TABLE 5.
Healthcare provider’s practice related to diagnosis, crisis management and outpatient follow-up of sickle cell patients.
| Variables | Nurses |
Physicians (N = 80) |
All (N = 318) |
|||||||
|---|---|---|---|---|---|---|---|---|---|---|
| A2 (N = 118) |
A1 (N = 110) |
A0 (N = 10) |
n | % | n | % | ||||
| n | % | n | % | n | % | |||||
| Screening or diagnosis | ||||||||||
| Haemoglobin profile | 52 | 44.1 | 54 | 49.1 | 9 | 90.0 | 54 | 67.5 | 169 | 53.1 |
| Practitioner diagnosed at least one case of SCD | 78 | 66.1 | 73 | 66.4 | 6 | 60.0 | 72 | 90.0 | 229 | 72.0 |
| Symptoms or signs evoking diagnosis | ||||||||||
| Fever | 60 | 50.8 | 63 | 57.3 | 4 | 40.0 | 49 | 61.3 | 176 | 55.3 |
| Pain | 89 | 75.4 | 83 | 75.5 | 6 | 60.0 | 76 | 95.0 | 254 | 79.9 |
| Cutaneous-mucosal pallor | 86 | 72.9 | 75 | 68.2 | 4 | 40.0 | 73 | 91.3 | 238 | 74.8 |
| Notion of previous transfusion | 82 | 69.5 | 78 | 70.9 | 5 | 50.0 | 74 | 92.5 | 239 | 75.2 |
| Jaundice | 87 | 73.7 | 75 | 68.2 | 6 | 60.0 | 62 | 77.5 | 230 | 72.3 |
| Swelling of hands and feet in infants | 69 | 58.5 | 63 | 57.3 | 4 | 40.0 | 65 | 81.3 | 201 | 63.2 |
| Notion of multiple deaths in the immediate family | 58 | 49.2 | 58 | 52.7 | 4 | 40.0 | 40 | 50.0 | 160 | 50.3 |
| Assessment of pain | ||||||||||
| Subjective (based on patient complaint) | 105 | 89.0 | 97 | 88.2 | 9 | 90.0 | 73 | 94.3 | 284 | 89.3 |
| Using a scale | 11 | 9.3 | 13 | 11.8 | 0 | 0.0 | 18 | 22.5 | 42 | 13.2 |
| Use of usual analgesics | ||||||||||
| Empirically | 62 | 52.5 | 63 | 57.3 | 5 | 50.0 | 42 | 52.5 | 172 | 54.1 |
| According to WHO guidelines | 56 | 47.5 | 59 | 53.6 | 5 | 50.0 | 44 | 55.0 | 164 | 51.6 |
| Analgesics used | ||||||||||
| Paracetamol | 57 | 48.3 | 40 | 36.4 | 5 | 50.0 | 22 | 27.5 | 124 | 39.0 |
| Paracetamol and codéine | 17 | 14.4 | 15 | 13.6 | 1 | 10.0 | 21 | 26.3 | 54 | 17.0 |
| NSAIDs (diclofenac, ibuprofen…) | 38 | 32.2 | 38 | 34.5 | 3 | 30.0 | 23 | 28.8 | 102 | 32.1 |
| Tramadol | 73 | 61.9 | 56 | 50.9 | 6 | 60.0 | 39 | 48.8 | 174 | 54.7 |
| Morphine | 1 | 0.8 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 1 | 0.3 |
| Other treatments | ||||||||||
| Transfusion | 9 | 7.6 | 14 | 12.7 | 1 | 10.0 | 12 | 15.0 | 36 | 11.3 |
| Hydration with saline | 12 | 10.2 | 15 | 13.6 | 2 | 20.0 | 14 | 17.5 | 43 | 13.5 |
| Oxygen | 35 | 29.7 | 35 | 31.8 | 4 | 40.0 | 39 | 48.8 | 113 | 35.5 |
| Hydroxyurea | 10 | 8.5 | 5 | 4.5 | 2 | 20.0 | 12 | 15.0 | 29 | 9.1 |
