regional Hospital Sekondi-Takoradi, Sekondi, Western Region, Ghana
2 Department of Community Health and Preventive Medicine, The Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
3 Department of Medical Microbiology and Immunology, Saint James School of Medicine, Anguilla, BWI; Department of Medical Microbiology and Parasitology, College of Medicine of the University of Lagos, Idi-araba, Lagos, Nigeria
4 Department of Medical Microbiology and Parasitology, College of Medicine of the University of Lagos, Idi-araba, Lagos, Nigeria
|Date of Web Publication||18-Aug-2014|
Dr. Verner N Orish
Department of Internal Medicine, Effia-Nkwanta Regional Hospital Sekondi-Takoradi, Sekondi P. O. Box 229, Western Region, Ghana
Source of Support: None, Conflict of Interest: None
Background: Sickle cell disease (SCD) is an inherited lifelong hemolytic disorder affecting many children in sub-Saharan Africa, especially in West and Central Africa. There is a limited public health education on SCD in Ghana with only two information centers in Accra and Kumasi, respectively.
Methodology: This cross-sectional study evaluated the knowledge of SCD among people living in Sekondi-Takoradi metropolis. Churches, saloons, internet cafes and bus stations were randomly selected in the center of the city with proximity to the central market.
Results: A total of 621 individuals were recruited, 52.5% (326) had knowledge of their hemoglobin (Hb) electrophoretic pattern while 47.5% (295) had none. In addition, 93.4% individuals had knowledge of SCD while 6.6% had no knowledge of SCD. Older individuals exhibited better knowledge of their Hb electrophoretic pattern than the younger ones (P = 0.019). Individuals with tertiary education and married couples exhibited higher knowledge of SCD when compared to their counterparts (P < 0.001).
Conclusion: Despite the relatively high knowledge of SCD and Hb electrophoretic pattern observed in this study, it is very important to increase neonatal screenings and health care services to the region. In addition, more emphasis is needed to increase public awareness of SCD especially in schools, churches, hospitals and the media.
Keywords: Ghana, hemoglobin electrophoretic pattern, neonatal screening, pre-natal education, sickle cell disease
|How to cite this article:|
Orish VN, Onyeabor OS, Sanyaolu AO, Iriemenam NC. Evaluating the knowledge of sickle cell disease and hemoglobin electrophoretic pattern among people living in Sekondi-Takoradi Metropolis, Ghana. J Med Trop 2014;16:56-60
|How to cite this URL:|
Orish VN, Onyeabor OS, Sanyaolu AO, Iriemenam NC. Evaluating the knowledge of sickle cell disease and hemoglobin electrophoretic pattern among people living in Sekondi-Takoradi Metropolis, Ghana. J Med Trop [serial online] 2014 [cited 2019 May 23];16:56-60. Available from: http://www.jmedtropics.org/text.asp?2014/16/2/56/139047
| Introduction|| |
Sickle cell disease (SCD) is a form of hemoglobinopathy characterized by the point mutation (A→T) of the β-globin in the genome sequence resulting in mutational replacement of valine for glutamic acid at the sixth position of the β chain of hemoglobin (Hb).  Hemoglobinopathies are the most common single gene disorder in the world.  Nearly 70% of children born world-wide with hemoglobinopathy have SCD.  Over 70% of the world's population of children with SCD are born in sub-Saharan Africa, predominantly in West and Central Africa. ,,, The prevalence of SCD in most West African countries has been estimated using the results obtained from new-born screening.  The prevalence ranges from 1 in 33 in Nigeria, to 1 in 57 in Burkina Faso and 1 in 71 in DR Congo. 
