Caregivers’ Perceived Threat of Sickle Cell Disease Complications and Hydroxyurea Use Among Health Insured Children with Sickle Cell Disease in Dar es Salaam, Tanzania: an Analytical Cross-Sectional Study

Abstract

Background Tanzania is among the five countries with the highest prevalence of sickle cell disease (SCD) globally. Although hydroxyurea (HU) is available, only a quarter of persons with SCD are reported to use it in Tanzania. Perceived disease threat is associated with medication usage in patients with chronic diseases. We assessed the factors associated with caregivers’ perceived threat of SCD complications and its relationship with HU use among health-insured children with SCD attending clinics in Dar-es-Salaam. Methods We conducted a cross-sectional hospital-based study from May to August 2023. We enrolled 374 caregivers of health-insured children with SCD from 4 public SCD clinics. The modified original and revised Champion’s Health Belief Model Scales were used to derive scores for the main outcomes (perceived susceptibility, severity, and threat of SCD; highest possible score, corresponding to the largest perceived threat = 765). Mann-Whitney and Kruskal Wallis tests were used for comparisons of the outcomes across sociodemographic characteristics. Regression analysis of factors associated with perceived SCD threat, and Poisson regression for analysis of association between perceived threat and HU usage were conducted. Results The median scores (InterQuartale Range) for perceived susceptibility, severity, and threat of SCD complications were 13 (7, 14), 39 (26, 44), and 559 (175, 598), respectively. Sixty-one percent of caregivers had high SCD perceived threat. The caregivers of under-five children had 141 lower median SCD threat scores compared to those of children aged 13–17 years, p-value < 0.001. Participants from Regional Referral Hospitals had lower median threat scores compared to participants attending Muhimbili National Hospital (MNH), 177 for Amana, 325 Temeke, 585 MNH Mloganzila, and 557 MNH Upanga, p-value < 0.001. Children of caregivers with high perceived SCD threat were 3.4 times more likely to use HU compared to those with low SCD threat perception (Incidence Rate Ratio 3.4, 95% CI: 2.7–4.5, p-value < 0.001). Conclusion Perceived threat of SCD predicts the likelihood of SCD patients using HU in Dar-es-Salaam, Tanzania. We recommend health education to caregivers aiming to improve their SCD threat perception and thus improve the use of HU among children with SCD in similar settings.