The clinical presentation, utilization, and outcome of individuals with sickle cell anaemia presenting to urban emergency department of a tertiary hospital in Tanzania

Simple item page
dc.contributor.authorSawe, Hendry R
dc.contributor.authorReynolds, Teri A
dc.contributor.authorMfinanga, Juma A
dc.contributor.authorRunyon, Michael S
dc.contributor.authorMurray, Brittany L
dc.contributor.authorWallis, Lee A
dc.contributor.authorMakani, Julie
dc.date.accessioned2018-09-25T11:15:48Z
dc.date.available2018-09-25T11:15:48Z
dc.date.issued2018-09-17
dc.date.updated2018-09-23T03:32:01Z
dc.description.abstractBackground Sickle cell anaemia (SCA) is prevalent in sub-Saharan Africa, with high risk of complications requiring emergency care. There is limited information about presentation of patients with SCA to hospitals for emergency care. We describe the clinical presentation, resource utilization, and outcomes of SCA patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methods This was a prospective cohort study of consecutive patients with SCA presenting to ED between December 2014 and July 2015. Informed consent was obtained from all patients or patients’ proxies prior to being enrolled in the study. A standardized case report form was used to record study information, including demographics, relevant clinical characteristics and overall patients outcomes. Categorical variables were compared with chi-square test or Fisher’s exact test; continuous variables were compared with two-sample t-test or Mann-Whitney U-test. Results We enrolled 752 (2.7%) people with SCA from 28,322 patients who presented to the MNH-ED. The median age was 14 years (Interquartile range [IQR]: 6–23 years), and 395 (52.8%) were female. Pain 614 (81.6%), fever 289 (38.4%) were the most frequent presenting complaint. Patients with fever, hypoxia, altered mental status and bradycardia had statistically significant relative risk of mortality of 10.4, 153, 50 and 12.1 (p < 0.0001) respectively, compared to patients with normal vitals. Overall, 656 (87.2%) patients received Complete Blood Cell counts test, of these 342 (52.1%) had severe anaemia (haemoglobin < 7 g/dl), and a 30.3 (p = 0.02) relative risk of relative risk of mortality compare to patients with higher haemoglobin. Patients who had malaria, elevated renal function test and hypoglycemia, had relative risk of mortality of 22.9, 10.4 and 45.2 (p < 0.0001) respectively, compared to patient with normal values. Most 534 (71.0%) patients were hospitalized for in patients care, and the overall morality rate was 16 (2.1%). Conclusions We described the clinical presentation, management, and outcomes of patients with SCA presenting to the largest public ED in Tanzania, as well as information on resource utilization. This information can inform development of treatment guidelines, clinical staff education, and clinical research aimed at optimizing care for SCA patients.
dc.identifier.apacitationSawe, H. R., Reynolds, T. A., Mfinanga, J. A., Runyon, M. S., Murray, B. L., Wallis, L. A., & Makani, J. (2018). The clinical presentation, utilization, and outcome of individuals with sickle cell anaemia presenting to urban emergency department of a tertiary hospital in Tanzania. <i>BMC Hematology</i>, http://hdl.handle.net/11427/28491en_ZA
dc.identifier.chicagocitationSawe, Hendry R, Teri A Reynolds, Juma A Mfinanga, Michael S Runyon, Brittany L Murray, Lee A Wallis, and Julie Makani "The clinical presentation, utilization, and outcome of individuals with sickle cell anaemia presenting to urban emergency department of a tertiary hospital in Tanzania." <i>BMC Hematology</i> (2018) http://hdl.handle.net/11427/28491en_ZA
dc.identifier.citationSawe, H. R., Reynolds, T. A., Mfinanga, J. A., Runyon, M. S., Murray, B. L., Wallis, L. A., & Makani, J. (2018). The clinical presentation, utilization, and outcome of individuals with sickle cell anaemia presenting to urban emergency department of a tertiary hospital in Tanzania. BMC Hematology, 18(1), 25.