Over the past years, the global burden of SCD is increasing and highlights the need for appropriate public health policies especially in the developing countries like Ghana.  As long as people continue to migrate from other countries due to economic constrains, improved services of individuals with SCD are vital  and will continue to increase especially during young adult transition. Recent data indicated that young adults transitioning from pediatric clinics experience increased mortalities. , The clinical manifestations of SCD include bone pains, increased risk of infections, chronic anemia, cerebrovascular events and progressive organ damage.  SCD is a world-wide disease but its clinical manifestation varies among patient with the disease due to diverse genetic and environmental factors.  There are five major haplotypes of SCD; Senegal, Benin, CAR OR BANTU, Cameroon and Arab-Indian (Asian). The Bantu haplotype has the most severe clinical symptoms and the Arab-Indian has the least severe clinical course. The reason for the least severe symptoms for the Arab-Indian is the presence of raised levels fetal Hb F which inhibits Hb S polymerization. 
Despite the geographical distribution of SCD in tropical area, it is becoming a global issue because of population migration as a result of globalization.  The increasing trend of SCD throughout the world is highlighted by the implementation of universal screening by countries like United States of America, United Kingdom and France in order to address the resulting challenges and prevention of SCD in a multicultural populace. In the United States of America, early identification of SCD through new-born screening has improved survival by preventing sepsis through the use of prophylactic penicillin.  Thus, it is important to upgrade knowledge and awareness, diagnosis and management of this disease in middle and low in-come countries as this will directly impact high income countries.  Advances in health care allowed American children with SCD to live through adulthood  but this is antithesis in most low-income countries. In Ghana, new-born screening performed in Kumasi indicated that 23% of the infants tested carry a gene associated with SCD and 1 in 55 of all babies born have SCD. 
Furthermore, the most organized and consistent information on SCD in Ghana is from centers in Accra and Kumasi with limited public education.  In this study, we ascertained the knowledge of SCD and Hb electrophoretic pattern among people in Sekondi-Takoradi metropolis of the western part of Ghana.
This study was conducted in Sekondi-Takoradi metropolis of the western region of Ghana. It is the commercial capital of the region replete with people of diverse ethnic and socio-economic background. It is the administrative capital of the Western Region with a land area of about 385 km 2 and is strategically located in the South-Western part of Ghana, about 242 km to the West of Accra, the capital city. It is also approximately 280 km from the Cote d'lvoire border in the West. Sekondi-Takoradi has an estimated population 445,205 inhabitants.  It is Ghana's third largest city and an industrial and commercial center, with tourist attraction annually.
In total, about 31 private hospitals, five government health centers and another five community clinics/maternities offer various forms of health care services. Effia Nkwanta Regional Hospital is the referral center of the region located in the metropolis. There are no specific sickle cell centers in these hospitals as SCD patients visit the medical and pediatric outpatient clinics. Standardized questionnaire was designed to capture socio-demographic characteristics as well as the knowledge of sickle cell and Hb electrophoretic pattern. Questionnaires were administered by trained research assistants. Survey sites included randomly selected internet cafes, saloons, churches, hospitals (out patients and their relatives), retail shops and bus stations. This study was carried out between January and March, 2013. These sites were randomly selected based on their proximity to the central market area in the heart of the metropolis. Since 12 years is the assumed age for the completion of elementary education, individuals (male and female) above the age of 12 years (range 12-77 years) were recruited in this study. Written informed consents were given by the recruited participants or their guidance and ethical clearance was obtained from the Ghana Health Service Ethical Committee.
Data analyses were performed using IBM SPSS Statistics version 21.0 (IBM, Armonk, NY, USA). P < 0.05 was considered to be statistically significant. Univariate analyses were based on Pearson χ2 tests for comparison of proportions and ANOVA for the comparison of continuous variable. Fisher's exact tests were used when the expected cell counts were below 5. The effects of sex, marital status, education and sources of Hb electrophoretic pattern and SCD knowledge were evaluated using a multivariate logistic regression model controlling for age and residence which was significant during univariate analysis. All tests were two-tailed and the odds ratio (OR) and 95% confidence interval (CI) were used to measure the strength of the association.
| Results|| |
Of the 621 recruited individuals, 52.5% (326) had knowledge of their Hb electrophoretic pattern while 47.5% (295) had none and 93.4% individual had knowledge of SCD while 6.6% had no knowledge of SCD [Table 1].
