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A Quarter Of Adult Population In Nigeria Carries A Defective S-gene, Ehanire

Nigeria presently has the greatest burden of Sickle Cell Disease (SCD) in the world, ahead of the Democratic Republic of Congo and India, according to the Minister of Health, Dr Osagie Ehanire, with an estimated 25% of the adult population carrying a faulty S-gene.

According to the World Health Organization (WHO), sickle cell anemia affects 2% of new-borns in Nigeria, resulting in a total of roughly 150,000 afflicted children born each year.

In his statement for World Sickle Cell Day 2021, Ehanire claimed that around 50–80 percent of the estimated 150,000 infants born with SCD in Nigeria die before the age of five years and those that manage to survive suffer end-organs damage which shortens their lifespan including stroke.

According to him, “Available record shows that Sickle Cell Disease affects nearly 100 million people in the world and is also responsible for over 50% of deaths in those with the most severe form of the disease (Hb SS). It is the most prevalent genetic disease in the WHO African Region. In many countries of the region including Nigeria, 10%–40% of the population carries the sickle-cell gene resulting in estimated Sickle Cell Disease prevalence of at least 2%.

“The situation in the region also indicates that national policies and plans are inadequate; appropriate facilities and trained personnel are scarce; adequate diagnostic tools and treatment are insufficient for the prevention and control of the disease.

“Sickle Cell Disease is among the top 5 non-communicable diseases (NCDs) significantly contributing to maternal, neonatal, infant and child disability, morbidity and mortality and one disorder that may negatively undermined the attainment of Sustainable Development Goals (SDGs) 1, 3 and
SCD is frequently associated with problems such HIV/AIDS (especially in those with history of frequent blood transfusion) and stroke, other are failure to thrive in children, stunting, stigmatization, job discrimination and illness related absenteeism from school and work, depression and psychosocial illnesses, marital issues such as difficulty in getting married, recurrent and miscarriages.”

The Minister stated that the theme of the World Sickle Cell Day is :“Shine the Light on Sickle Cell” gives us a unique opportunity to raise awareness about the increasing burden of SCD and eliminate the negative notion associated with it as well as building synergy with civil society organizations, international institutions and development partners towards the prevention, control and management SCD in Nigeria.

In recognition of the huge burden of Sickle Cell Disease in Nigeria, the government of Nigeria over the years has instituted several strategic Interventions to address the challenges of the disease through the FMOH. These strategic interventions includes: Six centres of excellence for the control and management of Sickle Cell Disease were established across Nigeria one in each geo-political zones with each equipped with HPLC and other complementary equipment and staff to serve as a hub for newborn screening; National guidelines for the prevention, control and management of Sickle Cell Disease including protocol for newborn screening were produced. E-copies are available online; Integration of the Non-Communicable Diseases including Sickle Cell Disease care and services into the primary healthcare services was initiated. This is an ongoing initiative; and Draft Nigeria-PEN adapted from WHO-PEN included Sickle Cell Disease for Nigeria taking into account the genetic counselling, diagnosis, newborn screening and comprehensive care package for Sickle Cell Disease within the primary healthcare level with inbuilt cost-effective referral system.

More so, the establishment of the Multi-sectorial Action Program (MSAP) Technical Committee involving different MDAs in addressing the prevalence of Non-Communicable Diseases in Nigeria; Advocacy and mass mobilization for awareness creation on Sickle Cell Disease and the importance of genetic counselling and testing for Hb genotype commenced in some parts of the country. This is an ongoing initiative; The Federal Ministry of Health ongoing validation study for the use of Point of Care Screening Test (POCT) kit for early identification and diagnosis of Sickle Cell Disease in of new-born, children and adult at all levels of care in Nigeria; and Harmonization of the various Sickle Cell Disease Bills pending at the National Assembly to increase Government attention for the prevention, control and management of SCD in the country within the framework of Non-Communicable Diseases control programme as part of UN-WHO strategy for the prevention, control and management of SCD.

Government current plan for the immediate future includes the following:Revitalization and re-positioning of the six zonal Sickle Cell Disease centres for improved Sickle Cell Disease service delivery and access to care for those living with the disease; Implementation of the national guideline for the prevention, control and management of Sickle Cell Disease including the protocol for newborn screening; Integration of Sickle Cell Disease care and services into the maternal and child health services especially at the primary and secondary levels of healthcare in Nigeria to improve early identification of cases and enrolment into the comprehensive care for Sickle Cell Disease.

In addition, Scaling up of advocacy and mass mobilization of communities on Sickle Cell Disease across Nigeria including continuous advocacy for access to drugs and diagnostics for Sickle Cell Disease and mass mobilization for support for the newborn screening policy; Strengthening supportive supervision, monitoring and evaluation; Institutionalise early identification of cases through universal newborn screening at all levels of care; and Partnering with social, community, civil society groups, development partners and the private sectors to improve social impacts, initiate and enhance sickle-cell disease surveillance.  

Finally, sickle cell disease though endemic in Nigeria is also preventable.  We must all make concerted efforts in checking our genotype and key into this Initiative so that together we can halt this epidemic. This will ensure the reduction in the prevalence of sickle cell disease in our country.

Sickle Cell Disease is a genetic (hereditary) disorder that occurs when an individual has inherited two mutant (abnormal) haemoglobin (Hb) genes from both parents, at least one of which is HbS and the resulting symptoms and signs are due to abnormality in the shape of red blood cells. In sickle cell disease, red blood cells are deformed (taken the shape of “sickle”), rigid and fragile and by reason of this being unable to sufficiently carry out their normal functions, notably oxygen delivery.

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