29/11/2024
*SICKLE CELL DISEASE: KENYA'S GENETIC STRUGGLE*
By Wekesa E.N.
Sickle cell disease (SCD) has a deep historical and genetic roots, especially in regions like sub-Saharan Africa, including Kenya. This inherited blood disorder, caused by mutations in the hemoglobin gene, emerged as an evolutionary response to malaria. Carriers of the sickle cell trait (HbAS) were found to have a survival advantage against malaria, particularly in regions where the disease was endemic. Over generations, this genetic adaptation became prevalent in malaria-endemic areas, making sickle cell disease more common in such populations.
"As a sickle cell carrier, the last time I was diagnosed of malaria was 5 years ago", recalled Ariana,a caregiver (not her real name)
"Sickle cell carriers have a fetal hemoglobin that fights against malaria and makes them resistant to it", said Dr. Obura Elvis an oncological pharmacist at Moi Teaching and Referral Hospital
In Kenya, SCD affects approximately 1 in 10 people in certain regions, especially in the western and coastal parts of the country. These areas overlap with zones historically affected by malaria, highlighting the genetic link.
"Sickle cell cases are common in the western and coastal regions of Kenya, since they are malaria prone areas", said Peter Ahago during a sickle cell training at Baraka health center with sickle cell warriors and caregivers
The prevalence of SCD comes with significant health challenges. Children born with the disease face a high risk of severe complications, including anemia, organ damage, and recurrent pain episodes. Without timely diagnosis and treatment, many do not survive past childhood.
"Some common complications of sickle cell include stroke, vision loss, acute chest syndrome,spleenic sequential,AVN and leg ulcers. These complications might be life threatening if not handled early ", added Ahago
The current state of SCD care in Kenya is improving but remains constrained by limited resources. Access to specialized treatment, such as hydroxyurea therapy and bone marrow transplants, is still out of reach for many. The government and organizations like the Ministry of Health and Kenya Haemophilia and Thrombosis Association have prioritized newborn screening and public awareness campaigns to reduce the burden of the disease. Recent partnerships with global health organizations aim to expand these programs.
"The government should work with speed on the implementation of SHIF and include the sickle cell clinic funding under the SHA funding to help lighten the burden of the costs of managing SCD", said Kiplagat a caregiver during a conversation during the SCD clinic at MTRH
However, more is needed to fully address the challenges. “Sickle cell disease is a silent epidemic in Kenya,” notes Dr. Jane Githinji, a hematologist at Kenyatta National Hospital. “We need comprehensive care programs that include early screening, regular follow-ups, and community education.”
Globally, innovations such as gene therapy are showing promise in treating SCD, though they are still expensive and inaccessible in Kenya. Local efforts focus on improving palliative care and ensuring essential medicines like folic acid and pain management drugs are available. The WHO notes that coordinated management and prevention programs could significantly reduce the health burden of SCD in Africa, including Kenya.
Kenya’s fight against sickle cell disease is ongoing, with a need for increased investment in healthcare infrastructure and research. As public awareness grows, so does hope for better outcomes for those living with this challenging condition.