In addition, older individuals exhibited better knowledge of their Hb electrophoretic pattern than the younger ones (P = 0.019). Individuals with tertiary education and those that are married also exhibited improved knowledge of their Hb electrophoretic pattern (P < 0.001). Interestingly, prospective couples (86.2%) performed their blood genotype before marriage while 13.8% did not. The general knowledge of Hb electrophoretic pattern and that of the children increased the chances of the individual knowledge of Hb electrophoretic pattern (P < 0.001).
[Table 2] shows the sources of the knowledge obtained about SCD. School had the highest influence (58.3%) followed by hospital (27.6%), family (16.9%) and church (13.5%).
Multivariate logistic regression analysis indicated that males were more probable to know their blood genotype than females (adjusted OR, 1.74; 95% CI, 1.27-2.39; P = 0.001) [Table 3]. Similarly, married couples were more likely to know about SCD than single individuals (adjusted OR, 2.10; 95% CI, 1.50-2.95; P < 0.001). School was acknowledged as a major source of knowledge of SCD (adjusted OR, 2.77; 95% CI, 1.99-3.84; P < 0.001). In addition, using no education as an indicator in the logistic regression analysis, individuals with tertiary education increased their probability of SCD knowledge (adjusted OR, 19.5; 95% CI, 4.30-88.54; P < 0.001). Hospital, church, radio and others were additional potential sources of sickle disease knowledge identified while television was less likely a source of knowledge in this study [Table 3].
|Table 3: Multivariate logistic regression analysis of factors associated with knowledge of sickle cell disease|
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| Discussion|| |
This present study was aimed to assess the knowledge of SCD and sickle cell trait (SCT) among people living in Sekondi-Takoradi metropolis. Results from this study showed that more than half of the individuals sampled have knowledge of their Hb electrophoretic pattern and SCD in general. In a similar study carried out in the east bay region of Northern California, the majority of respondents had appropriate knowledge about the genetic basis and heredity of SCD while only 16% knew their trait status.  In this study, older individuals, individuals with tertiary education and married couple exhibited better knowledge of their Hb electrophoretic pattern. The knowledge of SCD was a strong influence in people knowing their Hb electrophoretic pattern.
School has the highest influence of impacting knowledge about SCD while television was the least. This result is in contrast with the Northern California study where information from friends and acquaintances provided the highest source of information of SCD.  SCD is a serious genetic disorder that affects people globally. Due to the serious health and social implications associated with SCD there is an urgent need to increase the public knowledge and awareness of the disease. The World Health Organization (WHO) has estimated that 5% of child hood mortality in Africa is caused by SCD, especially of children under 5 years. 
Despite the lack of accurate knowledge of SCD, Africans have been aware of the manifestations of the disease for centuries.  In attempt to make sense out of these manifestations, most Africans generate their own false biographical account within the framework of their broader social and cultural context.  The WHO introduced neonatal screening together with prenatal education as a means to control SCD. In Ghana, this is done mainly in two centers in Accra and Kumasi which is not enough for the country's increasing population. However, aside the need to scale up neonatal screening centers to cover all of Ghana, a wider community education is very much lacking.  The vehicles for community education in this region include churches, schools, hospitals and the media. The result from this study shows that schools are the best channel for public health information regarding SCD, which means that formal education not only provide a path for social success but also creates the necessary environment for public health knowledge especially in a developing country like Ghana. Previous studies in Ghana had linked the beneficial effect of education on health,  and also in the Northern California study, focus group participants recommended education on SCD and SCT from elementary school through college as a way of bridging the gap on the knowledge of the disease between older and younger participants observed in the study. , It is vital to increase the awareness of SCD especially during elementary and secondary schools and formal education should be encouraged for better public health knowledge especially with regards to SCD.
