Determinants of Uptake and Adherence to Recommended Care Among Children With Sickle Cell Disease in Bungoma County Referral Hospital

Abstract

Background: Sickle Cell Disease is a global public health issue designated by the World Health Organization and the United Nations. In sub-Saharan Africa, 240,000 newborns are born with Sickle Cell Disease every year. By 2050, it may reach 400,000. Approximately 24-68% decrease in mortality has been seen with the advent of common drugs for treating sickle cell disease. Contrarily, poor drug compliance is linked to higher healthcare use, frequent emergency room visits, and hospital admissions. Primary objective: To determine the level of uptake of recommended care among children with sickle cell disease at Bungoma County Referral Hospital. Secondary objectives: To (1) determine factors associated with the uptake of recommended care among children with sickle cell disease and (2) describe barriers and facilitators to adherence to recommended care among the children with sickle cell disease at Bungoma County Referral Hospital Study design: The study design was a multi-method: cross-sectional and qualitative. Methodology: Eligible participants were aged between 6 months and 18 years with sickle cell disease, attended the clinic, and consented before participating in the study between December 2023 and February 2024. Quantitative data on the level of uptake of vaccines and medication was retrieved from patient medical records. Further quantitative data was obtained using a questionnaire from healthcare workers. Different variables were analyzed from the quantitative data using STATA and presented as mean, median, and measures of central tendency, and a p-value of <0.05 was considered significant. Qualitative data was obtained through in-depth interviews with the caregivers, standardized questionnaires for the healthcare workers, and targeted focused group discussions with children above 12 years. Thematic analysis was done using the canvas method. Results: 215 participants were recruited, males (52.1%), with a median age at diagnosis of 2 years. Caregivers included both parents (76.3%) and single mothers (8.8%). 37.2% had primary education, 10.2% were formally employed, and 73.5% were unemployed.

The level of uptake from the medical records was HU 96.3%( n=207), penicillin V 92.6% (n=199), folic acid 97.7%(n=210), and fansidar 89.8%(n=193). There was 100% uptake of Kenya Expanded Program for Immunization vaccines; 9 children received Haemophilus influenza type B, 7 received pneumococcal, and two meningococcal. Adherence was assessed using a BMQ screen, and 49.8% of children adhered to medication. Children less than five years old (AOR 4.01, p-value <0.001) in a home with a single mother (AOR 3.0, p-value 0.05) with formal employment (AOR 2.97, p-value 0.04) had increased odds of being adherent to recommended care. Barriers identified included forgetting medicines at home and financial challenges, which made accessibility and affordability of drugs an issue. Facilitators were health education, making drugs affordable through subsidization, and social support through support groups. Conclusions and Recommendations: Vaccination rates were poor, with moderate adherence to medication. Positive factors included younger age and caregivers with formal employment. Financial challenges were a significant barrier to non-adherence, with the facilitator aiming at continuous education for caregivers and adolescents. Accessibility and subsidization of both the medication and vaccines by the government would significantly improve vaccination rates and medication adherence