Original Research

Operational analysis of the national sickle cell screening programme in the Republic of Uganda

Arielle G. Hernandez, Charles Kiyaga, Thad A. Howard, Isaac Ssewanyana, Grace Ndeezi, Jane R. Aceng, Russell E. Ware
African Journal of Laboratory Medicine | Vol 10, No 1 | a1303 | DOI: https://doi.org/10.4102/ajlm.v10i1.1303 | © 2021 Arielle G. Hernandez, Charles Kiyaga, Thad A. Howard, Isaac Ssewanyana, Grace Ndeezi, Jane R. Aceng, Russell E. Ware | This work is licensed under CC Attribution 4.0
Submitted: 16 June 2020 | Published: 12 August 2021

About the author(s)

Arielle G. Hernandez, Hospital Medical Center, Cincinnati, Ohio, United States; and, Global Health Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States; and, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, Texas, United States
Charles Kiyaga, Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
Thad A. Howard, Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States; and, Global Health Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
Isaac Ssewanyana, Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
Grace Ndeezi, Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
Jane R. Aceng, Ministry of Health, Kampala, Uganda
Russell E. Ware, Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States; and, Global Health Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States; and, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States


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Abstract

Background: Sickle cell anaemia is a common global life-threatening haematological disorder. Most affected births occur in sub-Saharan Africa where children usually go undiagnosed and die early in life. Uganda’s national sickle cell screening programme was developed in response to a 2014 sickle cell surveillance study that documented a high disease prevalence.

Objective: This study describes the temporal and financial aspects of Uganda’s 2014–2019 sickle cell screening programme.

Methods: National sickle cell screening data from Uganda’s Central Public Health Laboratories were used to calculate turn-around times (TATs) from sample collection to delivery, testing, and result reporting for blood samples collected from February 2014 to March 2019. The parameters affecting specific TATs were assessed. The exact programme expenditures were analysed to determine cost per test and per positive sickle cell disease case detected.

Results: A total of 278 651 samples were analysed. The median TAT from sample collection to laboratory receipt was 8 days (interquartile range [IQR]: 6–12), receipt to testing was 3 days (IQR: 1–7), and testing to result reporting was 6 days (IQR: 3–12). Altogether, the sample continuum averaged 16 days (IQR: 11–24). Lower level healthcare facilities were associated with longer sample delivery TATs. Calendar months (January and December) and larger sample volumes impacted testing and result reporting TATs. The cost per test was $4.46 (United States dollars [USD]) and $483.74 USD per positive case detected.

Conclusion: Uganda’s sickle cell screening programme is efficient and cost-effective. Universal newborn screening is the best strategy for detecting sickle cell anaemia in Uganda.


Keywords

Uganda; sickle cell disease; newborn screening; turn-around time; cost-effectiveness

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