Age-wise sickle cell disease survival and resource contraints in Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu

Abstract

Background: The burden of sickle cell disease weighs heavily on County Government of Kisumu. In the Lake Region Economic Bloc (LREB), Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) is the main center for management and treatment of patients with sickle cell disease (SCD). The traffic of SCD patients require commensurate resources, which overwhelm the facility, and has a bearing on the outcome. In this paper we consider survival of sickle cell patients in the resource strained JOOTRH. Method: This analysis used retrospective JOOTRH operational data collected from February 18, 2019 and May 23, 2023. In this case, the data used is not based on experimental design. Reported mortality data of 71 patients followed up at the facility was used in a Kaplan-Meier nonparametric model and Cox Proportion Hazard Model to estimate monthly survival rate. The patients are categorized by age as either ≤13years or > 13years. Results are interpreted and presented. Consequently, results obtained were discussed with clinicians in two focused group discussions. Results: Analysis reveals age-related differences in mortality. The mean age at death is 7 years (7, 95% CI: 1-12) for patients younger than 13 years; and 33 years (33, 95% CI: 24-66) for those aged 13 years and above. Median ages at death are 7 and 24 years, respectively, with corresponding modal ages of 7 and 29 years. The estimated mean survival probability for individuals older than 13 years is 44.7%, and the probability of loss to follow-up in this group was 47%. Overall, the probability of a patient surviving beyond 13th birthday 45.3%. The log-rank test indicates a statistically significant difference in survival between the <13-year and ≥13-year groups. The median survival time from initiation of follow-up is 18 months (18, 95% CI: 11-24). Patients younger than 13 years exhibited an 85.6% higher hazard of death relative to older patients. Out 71 patients 62 died during follow-up and 9 are censored. Conclusion: The survival of SCD patients in the facility heavily depends on requisite resources. Based on focused group discussion with clinicians, most patients stopped showing up at clinic for lack of medicine: Hydroxyurea, folic acid, paludrine, morphine,