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Publications

Journal Article Epublish

PubMed: 40780722 DOI: 10.1136/bmjopen-2025-104303

Indications for hospitalisation and predictors of 30-day re-admission of patients with sickle cell disease in Uganda: a retrospective study.

BMJ Open 15(8):e104303

Authors: Winnie Kibone, Conrad Muzoora, Felix Bongomin, Margaret Amelia Namiiro, Samuel Ssenkungu, Emmanuel Ochola, Phillip Kasirye, Davidson H Hamer

Affiliations

  • Department of Medical Microbiology and Immunology, Gulu University, Gulu, Uganda.
  • Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
  • Department of Medical Microbiology and Immunology, Gulu University, Gulu, Uganda.
  • Department of Internal Medicine, Gulu Regional Referral Hospital, Gulu, Uganda.
  • Department of Paediatrics and Child health, Makerere University, Kampala, Uganda.
  • Department of HIV, Lacor Hospital, Gulu, Northern Region, Uganda.
  • Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
  • Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA.

Abstract

BACKGROUND

Sickle cell disease (SCD) is associated with significant mortality and morbidity, especially in low- and middle-income countries.

OBJECTIVES

We determined the indications for hospitalisation and predictors of 30-day re-admission among patients with SCD in Northern and Central Uganda.

DESIGN

Retrospective chart review.

SETTING

Mulago National Referral Hospital in Kampala, St. Mary's Hospital Lacor in Gulu and Gulu Regional Referral Hospital in Gulu, Uganda.

PARTICIPANTS

Patients with confirmed SCD admitted between January 2020 and January 2025 were included.

OUTCOMES

Primary outcome: indication for hospitalisation.

SECONDARY OUTCOMES

rate and predictors of 30-day hospital re-admission. Socio-demographic, clinical history and hospitalisation data were extracted using a pretested data extraction tool.

RESULTS

We enrolled 505 patients, accounting for 714 hospital admissions, with a mean age of 8.1±6.2 years. Most participants (n=489, 96.8%) had less than four admissions per year, with a median of 1 admission (IQR: 0-2). The most common indications for hospitalisation were infection (n=375, 52.5%), painful crisis (n=366, 51.3%) and anaemia (n=186, 26.1%). Malaria was the most prevalent infection (n=244, 65%). The median length of hospital stay was 4 days (IQR: 3-6), with a 30-day re-admission rate of 6.9% (n=49). Admission with painful crisis (adjusted OR (AOR): 0.45, 95% CI: 0.23 to 0.89, p=0.021), receiving a blood product (AOR: 0.32, 95% CI: 0.16 to 0.66, p=0.002) and having four or more admissions per year (AOR: 0.84, 95% CI: 0.04 to 0.17, p<0.001) were inversely associated with re-admission within 30 days of last admission.

CONCLUSIONS

Infections, especially malaria, and painful crises were the leading causes of hospitalisation among Ugandan patients with SCD. Frequent admissions, painful crises and blood transfusions were associated with lower 30-day re-admission risk. There is an urgent need to strengthen malaria prevention strategies and optimise access to disease-modifying therapy, such as hydroxyurea, to improve patient outcomes.

MeSH

Cells, Malaria, Blood, Anemia, Sickle Cell, Retrospective Studies, Infections