Prescription, Compliance and Barriers to Prophylactic Regimen among Children with Sickle Cell Disease at Mama Lucy Kibaki Hospital
Abstract
Background: Especially in sub-Saharan Africa, sickle cell disease (SCD), a severe hereditary hemoglobinopathy, is a major cause of morbidity and mortality. To lower problems, hospitalizations, and mortality, preventative regimens such as Hydroxyurea (HU), Penicillin V, and folate supplements are essential. Notwithstanding the established advantages, following these regimens is still very difficult, and there is a dearth of information on prescription trends and compliance rates in Kenya. The objective of this study was to assess the trends in prescriptions, adherence levels, and obstacles to adherence among children with sickle cell disease at Mama Lucy Kibaki Hospital. Methods: A cross-sectional mixed-methods study was conducted among children with SCD attending Mama Lucy Kibaki Hospital. A total of 144 caregiver-child pairs were recruited using consecutive sampling. Quantitative data were collected using semi-structured questionnaires, while qualitative data were obtained through Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs). Descriptive statistics were used to analyze quantitative data, while qualitative data were thematically analyzed. The study adhered to ethical research standards, with approvals obtained from relevant authorities. Results: The most frequently prescribed prophylactic medications were folate (97.9%), penicillin V (86.9%), and hydroxyurea (81.3%). Despite high prescription rates, compliance and dosing accuracy varied. Only 39.3% of children received the correct hydroxyurea dosage, and 70.2% were underdosed on penicillin V. Overall, 66.4% of children were compliant with at least one prophylactic medication. Forgetting (46.5%), not understanding the significance of the drugs, medicine shortages at the institution, and children refusing to take their meds were the most frequently mentioned obstacles to compliance. From provider interviews, challenges such as lack of prescription standardization, limited diagnostic and dosing tools, and inadequate staffing were noted as contributors to poor adherence to national SCD treatment guidelines. Conclusion: Children with sickle cell disease at Mama Lucy Kibaki Hospital do not always follow their preventive regimens, especially when it comes to antimalarial prophylaxis. Adherence may increase if medication stock-outs are addressed, caregiver education is improved, and routine clinic follow-up is reinforced. In environments with limited resources, these results highlight the necessity of focused interventions to enhance SCD outcome
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