| Popis: |
Background: Sickle cell disease, the inherited blood disorder characterized by anemia, severe pain and other vaso-occlusive complications, acute chest syndrome, disproportionate hospitalization, and early mortality, has significant financial, social, and psychosocial impacts and drains individuals, families, and health systems globally. Hydroxyurea could improve the health of the 300,000individuals borneach year with sickle cell disease in sub-Saharan Africa; however, challenges to adoption and adherence persist. This study assessed the barriersto therapeutic use of hydroxyurea forsickle cell diseasewithin the Nigerian healthcare system, specifically from the level of the patient, provider, and health system.Methods:A cross-sectionalsurvey was administered to physicians (n=70), nurses or counselors (n=17), and patients or their caregivers (n=33) at 13 health centers.Results: The majority of physicians (74.3%) prescribe hydroxyurea, and half stated hydroxyurea is the standard of care. Among clinicians, barriers includedlimited knowledge of the drug, as well as low self-efficacy to prescribe among physicians and to counsel among nurses;perceived side effects;perceived patient preference for traditional medicine;cost for patient and expense of accompanying laboratory monitoring;and limited availability of the drug and equipment for laboratory monitoring. Among patients and caregivers, barriers included lack of knowledge; perceived side effects; cost;religious beliefs of disease causation; and lack of pediatric formulation.Conclusions: Findings suggest that patient, provider, and health systems-level interventionsare needed to improve hydroxyurea uptake among providers and adherence among patients with sickle cell disease in Nigeria. Interventions such as patient education, provider training, and policy change could address the disproportionate burden of sickle cell disease in sub-Saharan Africa and thus improve health equity. |
