How Tanzania can stop rising sickle cell patients as alarm grows

Saturday January 15 2022
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Muhimbili National Hospital's Haemophilia department head Dr Stella Rwezaula

By Louis Kalumbia

Dar es Salaam. Alarm has been raised following the growing trend of sickle cell in the country with the majority of citizens remaining ignorant over the health condition.

Tanzania is ranked fourth in Africa after Nigeria; the Democratic Republic of Congo (DRC) and Angola by the large number of the population with the disease and the fifth globally.

Statistics from the Haematology department at the Muhimbili National Hospital (MNH) shows that about 15 to 20 percent of Tanzanians carry genes of sickle cell disease (patients or carriers).

Speaking during an exclusive interview with The Citizen recently, the head of the Haematology department, Dr Stella Rwezaula, says at least 11,000 children are born with sickle cell in the country every year.

She says that translates to about six to seven children born with the disease annually out of 1,000 live births. “This is alarming because Tanzanians do not have the culture of making regular check-ups especially before marriage and shortly after birth because those are the means of reducing the severity of the problem,” she says.

According to her, couples should undergo medical check-ups in order to predict the status of the new-born, noting that most importantly children should be checked after birth in order to understand their status immediately after birth and before leaving the hospital after delivery.

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She says understanding the status would enable the children with the positive status to immediately start medications after reaching the age of two instead of waiting until they become anaemic.

“Suffering children should be educated about the condition and precautionary measures they are supposed to take whenever they are subjected in places with limited supply of oxygen including when in flight; diving and climbing high mountains like Mount Kilimanjaro,” says Dr Rwezaula.

She says the government should continue improving healthcare services through provision of diagnostic equipment and medicines at affordable prices to all parts of the country including rural areas.

Furthermore, she suggests that at least all regional hospitals should be equipped with sickle cell diagnosis equipment.

Despite the notable improvement that has seen reduction of children under the age of five dying from the condition from 90 percent to about 30 percent, much needs to be done.

“The slight decline is caused by a slight increase of understanding among citizens and improved health services especially among the urban population,” she says.


About the health condition

Dr Rwezaula says a person with sickle cell is said to have abnormal haemoglobin (HB) in the red blood cells due to changes in genetics making it appear in the shape of a sickle or new moon instead of the normal round shape.

Furthermore, she says a healthy person has red blood cells with haemoglobin ‘A’; while those with sickle cell have haemoglobin ‘S’ following changes that have taken place in the protein constituting it.

“The changes in the haemoglobin occur when a protein skips normal positioning, therefore inflicting total changes in the systematic arrangement including acquiring the shape of a new moon,” says Dr Rwezaula.

According to her, children are born with health conditions after inheriting them from both parents carrying genes of the codition, a process which is scientifically known as recessive.

She says a child starts manufacturing adult haemoglobin ‘AA’ after reaching the age of six months that are usually round in shape.

“But, a person with sickle cell will produce haemoglobin ‘AS’ therefore acquiring the shape of a sickle or new moon,” she says.


How the condition is inherited

Dr Rwezaula said the condition could be transmitted to a child when both parents are carriers with the possibility of giving birth to normal children (AA); carriers (AS) and patients (SS).

She said there was little or no difference between carriers and normal people, only patients differ from the duo (normal and carrier) because they will be showing all symptoms.

“A family (couple) with normal and carrier persons has the possibility of giving birth to normal and carrier children. This is where the importance of medical check-ups, marriage or birth of a child becomes a matter of paramount importance,” she says.


Health complications

Dr Rwezaula says manufactured abnormal haemoglobin shocks the body and immediately starts measures of getting rid of it.

According to her, normal haemoglobin lives in the human’s body for between 90 and 100 days before their removal through the spleen, while those in sickle cell patients are destroyed within 10 and 20 days.

“However, low haemoglobin is manufactured as compared to the amount destroyed leading to frequent decline of blood among sickle cell patients. Blood levels stand at six, sometimes four or three but don’t exceed nine,” she says.

Furthermore, haemoglobin destruction produces excessive gall that after filling the bladder spreads to other parts of the body, attributing to yellow eyes among sickle cell patients.

She says the shape of red blood cells allows free movement in the human blood vessels, noting that abnormal ones block the passage leading to serious pains in the patients’ body which is also referred to as ischemia.

“Patients could develop strokes if blocked blood vessels are located at the head.

We are always advising the patients to drink more water and sometimes they are subjected to drips in the hospitals,” she says.

Dr Rwezaula says patients’ bones tend to accelerate the process to manufacture blood cells in order to compensate for destructions made, therefore overwhelming them.

“This increases pain and bone elongation. This accounts to the reason why most sickle cell patients have thin legs and hands as well as enlarged heads,” she says.

She said sickle cell patients are everyday given ferric acids that function as an important raw materials in the manufacture of red blood cells throughout their lives. Inadequate supply of blood in some parts of the body due to blockages leads to failure healing of wounds once the patient gets injured.

“Also, sickle cell haemoglobin tends to block transportation of blood to and fro the kidneys, liver, heart and many other parts worsening their health conditions,” says Dr Rwezaula.

She adds, “They will always suffer from anaemia, frequent tireless, pains, yellowish, stroke and wounds. They will also require heap replacement and sometimes acute chest syndrome due to lack of enough oxygen in the lungs.”

Dr Rwezaula says the health of sickle cell patients worsen after contracting some infections such as malaria because apart from defected blood cells that are destroyed within a few days, normal blood cells would also be destroyed.

Urban, rural comparison

She says urban areas have the advantage due to availability of modern and large hospitals; easy diagnosis and higher levels of understanding among its citizens as compared to rural areas.

This is because of the high number of health experts found in urban areas making it easy for disease diagnosis at tender age as compared to their rural counterparts, according to her.