| Outpatient follow-up | ||||||||||
| Provider has ever followed a SCD patient | 40 | 33.9 | 38 | 34.5 | 5 | 50.0 | 32 | 40.0 | 115 | 36.2 |
| SCD follow-up may be once a month | 27 | 22.9 | 27 | 24.5 | 4 | 40.0 | 22 | 27.0 | 80 | 25.2 |
| Laboratory tests | ||||||||||
| Haemoglobin. white blood cell count. complete blood count | 103 | 87.3 | 97 | 88.2 | 8 | 80.0 | 71 | 88.8 | 279 | 87.7 |
| Sedimentation rate | 15 | 12.7 | 7 | 6.4 | 1 | 10.0 | 4 | 5.0 | 27 | 8.5 |
| C-reactive protein | 8 | 6.8 | 16 | 14.5 | 0 | 0.0 | 4 | 5.0 | 28 | 8.8 |
| Lactate dehydrogenase | 20 | 16.9 | 35 | 31.8 | 2 | 20.0 | 20 | 25.0 | 77 | 24.2 |
| Urea and creatinine | 38 | 32.2 | 19 | 17.3 | 2 | 20.0 | 53 | 66.3 | 112 | 35.2 |
| Transaminases | 24 | 20.3 | 34 | 30.9 | 4 | 40.0 | 41 | 51.3 | 103 | 32.4 |
| Total/indirect bilirubin | 38 | 32.2 | 26 | 23.6 | 4 | 40.0 | 52 | 65.3 | 120 | 37.7 |
| 10-reagent urine dipstick | 19 | 16.1 | 44 | 40.0 | 2 | 20.0 | 21 | 26.3 | 86 | 27.0 |
| Conventional radiography | 37 | 31.4 | 61 | 55.5 | 4 | 40.0 | 38 | 47.5 | 140 | 44.0 |
| Abdominal ultrasound | 46 | 39.0 | 60 | 54.5 | 4 | 40.0 | 54 | 67.5 | 164 | 51.6 |
| Cardiac ultrasound | 47 | 39.8 | 30 | 27.3 | 4 | 40.0 | 45 | 56.3 | 126 | 39.6 |
| Transcranial doppler ultrasound | 24 | 20.3 | 46 | 41.8 | 4 | 40.0 | 29 | 36.3 | 103 | 32.4 |
| Electrocardiogram | 41 | 34.7 | 28 | 25.5 | 2 | 20.0 | 40 | 50.0 | 111 | 34.9 |
| CT scan | 34 | 28.8 | 21 | 19.1 | 1 | 10.0 | 25 | 33.8 | 81 | 25.5 |
| Reason for transfer | ||||||||||
| Medical logistic and financial | 80 | 67.5 | 72 | 65.5 | 7 | 70.0 | 48 | 60.0 | 207 | 65.1 |
| Limited clinical skills of the centre | 92 | 78.0 | 78 | 70.9 | 7 | 70.0 | 48 | 60.0 | 225 | 70.8 |
| Medical reasons for referral | ||||||||||
| Pain resistant to usual analgesics | 98 | 83.1 | 88 | 80.0 | 6 | 60.0 | 46 | 57.5 | 238 | 74.8 |
| Persistent infection | 101 | 85.6 | 100 | 90.9 | 5 | 50.0 | 53 | 66.3 | 259 | 81.4 |
| Decompensated anaemia | 97 | 82.2 | 92 | 83.6 | 8 | 80.0 | 67 | 83.8 | 264 | 83.0 |
| Reference-counter-reference | ||||||||||
| Provider develops referral score | 90 | 76.3 | 88 | 80.0 | 8 | 80.0 | 65 | 81.3 | 251 | 78.9 |
| Provider receive counter-reference score | 18 | 15.3 | 11 | 10.0 | 0 | 0.0 | 3 | 3.8 | 32 | 10.1 |
SCD, sickle cell disease; WHO, World Health Organizations; CT, computed tomography; NSAIDs, Non-steroidal anti-inflammatory drugs.