Short stature in children with homozygous sickle cell disease: Clinical correlates and risk factors from a single-centre cohort in central India

Growth impairment is a common complication in sickle cell disease (SCD), but data from central India remain limited. To assess the prevalence of short stature in children with homozygous sickle cell anemia (HbSS) and identify associated clinical and treatment-related risk factors. A cross-sectional study was conducted among 225 children aged 6 months–12 years with confirmed HbSS by HPLC, attending the Pediatric Hematology Clinic at NSCB Medical College, Jabalpur (Jan 2021–Dec 2023). Demographic, clinical, and treatment details were collected through medical records and caregiver interviews. Short stature was defined as height-for-age <–2 SD (WHO growth charts). Logistic regression was used to determine risk factors. Short stature was observed in 32.4 % of participants. Children with >3 hospitalizations/year (21.8 %; χ 2 = 81.49, p < 0.05), >3 transfusions/year (18.7 %; χ 2 = 57.89, p < 0.05), frequent VOCs (>3/year, 29.3 %; χ 2 = 22.0, p < 0.05), and recurrent ACS (≥3/year, 3.6 %; χ 2 = 22.69, p < 0.05) were significantly more likely to have short stature. Stroke was rare (2.7 %) and not associated with growth impairment. Hydroxyurea adherence strongly influenced outcomes: irregular use (18.7 %) was associated with higher odds of short stature (OR = 0.056, p = 0.001), while non-use (12 %) showed a markedly increased risk (OR = 19.49, p = 0.039). Nearly one-third of children with HbSS in central India exhibit short stature, possibly associated with high disease burden and poor hydroxyurea adherence. Findings highlight the need for early growth monitoring, improved adherence strategies, and larger multicenter studies incorporating bone age, pubertal staging, and nutritional assessment.