Evaluation of Sickle Cell Crisis Determinants among Sickle Cell Disease Patients Aged 15 Years and Below in Three Selected Health Facilities in Nairobi City County, Kenya

Abstract

Considering the lack of curative armamentaria for SCD and its crises, the associated management costs exert an unquantifiable burden on parents/caregivers, compounded with psychological trauma, social stigma, and other devastating effects. This study investigated factors associated with sickle cell crisis among SCD patients aged 15 years and below in three hospitals in Nairobi city County. A descriptive cross-sectional study was conducted among children aged ≤15 years with sickle cell disease (SCD), their caregivers, and healthcare professionals at three SCD-focused health facilities in Nairobi city County. A total of 193 participants were recruited using systematic sampling, while healthcare professionals were purposively selected. Data were collected using pretested structured questionnaires assessing sociodemographic and socioeconomic factors, knowledge and perceptions of SCD, medication adherence, and SCD-associated crises. Quantitative and qualitative data were analysed using descriptive statistics, thematic analysis, and multiple logistic regression in GraphPad Prism, with ethical approval and informed consent obtained prior to study commencement. The results showed that most patients aged below 15 years with SCD in the sampled hospitals were females (52.85 %). Regarding age, most affected patients were aged 0-5 years (46.63 %). 65.80 % of all the patients had primary school level of education, with a paltry 7.77 % having a secondary school level of education. Besides, most of the caregiver respondents of SCD patients aged 15 years and below were females (92.23 %). Most caregivers (37.82 %) were aged 26-30 years followed by those aged 31-35 years (26.42 %), with a minority (13.99 %) being aged 21-25 years. Most caregivers had attained primary education (53.37 %), were married (75.13 % and were peasants (63.73 %). The results showed most (96.89 %) caregivers resided in rented houses, which were mostly single-roomed (62.18 %), and most (62.69 %) earned <KSh10,000 a month. It was observed that 83.94 % of the sampled SCD patients aged 15 years and below had SCD-associated crises, namely abdominal pains (69.75 %), joint pains (72.22 %), acute chest pain (24.69 %), and bone pain (32.10 %). Most patients with sickle cell crises were females (52.47 %) while male patients with sickle cell crises accounted for 47.53 %. Multiple logistic regression showed that female gender, age-group of 6-10 years, and frequent hospital visits (more than twice a month) significantly increased the log odds for severe SCD crisis. Thus, the final fitted multiple logistic regression model for predicting SCD crisis in children aged 15 years and below was stated as follows: ln[P(Y=1)/P(Y=0)] = β0 + β1(Patient gender [Female]) + β2 (Patient Age-group [11 15 years]) + β3(Patient Age-group [6-10 years])+ β4(Frequency of Hospital Visits [More than twice a month]) = 0.1588+ 1.116 (Patient Gender [Female])+0.7197(Patient Age-group [11-15 years])+2.668 (Patient Age-group [6-10 years])-1.732 (Frequency of Hospital Visits [More than twice a month]). Further, the study observed varying levels of adherence to treatment regimen requirements for SCD patients aged 15 years and below in the selected hospitals, with unaffordability, forgetiveness, unavailability of the medications, or their inaccessibility being the most cited reasons, among others, by caregivers for non-adherence. Most healthcare workers adhered to and documented the treatments for patients with SCD and associated cries, except vaccines, which were never administered. Most caregivers had a good attitude, beliefs, and perceptions towards SCD patients aged 15 years and below in this study. The female gender and age-group significantly increased the log xvii odds for knowledge about SCD and its crisis. Therefore, the final multiple logistic regression model for predicting knowledge about SCD in parents and caregivers of children was stated as; ln[P(Y=1)/P(Y=0)] = β0 + β1(Gender [Female]) + β2 (Age group [26-30 years]) + β3(Age-group [31-35 years])+ β4(Age-group [>36 years]) = 1.415 -1.674 (Gender [Female])+3.849 (Age-group [26-30 years])+5.220 (Age-group [31-35 years]) + 3.856 (Age-group [> 36 years]). This study showed that patient and caregiver factors influence the severity of SCD and its crises, and their appropriate modification may improve the prognosis and the wellbeing of both the patients and the caregivers. Further, appropriate strategies must be formulated and implemented to improve adherence to treatment requirements for SCD patients aged 15 years and below to improve prognosis and quality of life.