The Key to Combating Sickle Cell Disease in High-Prevalence Regions Like Mali: Hemoglobin Electrophoresis for All, From Birth to Marriage

Background: Sickle cell disease (SCD) is a significant public health concern, particularly in Africa, where approximately 200,000 newborns are affected annually. West African countries show carrier rates between 5% and 20%, with Mali averaging 12% and 3% of individuals carrying the homozygous form. Despite the burden, preventive strategies remain underutilized. Aim: This study aims to support the prevention of births affected by SCD by emphasizing universal hemoglobin electrophoresis screening and informed reproductive choices. The primary goal is to identify carriers and discourage marriages between two carriers to reduce disease incidence. Results: Among 1,737 children with valid hemoglobin data, the prevalence of sickle cell trait (Hb AS) was 15.6% (n = 273), significantly higher than the estimated national average of 12% (p < 0.001). While mean hemoglobin levels were significantly lower in Hb SS patients (8.33 g/dL) compared to other profiles (Hb AA: 11.95 g/dL; Hb AS: 11.93 g/dL; Hb AC: 11.72 g/dL; all p < 0.001), no significant differences were found between carriers (Hb AS, Hb AC) and non-carriers (Hb AA) (all p > 0.05). Conclusion: Hemoglobin levels alone are not sufficient to distinguish carriers from non-carriers for SCD, highlighting the importance of hemoglobin electrophoresis for accurate identification.