Despite the relatively high knowledge of Hb electrophoretic pattern observed in this study, it is very important to increase neonatal screenings and health care services to this increasing population of Ghana. As well, there is need for uninterrupted, coordinated and appropriate care for both pediatric and adult patients. More emphasis is however needed to increase public awareness of SCD especially in schools, churches and the media.
| Acknowledgments|| |
The authors thank all the participants of this study, the research assistants and questionnaires administrators. The authors also extend their appreciation to all shop owners and the authorities of churches where the study was conducted. We are very grateful for your support, understanding and encouragement.
| References|| |
|1.||Hoppe C, Styles L, Vichinsky E. The natural history of sickle cell disease. Curr Opin Pediatr 1998;10:49-52. |
|2.||Weatherall DJ. The challenge of haemoglobinopathies in resource-poor countries. Br J Haematol 2011;(In press). |
|3.||WHO. Executive Board Resolution on sickle cell anaemia. Geneva, Fifty-Ninth World Health Assembly, Provisional Agenda Item 11.4. 2006. |
|4.||Rees DC, Williams TN, Gladwin MT. Sickle-cell disease. Lancet 2010;376:2018-31. |
|5.||Modell B, Darlison M. Global epidemiology of haemoglobin disorders and derived service indicators. Bull World Health Organ 2008;86:480-7. |
|6.||Dennis-Antwi JA, Culley L, Hiles DR, Dyson SM. ′I can die today, I can die tomorrow′: Lay perceptions of sickle cell disease in Kumasi, Ghana at a point of transition. Ethn Health 2011;16:465-81. |
|7.||Piel FB, Hay SI, Gupta S, Weatherall DJ, Williams TN. Global burden of sickle cell anaemia in children under five, 2010-2050: Modelling based on demographics, excess mortality, and interventions. PLoS Med 2013;10:e1001484. |
|8.||Wonkam A, Ponde C, Nicholson N, Fieggen K, Ramessar R, Davidson A. The burden of sickle cell disease in Cape Town. S Afr Med J 2012;102:752-4. |
|9.||Quinn CT, Rogers ZR, McCavit TL, Buchanan GR. Improved survival of children and adolescents with sickle cell disease. Blood 2010;115:3447-52. |
|10.||Jordan L, Swerdlow P, Coates TD. Systematic review of transition from adolescent to adult care in patients with sickle cell disease. J Pediatr Hematol Oncol 2013;35:165-9. |
|11.||Oner C, Dimovski AJ, Olivieri NF, Schiliro G, Codrington JF, Fattoum S, et al. Beta S haplotypes in various world populations. Hum Genet 1992;89:99-104. |
|12.||Meier ER, Miller JL. Sickle cell disease in children. Drugs 2012;72:895-906. |
|13.||Ohene-Frempong K. 2013. Available from: http://www.sicklecelldisease.org/sicklecelldisease/uploads/File/2013_Convention_PowerPoint_Presentations/Ohene-Frempong-SCDAA-Convention-Sep-2013_copy.pdf. [Last accessed on 2013 Nov 25]. |
|14.||Wikipedia. Sekondi-Takoradi. From Wikipedia, the free encyclopedia, 2013. Available from: http://www.enwikipediaorg/wiki/Sekondi-Takoradi. [Last accessed on 2013 Dec 10]. |
|15.||Treadwell MJ, McClough L, Vichinsky E. Using qualitative and quantitative strategies to evaluate knowledge and perceptions about sickle cell disease and sickle cell trait. J Natl Med Assoc 2006;98:704-10. |
|16.||WHO. Sickle-cell disease and other haemoglobin disorders. Fact sheet N°308, 2011. Available from: http://www.who.int/mediacentre/factsheets/fs308/en/. [Last accessed on 2013 Nov 26]. |
|17.||Konotey-Ahulu FI. Sickle-cell disease and the patient. Lancet 2005;365:382-3. |
|18.||Peters E, Baker DP, Dieckmann NF, Leon J, Collins J. Explaining the effect of education on health: A field study in Ghana. Psychol Sci 2010;21:1369-76. |
|19.||Smith GM, Lewis VR, Whitworth E, Gold DT, Thornburg CD. Growing up with sickle cell disease: A pilot study of a transition program for adolescents with sickle cell disease. J Pediatr Hematol Oncol 2011;33:379-82. |
[Table 1], [Table 2], [Table 3]