AIPMED

ANNALS OF IBADAN POSTGRADUATE MEDICINE

KNOWLEDGE, ATTITUDE AND USE OF HYDROXUYREA AMONG ADULT SICKLE CELL DISEASE PATIENTS

O. Sonubi and T.R. Kotila

Department of Haematology, University College Hospital, Ibadan, Nigeria


ABSTRACT

Introduction: Hydroxyurea is the only cytotoxic drug approved for use in the care of sickle cell disease patients. It has been found to be effective in fixed low dose in low resource economy where the cost of the drug and frequent monitoring may be a barrier. This study looked at the knowledge, attitude and use of hydroxyurea in a low resource country with a high burden of the disease.

Methods: Data was obtained using a self-administered questionnaire in 101 consecutive adult sickle cell disease patients in a tertiary health care facility.

Results: All the patients responded to the questionnaire, majority (67%) of the respondents were below 40years with equal numbers of male and female patients. Of the respondents, 15.5% have > 3 painful crises in a year. Half of the respondents were not admitted in the preceding year with 6 (5.9%) of them having had >3 admissions. Less than a quarter (21.2%) had knowledge of hydroxyurea, but 52.5% were willing to use the drug while 4.3% had previously or are currently using it. Only 11 respondents were aware of the side effects and the information was mostly through their Physicians. Those willing to use the drug were also willing to attend follow-up clinic monthly.

Conclusion: Though the awareness about hydroxyurea is low in our group of patients, many are willing to use the medication and attend follow up clinics. There is a need to create more awareness about the drug especially by Physicians who care for the patients.

Keywords: Attitude, Hydroxyurea, Knowledge, Sickle cell disease, Low-income-country

Correspondence

Dr. T. Kotila

Department of Haematology,

University College Hospital,

Ibadan

tkotila@com.ui.edu.ng


INTRODUCTION

Sickle cell disease (SCD) is an inherited chronic hemolytic anaemia associated with recurrent painful episodes. It is ‘one of the most commonly inherited diseases world-wide with over 250,000 new births each year’.1 The most prevalent is sickle cell anaemia, the homozygote (HbSS) state. Patients with this disorder have a chronic hemolytic anemia, but the rates of the most common acute vaso-occlusive events vary considerably. High crisis rates are associated with high haematocrit and low fetal hemoglobin levels, hence efforts are geared towards increasing the fetal hemoglobin level.2,3

Hydroxyurea (HU) is one of the few approved diseasemodifying medication in the treatment of SCD. HU therapy has been shown to ameliorate the severity of the disease in SCA, mainly by inducing HbF production.3 There is evidence that escalation of the dose of HU to the maximum tolerated dose (MTD) significantly increases HbF levels yielding a good clinical response.4 Mortality and morbidity rates in sickle cell disease (SCD) have been considerably reduced since the introduction of HU in populations where it is used.5,6 

It is therefore surprising that the degree to which HU is used in our hospital is low, despite being the foremost tertiary hospital in Nigeria where SCA affects 2-3% of the population. This study aims to determine the level of awareness of HU therapy and the willingness of the patients to commence its use.

METHODS

This is a cross-sectional study carried out among sickle cell disease patients attending an adult Haematology outpatient clinic of a tertiary institution. Data were collected from 101 consecutive patients using a self-administered questionnaire. The data collected included socio-demographic characteristics of the study participants, their knowledge and attitude towards use of hydroxyurea. The collected data was coded and analyzed with SPSS version 22. The responses were recorded in proportions and a bivariate analysis of the knowledge, interest and use of hydroxyurea was done using Pearson’s chi square test.