Sickle cell disease management in Africa requires a significant shift in approach, according to Dr. Enam Sefakor Bankas, a hematologist at Korle-Bu Teaching Hospital in Accra, Ghana. While advances in treatment offer new hope for people living with the condition, high costs, limited screening, and gaps in healthcare delivery continue to restrict access across the continent. Dr. Bankas emphasized that successful treatment should enable patients to attend school, complete university education, build careers, raise families, and participate fully in society.
Sickle cell disease is an inherited blood disorder that causes red blood cells to become rigid and sickle-shaped, obstructing blood flow, damaging organs, and triggering severe episodes of pain, anaemia, and other life-threatening complications. Historically, treatment focused on managing pain and complications as they arose. However, advances in medical research have expanded treatment options, including disease-modifying medicines, stem cell transplantation, and emerging gene therapies. Dr. Bankas highlighted that hydroxyurea, a disease-modifying medicine, can reduce painful episodes and improve patients' quality of life when appropriately prescribed and monitored.
Hydroxyurea was approved for use in Ghana in 2018 and was included in the National Health Insurance Scheme in 2022, improving access to the medicine. As a result, 20 treatment centres participated in efforts to provide hydroxyurea to children and adults, with approximately 3,648 patients recruited into treatment. Despite this progress, challenges relating to affordability, access to medicines, and the availability of specialised services remain. Other disease-modifying treatments, such as crizanlizumab and L-glutamine, work through different mechanisms to reduce complications associated with sickle cell disease.
However, these treatments remain difficult to access in many African settings due to high costs, specialised infrastructure requirements, and the challenges of identifying suitable donors or establishing advanced treatment facilities. Gene therapies, which use a patient's own cells modified to address the underlying disease process, offer potentially transformative options for eligible patients. Nevertheless, these interventions carry significant risks, including complications associated with chemotherapy used during preparation, and remain beyond financial reach for many patients in sub-Saharan Africa.
Early diagnosis remains a critical gap in improving outcomes across Africa. Dr. Bankas identified screening and diagnostic capacity as major obstacles, particularly in community outreach settings where laboratory infrastructure and reliable electricity may be limited. Rapid point-of-care tests can help identify people who may have sickle cell disease, but positive screening results require confirmatory testing. More specialised laboratory techniques, such as high-performance liquid chromatography, can help establish a diagnosis but are often costly and limited in availability.
Artificial intelligence could eventually help strengthen diagnostic services, particularly in areas with shortages of laboratory specialists and haematologists. Dr. Bankas noted that AI-assisted analysis of blood films could support the identification of suspicious cases and direct patients towards further testing. Ghana recently introduced national sickle cell disease screening and case-management guidelines, emphasising early detection, essential medicines, continuing care, psychosocial support, and referral systems. However, effective implementation will require investment in diagnostic services, reliable medicine supplies, and stronger referral networks.
Beyond access to medicines, the discussion highlighted the need to improve how healthcare professionals understand and respond to sickle cell pain. People experiencing painful crises sometimes encounter suspicion that they are seeking opioid medicines for non-medical reasons, leading to inadequate pain relief and unnecessary suffering. Patients may also face financial difficulties, struggle to afford transport to healthcare facilities, or ration prescribed pain medicines due to concerns about future episodes or costs.
Key points
- Sickle cell care in Africa must shift from just survival to helping patients live full lives.
- Advances in treatment, including disease-modifying medicines and gene therapies, offer new hope for people living with sickle cell disease.
- Persistent barriers to diagnosis, treatment affordability, and continuity of care restrict access to effective treatments across Africa.
