Sickle Cell Disease (SCD) remains a serious but often under addressed public health issue in The Gambia.
Accurate national prevalence data have long been limited due to the absence of a comprehensive newborn screening system, according to a July 2024 study published by the International Journal for Hemoglobin Research.
However, a 2024 pilot newborn screening program, implemented in hospitals in Banjul and regional centers, confirmed that the disease is present in both urban and rural areas. The program marked a vital step forward in identifying affected infants early and initiating timely interventions.
Research indicates that the national prevalence rate of SCD rose from approximately 0.8% in 1989 to nearly 1.7% in 2023. Currently, around two to three new cases are diagnosed weekly in health facilities, suggesting that SCD continues to affect more Gambians every year. Still, many children, especially in remote communities, are believed to go undiagnosed due to the lack of routine national screening and public awareness.
Causes of Sickle Cell Disease
Sickle Cell Disease is inherited in an autosomal recessive pattern. A child must inherit the defective sickle cell genetic from both parents to develop the disease.
Individuals with only one copy of the genetic are said to have the sickle cell trait, which typically causes no symptoms but can be passed on to offspring.
The disease causes red blood cells to become rigid and form crescent-shaped structures. These abnormal cells have a significantly shorter lifespan, ranging from 10 to 20 days, compared to the typical 120 days for normal red blood cells.
Because the body cannot replenish red blood cells fast enough, chronic anemia occurs. Additionally, the misshapen cells can block blood vessels, reducing oxygen delivery to tissues and organs, which leads to complications such as pain crises and organ damage.
Symptoms of Sickle Cell Disease
- Pain crises: Episodes of sudden, severe pain in the chest, joints, abdomen, or bones due to restricted blood flow.
- Anemia: Fatigue, pallor, and shortness of breath from insufficient red blood cells.
- Infections: Damage to the spleen increases vulnerability to bacterial infections.
- Delayed growth and puberty: Children with SCD often experience slower physical development.
- Organ complications: Over time, recurrent blockages can damage vital organs, including the liver, kidneys, and lungs.
- Stroke: Children with SCD are at an increased risk of stroke.
- Jaundice: The skin and eyes may appear yellow due to the rapid breakdown of red cells.
Treatment and Support in the Gambia
The Edward Francis Small Teaching Hospital (EFSTH) in Banjul is the main referral center for SCD in the country. It operates a weekly pediatric sickle cell clinic led by a consultant pediatrician, supported by dedicated nurses and laboratory staff. Children diagnosed with SCD are often referred here from all over The Gambia for more specialized care.
The Medical Research Council Unit the Gambia (MRCG), a major research and clinical center, also plays a role in managing SCD cases. It provides inpatient care, especially regarding infectious complications, and contributes to research that helps inform national treatment protocols.
Several regional hospitals and primary healthcare centers assist in providing basic care, but these are often under equipped to manage severe complications.
Medical Treatments Offered
Treatment in The Gambia focuses on both symptom management and prevention of complications. Among the options available are:
- Pain relief: Paracetamol and NSAIDs are commonly used, while opioids are prescribed for severe pain episodes.
- Folic acid supplements: Help support red blood cell production.
- Penicillin prophylaxis: Administered to young children to prevent bacterial infections.
- Vaccinations: Critical vaccines include pneumococcal, Hib, and meningococcal to reduce infection risks.
- Blood transfusions: Used in severe anemia and to prevent stroke in children with high-risk profiles.
- Hydroxyurea: Available at EFSTH for patients who qualify; it reduces the frequency of pain crises and the need for transfusions.
Despite these efforts, access to consistent treatment remains unequal, especially outside the capital.
Support Network
The Sickle Cell Association Gambia (SCAG), founded in 2007, is a key player in national advocacy and patient support. The association runs awareness campaigns, provides counseling to families, and promotes genetic education to help individuals understand inheritance risks.
SCAG also helps families cope with the emotional and financial burden of living with SCD and regularly engages with communities to break the stigma attached to the disease.
Challenges
Despite progress, multiple obstacles continue to affect care for people with SCD in The Gambia:
- Limited specialist care: There is currently only one hematologistserving the entire population, which significantly limits expert consultation.
- Geographic inequalities: Most advanced services are concentrated in Banjul. Rural families face financial and logistical challenges in accessing care.
- No national screening policy: Children are often diagnosed only after presenting symptoms, which delays early intervention.
- Public misinformation: Myths and stigma about the disease still exist, leading to denial, shame, or delayed treatment-seeking.
- High infection risk: Patients are more prone to bacterial infections, which are prevalent in The Gambia’s climate and living conditions.
- Data gaps: There is no national registryfor SCD patients, making it difficult to plan for medication needs, clinical follow-up, or nationwide research.
- Financial Constrain: Many families struggle with out-of-pocket expenses for medicines, transport, and frequent hospital visits.
Sickle Cell Disease continues to claim the health and well-being of many Gambians, especially children. While The Gambia has taken some steps, such as pilot screenings, dedicated clinics, and awareness programs, there remains an urgent need to scale up efforts nationally. Ensuring equitable access to diagnosis, treatment, and education will be crucial in reducing the burden of the disease and improving the lives of those living with SCD across the Gambia.
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