Caregivers’ Perceived Threat Of Sickle Cell Disease Complications And Its Association With Hydroxyurea Use Among Children With Sickle Cell Disease In Dar Es Salaam, Tanzania

Mwashungi Ally,1,2 Deodatus Conatus Kakoko,1 Calvin Swai,3 Emmy Metta,1 Mbonea Yonazi,2,4 Julie Makani,1,2 Elia John Mmbaga,1,5 Melkizedeck Thomas Leshabari,1 KÃ¥re Moen,5 Tone Kristen Omsland,5 Emmanuel Balandya1,2 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania; 2Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania; 3University of Dodoma, Dodoma, Tanzania; 4Muhimbili National Hospital, Dar-es-Salaam, Tanzania; 5Department of Community Medicine and Global Health, University of Oslo, Oslo, NorwayCorrespondence: Mwashungi Ally, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, 9-United Nations Road, Upanga, Dar-es-Salaam, Tanzania, Tel +255 653 986 798, Email [email protected]: Tanzania is the fifth country with the highest sickle cell disease (SCD) prevalence globally. Although hydroxyurea (HU) is available, only 25% of persons with SCD are reported to use it in Tanzania. Perceived disease threat is associated with medication usage in patients with chronic diseases. We assessed the factors associated with caregivers’ perceived threat of SCD complications and its relationship with HU use among children with SCD in Dar-es-Salaam.Methods: We conducted a cross-sectional hospital-based study from May to August 2023. We enrolled 374 caregivers of health-insured children with SCD from 4 public SCD clinics. We adapted the modified original and revised Champion’s Health Belief Model Scales to derive perceived threat scores. We used Mann-Whitney and Kruskal-Wallis tests to compare the outcomes across sociodemographic characteristics and regression analysis for factors associated with perceived SCD threat.Results: The median score (InterQuartile Range) for perceived threat of SCD complications was 559 (175, 598). Sixty-one percent of caregivers had a high SCD perceived threat. The caregivers of under-five children had 141 lower median SCD threat scores than those of children aged 13– 17 years, p-value < 0.001. Participants from Regional Referral Hospitals (RRH) had lower median threat scores compared to participants attending Muhimbili National Hospital (MNH), 177 for Amana RRH, 325 Temeke RRH, 585 MNH Mloganzila, and 557 MNH Upanga, p-value < 0.001. Children of caregivers with high perceived SCD threat were 3.4 times more likely to use HU compared to those with low SCD threat perception (Incidence Rate Ratio 3.4, 95% CI: 2.7– 4.5).Conclusion: The perceived threat of SCD predicts the likelihood of SCD patients using HU in Dar-es-Salaam, Tanzania. We recommend health education to caregivers aiming to improve their SCD threat perception and thus improve the use of HU among children with SCD in similar settings.Keywords: Sickle cell disease, hydroxyurea, perceived threat