Oxidative Stress Burden in Paediatric Sickle Cell Anaemia: Effects of Hydroxyurea Therapy, Disease Severity, and Socioeconomic Factors

Background: Oxidative stress plays a central role in the pathophysiology of sickle cell anaemia (SCA), contributing to haemolysis, endothelial dysfunction, and disease complications.Hydroxyurea (HU), the main disease-modifying therapy for SCA, may influence oxidative balance; however, evidence in children from resource-limited settings remains limited.Objective: To evaluate oxidative stress and antioxidant status among children with sickle cell anaemia, comparing hydroxyurea users and non-users, and to examine variations according to clinical disease severity and socioeconomic status.Methods: This cross-sectional comparative study included 110 children with SCA aged 2-17 years attending Wesley Guild Hospital, Ilesa (WGH).Participants were stratified into HU users (n = 55) and non-HU users (n = 55).Oxidative stress markers, enzymatic and non-enzymatic antioxidants, and antioxidant vitamins were measured using Waters' high performance liquid chromatography methods.Disease severity was assessed using the Kuti and Adegoke severity scale, while socioeconomic status was classified using the Olusanya socioeconomic classification.Data was analyzed using appropriate parametric tests, with statistical significance set at p < 0.05.Results: Hydroxyurea users had significantly lower white blood cell counts compared with non-users (p = 0.018).Although mean malondialdehyde level was lower in HU users, the difference was not statistically significant (p = 0.181).No significant differences were observed in other oxidative stress markers, antioxidant enzymes, antioxidant vitamins, or total antioxidant capacity between HU users and non-users.Oxidative and antioxidant parameters did not differ significantly across disease severity categories or socioeconomic classes.Conclusion: Children with sickle cell anaemia exhibit a persistent oxidative burden irrespective of hydroxyurea use, disease severity, or socioeconomic status.While hydroxyurea demonstrates favourable haematological effects, its impact on oxidative stress appears limited.Adjunctive strategies targeting oxidative stress may be necessary to improve clinical outcomes in paediatric SCA.