Factors contributing to default among sickle cell patients Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana

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June, 2019
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Sickle Cell Disease (SCD) is one of the commonest hemoglobin hereditary disorders in the world. In sub-Saharan Africa, about 200,000 children are born with this disease annually contributing significantly to the global burden of disease. The disease is most common in the Mediterranean regions where there appears to be significant hemoglobinopathies including those of SCD. Studies done in Ghana show a carrier rate of between 10% to 30%. Children living with sickle cell disease experience a myriad of complications. The complications can be acute or chronic resulting in morbidity, increased hospitalizations and mortality. Children with SCD are supposed to be enrolled in a clinic and reviewed regularly to prevent these complications. Unfortunately children living with sickle cell are unable to attend these scheduled visits religiously. In the meantime, reliable data on why they are not able to meet these obligations are lacking. This research was therefore carried out to access the factors that contribute to default for reviews among pediatric SCD patients. A descriptive cross sectional study was used in this research and it involved the administration of questionnaires to caregivers of children aged 0-14 years (150 in total) suffering from SCD at the Komfo Anokye Teaching Hospital from April 2018 to June 2018. The questions focused on the demographic factors and barriers to health care experienced prior to receiving healthcare. Associations between demographic factors and reasons for not attending clinics on scheduled dates were tested with Stata software version 13. Educational and marital status of caregivers were significant contributing factors to defaulting clinical reviews with p values of (0.045 and 0.022) respectively, while 50% of study participants had ever defaulted reviews. There was a significant influence of family size to default to reviews. The larger the family size the more likely they were to default reviews (OR 1.40 p-value 0.039). There is a less likelihood for patients who have been admitted more than once to default (OR=0.281 with p-value= 0.122>0.050). High cost of healthcare contributed to default for reviews, (Chi-square= 28.959, p-value 0.000). The causes of admission were anaemic crisis followed by pain crisis. Health staff related issues such as rude staff, impatient providers and intimidating staff did not affect default for reviews. Children living with sickle cell disease need scheduled visits. Therefore caretakers must be educated continuously to ensure compliance. Sickle cell clinics should be set up in many hospitals across the country.
A thesis submitted to the Department of Health Policy, Management and Economics, School of Public Health, College of Health Science, Kwame Nkrumah University of Science and Technology, in partial fulfillment of the requirement for the degree of Master of Public Health in Health Policy, Management and Economics.
Sickle Cell, Patients, KATH, Kumasi