Burden of sickle cell anemia among hospitalized children in Angola: a retrospective study

Chronic pediatric diseases are a growing challenge because of their impact on morbidity and healthcare resource utilization. In Angola, evidence on the hospital burden of chronic diseases, particularly sickle cell anemia (SCA), remains limited. This study compared the clinical characteristics, management, and outcomes of children hospitalized with SCA and those with other chronic diseases. We conducted a retrospective observational study of children aged 1 month to 15 years admitted to the Department of Pediatrics of Clínica Sagrada Esperança, Luanda, Angola, between January and December 2024. Clinical, laboratory, treatment, and outcome data were extracted from electronic medical records. Continuous variables were compared using the Mann–Whitney U test and categorical variables using Pearson’s chi-square or Fisher’s exact tests. Median regression adjusted for age and sex assessed differences in admission hemoglobin levels. Among 1,169 pediatric admissions, 262 involving chronic diseases met the eligibility criteria, including 97 (37.0%) with SCA. Compared with children with other chronic diseases, those with SCA had more previous hospitalizations (median 2 [IQR 0–5] vs. 0 [IQR 0–1]; P < 0.001), longer pediatric intensive care unit stays (7 [4–8] vs. 3 [3–4] days; P = 0.008), and longer hospital stays (5 [3–7] vs. 4 [3–5] days; P < 0.001). They also had lower hemoglobin levels, higher leukocyte counts and C-reactive protein levels, and more frequently received analgesia (76% vs. 45%) and blood transfusion (26% vs. 5%) (all P < 0.001). The lower hemoglobin levels remained significant after adjustment for age and sex (adjusted median difference − 4.47 g/dL; 95% CI − 5.00 to − 3.93; P < 0.001). In-hospital mortality was low and did not differ significantly between groups. SCA was the leading chronic disease among hospitalized children and was associated with substantially greater morbidity and healthcare resource utilization than other chronic diseases. The low in-hospital mortality should be interpreted cautiously because the study was conducted in a well-resourced private tertiary hospital with a predominantly insured population. Strengthening early diagnosis, structured follow-up, disease-modifying therapy, and equitable access to comprehensive pediatric SCA care should remain priorities in Angola.