dc.identifier.ris TY - Journal Article AU - Sawe, Hendry R AU - Reynolds, Teri A AU - Mfinanga, Juma A AU - Runyon, Michael S AU - Murray, Brittany L AU - Wallis, Lee A AU - Makani, Julie AB - Background Sickle cell anaemia (SCA) is prevalent in sub-Saharan Africa, with high risk of complications requiring emergency care. There is limited information about presentation of patients with SCA to hospitals for emergency care. We describe the clinical presentation, resource utilization, and outcomes of SCA patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methods This was a prospective cohort study of consecutive patients with SCA presenting to ED between December 2014 and July 2015. Informed consent was obtained from all patients or patients’ proxies prior to being enrolled in the study. A standardized case report form was used to record study information, including demographics, relevant clinical characteristics and overall patients outcomes. Categorical variables were compared with chi-square test or Fisher’s exact test; continuous variables were compared with two-sample t-test or Mann-Whitney U-test. Results We enrolled 752 (2.7%) people with SCA from 28,322 patients who presented to the MNH-ED. The median age was 14 years (Interquartile range [IQR]: 6–23 years), and 395 (52.8%) were female. Pain 614 (81.6%), fever 289 (38.4%) were the most frequent presenting complaint. Patients with fever, hypoxia, altered mental status and bradycardia had statistically significant relative risk of mortality of 10.4, 153, 50 and 12.1 (p < 0.0001) respectively, compared to patients with normal vitals. Overall, 656 (87.2%) patients received Complete Blood Cell counts test, of these 342 (52.1%) had severe anaemia (haemoglobin < 7 g/dl), and a 30.3 (p = 0.02) relative risk of relative risk of mortality compare to patients with higher haemoglobin. Patients who had malaria, elevated renal function test and hypoglycemia, had relative risk of mortality of 22.9, 10.4 and 45.2 (p < 0.0001) respectively, compared to patient with normal values. Most 534 (71.0%) patients were hospitalized for in patients care, and the overall morality rate was 16 (2.1%). Conclusions We described the clinical presentation, management, and outcomes of patients with SCA presenting to the largest public ED in Tanzania, as well as information on resource utilization. This information can inform development of treatment guidelines, clinical staff education, and clinical research aimed at optimizing care for SCA patients. DA - 2018-09-17 DB - OpenUCT DP - University of Cape Town J1 - BMC Hematology LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - The clinical presentation, utilization, and outcome of individuals with sickle cell anaemia presenting to urban emergency department of a tertiary hospital in Tanzania TI - The clinical presentation, utilization, and outcome of individuals with sickle cell anaemia presenting to urban emergency department of a tertiary hospital in Tanzania UR - http://hdl.handle.net/11427/28491 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12878-018-0122-3
dc.identifier.urihttp://hdl.handle.net/11427/28491
dc.identifier.vancouvercitationSawe HR, Reynolds TA, Mfinanga JA, Runyon MS, Murray BL, Wallis LA, et al. The clinical presentation, utilization, and outcome of individuals with sickle cell anaemia presenting to urban emergency department of a tertiary hospital in Tanzania. BMC Hematology. 2018; http://hdl.handle.net/11427/28491.en_ZA
dc.language.isoen
dc.publisherBioMed Central
dc.publisher.departmentDivision of Dermatologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rights.holderThe Author(s).
dc.sourceBMC Hematology
dc.source.urihttps://bmchematol.biomedcentral.com/
dc.subject.otherSickle cell anaemia
dc.subject.otherEmergency department
dc.subject.otherAnaemia
dc.subject.otherSub-Saharan Africa
dc.titleThe clinical presentation, utilization, and outcome of individuals with sickle cell anaemia presenting to urban emergency department of a tertiary hospital in Tanzania
dc.typeJournal Article
uct.type.filetypeText
uct.type.filetypeImage
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Sawe_2018_Article.pdf
Size:
554.25 KB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
1.72 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Journal Articles