Effectiveness of a hospital-based comprehensive sickle cell care program to improve coverage of proven interventions in tribal areas of Western India

Abstract

Objective: The objective of this study was to assess the effectiveness of a comprehensive hospital-based sickle cell disease (SCD) model involving improvements of proven interventions in a tribal area of Gujarat, India. Methods: This was a quasi-experimental study involving five primary health centers each in the intervention and control groups. This study was conducted from June 2016 to May 2018 in three tribal areas of Gujarat, India. The intervention was a hospital-based comprehensive care model for SCD patients. We included all SCD patients between the ages of 5 and 40 years in the study area. We measured outcomes at baseline and end line by household survey. The analysis was done using a difference-in-difference method. Results: A total of 84 and 101 patients were recruited in the intervention and control groups, respectively. The baseline characteristics were comparable in both the groups. At end line, there was a significant difference in coverage of proven interventions including pneumococcal vaccination- odds ratio (OR) 21.3 (95% CI 9.7–46.8, P value 0.002), folic acid - OR 4.1 (CI 2.2–7.8, P <0.001), chloroquine –OR 4.9 (CI 2.4–10.2, P <0.001), and hydroxyurea for severe SCD patients - OR7.1 (CI 1.8–28.6, P < 0.001) in the intervention group compared to the control group. The improvement for the clinical outcome indicators including pain crisis rate (mean difference [MD]: −0.18 [−1.17–0.812]), hospitalization rate (MD: −0.08 [−0.375–0.210]), and blood transfusion rate (MD: −0.60 [−0.532–0.412]) in the intervention group in comparison with the control group was nonsignificant. Conclusion: This study shows that the comprehensive hospital-based SCD model has great potential to improve the coverage of proven interventions for SCD. Further investigation is needed to assess the impact on clinical outcomes.