Abstract:

Background: Hydroxyurea therapy has been recognized as an effective approach for mitigating the severity of symptoms and complications associated with sickle cell anemia. However, despite its effectiveness, adhering to hydroxyurea therapy among caregivers of children with Sickle cell anemia remains a persistent challenge, particularly in resourceconstrained settings. Bugando Medical Centre, a prominent healthcare institution in the region, plays a central role in the care of pediatric sickle cell anemia patients. Nevertheless, the level of adherence and the contributing factors have not been comprehensively documented. Therefore, this study aims to assess the adherence rate to hydroxyurea therapy among caregivers of children with Sickle cell anemia who attend the sickle cell clinic at Bugando Medical Centre and to identify factors influencing non-adherence.

Methods: This study employed an analytical cross-sectional design, involving the analysis of data from a total of 172 participants. Data analysis was conducted using Stata version 15, with Modified Poisson regression employed to ascertain the association between various factors and adherence to hydroxyurea treatment among study participants.

Results: More than half (68.6%) of the children were between 1 and 10 years of age, with a median age of 8 years (Interquartile Range: 5-12 years). A notable proportion of the participants (23.8%) exhibited good adherence to hydroxyurea treatment, while (76.2%) displayed moderate to poor adherence. Children aged 1-10 years had a significantly higher likelihood of good adherence to hydroxyurea treatment (adjusted Prevalence Ratio [aPR] = 2.98, 95% CI = 1.18, 7.47) compared to the reference group aged 11-17 years. Likewise, children under the care of caregivers with secondary education had a significantly 41% higher chance of demonstrating good adherence to hydroxyurea treatment (aPR = 1.41, 95% CI = 1.19, 2.87) compared to those under the care of caregivers with primary education. Similarly, children under the care of caregivers with college/university education had a significantly 92% higher chance of good adherence (aPR = 1.92, 95% CI = 1.09, 4.63) compared to those under the care of caregivers with primary education. Participants with good knowledge of hydroxyurea had a significantly 55% higher chance of exhibiting good adherence to hydroxyurea treatment (aPR = 1.55, 95% CI = 1.10, 4.78) compared to those with poor knowledge of hydroxyurea treatment.

Conclusion: The study revealed that certain factors, including the child's age and the caregiver's educational level, are associated with good adherence to hydroxyurea treatment for sickle cell anemia. However, despite these associations, the rates of good adherence in the studied population are not as high as anticipated. These findings underscore the immediate need for targeted interventions aimed at enhancing knowledge and awareness of the critical importance of adhering to hydroxyurea treatment.

Key words: Adherence, Hydroxyurea, Sickle cell anemia, caregivers.