Outcomes of Hydroxyurea Accessed via Various Means and Barriers Affecting Its Usage Among Children with Sickle Cell Anaemia in North-Western Tanzania

Abstract

Emmanuela E Ambrose,1 Benson R Kidenya,2 Mwesige Charles,3 Joyce Ndunguru,4 Agnes Jonathan,4 Julie Makani,4 Irene K Minja,4,5 Paschal Ruggajo,4,6 Emmanuel Balandya4,7 1Department of Paediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 2Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 3Department of Laboratory Services, Bugando Medical Centre, Mwanza, Tanzania; 4Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 5Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 6Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 7Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaCorrespondence: Emmanuela E Ambrose, Department of Paediatrics and Child Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania, Tel [phone], Fax [phone], Email [email protected]: To assess clinical and haematological outcomes of Hydroxyurea accessed via various access means and uncover the barriers to its utilization in children with Sickle cell anaemia (SCA), North-western Tanzania.Patients and Methods: A retrospective study was conducted between October 2020 and April 2021 at Bugando Medical Centre (BMC) through review of medical files to compare the clinical and haematological outcomes among children with SCA at baseline and followed up retrospectively for at least one year of hydroxyurea utilization, accessed via cash, insurance and projects. Subsequently, a cross-sectional survey was conducted among parents and caregivers to ascertain the barriers to access of hydroxyurea via the various means. The p-values < 0.05 were considered statistically significant.Results: We identified 87 children with SCA who were on hydroxyurea for at least one year. The median age at baseline (before hydroxyurea) was 99 [78– 151] months, and 52/87 (59.8%) were male. Compared to baseline, there was a significant reduction in proportion of patients reporting vaso-occlusive crisis, admissions and blood transfusions, a significant increase in Haemoglobin and mean corpuscular volume, conversely a significant reduction in absolute neutrophil and reticulocytes to both insurance and project participants. There was no significant change in most of these parameters among patients who accessed hydroxyurea via cash. Further, a total of 24/87 (27.6%) participants reported different barriers to access of hydroxyurea, where 10/24 (41.7%) reported hydroxyurea to be very expensive, 10/24 (41.7%) reported insurance challenges, and 4/21 (16.6%) reported unavailability of the drug.Conclusion: The paediatric patients utilizing hydroxyurea accessed via insurance and projects, but not cash, experienced significant improvement in the clinical and haematological outcomes. Several barriers for access to hydroxyurea were observed which appeared to impact these outcomes. These findings call for concerted efforts to improve the sustainable access to hydroxyurea among all patients with SCA.Keywords: sickle cell anaemia, hydroxyurea, access, outcomes, North-western Tanzania

Keywords

• sickle cell anaemia
• hydroxyurea
• access
• outcomes
• north-western tanzania