Psychosocial functioning among children with sickle cell disease aged 6 - 13 years at Muhimbili National Hospital Dar - es - salaam, Tanzania.

Abstract

Background: There has been significant improvement in the care and treatment of children with sickle cell disease (SCD) that has increased survival and ultimately decreasing morbidity and mortality. The quality of life of those that survive into adulthood is often determined by the complications of SCD, and the psychosocial problems that these children develop. Several studies conducted in North America and United Kingdom showed that children with SCD have significant problems in these domains. However, information regarding psychosocial functioning among children in sub-Saharan Africa is limited. Broad Objective: To assess psychosocial functioning among children with SCD compared to children in comparison group aged 6-13 years at Muhimbili National Hospital. Methodology: This was a hospital based, cross sectional, analytical study that involved a comparison of conveniently selected children aged 6 to 13 years with SCD and group of children who have no SCD at the Sickle cell clinic at MNH, Dar es Salaam. Data analysis was done using SPSS version19. Descriptive frequency statistics was used to characterize participants in the sample as a whole. Patients’ characteristics were compared using chi square test for categorical variables. Logistic regression model was used to assess the association of risk factors and the overall psychosocial abnormality in children with SCD. Level of statistical significant was taken as 0.05. Expected value of findings: the findings of this study will have the potential of providing data that can be used to plan evidence based interventions to improve the overall management of children with SCD in Tanzania. Results: A total of 430 children aged 6-13 years were recruited, 215 being patients with SCD and 215 children with no SCD. A median age was 10 years. Females were 53.5% compared to males 46.5%.

Overall prevalence of abnormal Psychosocial functioning was high among children with SCD (57.7%) compared to those children with no SCD (42.3%) with p-value of <0.01. Similarly a highly statistical significant difference was observed in abnormal emotional prevalence 56.2% in children with SCD compared to 43.8% in children with no SCD. Abnormal school functioning in children with SCD (59%) compared to children without SCD (41%) with p-value of < 0.01. Abnormal social functioning was also higher (60.7%) in children with SCD compared to 39.3% in those children with no SCD and the difference was highly statistically significant (p-value < 0.01)

Having three or more episodes of painful crises per year is more likely to affect the abnormal overall Psychosocial prevalence in children with SCD with p-value of < 0.01 and 95%CI :( 0.10-0.75) in bivariate analysis and p-value of < 0.01 and 95%CI (0.08-0.64) in multivariate analysis. Conclusion: Children with SCD have shown slightly high psychosocial impairment as compared to children without SCD. And having three or more episodes of painful crises per year is associated risk factor to psychosocial impairment in children with SCD. Recommendations: Children with three or more painful episodes per year should have psychosocial assessment and those who will be found to have impaired psychosocial functioning should be given appropriate care.