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Abstract
Introduction. Sickle cell disease constitutes a major health burden in sub‑Saharan Africa. Vaso‑occlusive crises are the leading cause of hospitalization among affected patients. The quality of care largely depends on healthcare providers’ knowledge, attitudes, and practices, which remain poorly documented in the Democratic Republic of the Congo. This study assessed the knowledge, attitudes, and practices of healthcare providers in Kongo Central Province regarding the management of vaso‑occlusive crises. Methods. A descriptive, analytical cross‑sectional study was conducted from September 1 to December 1, 2025, among physicians, medical trainees, and nurses working in 34 health facilities of Kongo Central. A validated 44‑item electronic questionnaire was administered via KoboCollect. Associations were tested using χ², Fisher’s exact test, and odds ratios, with significance set at p < 0.05. Results. Of 160 invited providers, 103 responded (64%). Knowledge levels were basic in 60%, intermediate in 31%, inadequate in 8%, and advanced in 1%. Although 88% of participants demonstrated appropriate attitudes toward an acute vaso‑occlusive crisis, therapeutic practices frequently diverged from guidelines. Morphine was prescribed by only 15% of respondents, while 81% used tramadol. Standardized pain assessment scales were absent in 58% of clinical services. Conclusion. Substantial gaps in knowledge and practice exist among healthcare providers in Kongo Central, most notably the marked underuse of morphine and the frequent lack of pain assessment tools. Strengthening continuous education, disseminating the national treatment protocol, and improving access to essential analgesics are critical steps to reduce sickle cell‑related morbidity.
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References
- 1. Hegemann L, Narasimhan V, Marfo K, Kuma-Aboagye P, Ofori-Acquah S, Odame I. Bridging the access gap for comprehensive sickle cell disease management across sub-Saharan Africa: learnings for other global health interventions? Ann Glob Health. 2023;89(1):76. doi:10.5334/aogh.4132.
- 2. Piel FB, Steinberg MH, Rees DC. Sickle cell disease. N Engl J Med. 2017;376(16):1561 73. doi:10.1056/NEJMra1510865.
- 3. Hebbel RP, Osarogiagbon R, Kaul D. The endothelial biology of sickle cell disease: inflammation and a chronic vasculopathy. Microcirculation. 2004;11(2):129 51. doi:10.1080/10739680490278403.
- 4. McCormick M, Osei-Anto HA, Martinez RM. Addressing Sickle Cell Disease: A Strategic Plan and Blueprint for Action. Washington, DC: The National Academies Press; 2021. p. 1 496. doi:10.17226/26012.
- 5. Connor J, Flenady T, Massey D, Dwyer T. Clinical judgement in nursing—An evolutionary concept analysis. J Clin Nurs. 2023;32(13 14):3328 40. doi:10.1111/jocn.16469.
- 6. Gordon RD, Welkie RL, Quaye N, Hankins JS, Kassim AA, Thompson AA, et al. Burden of employment loss and absenteeism in adults and caregivers of children with sickle cell disease. Blood Adv. 2024;8:1143 50. doi:10.1182/bloodadvances.2023012002.
- 7. Yawn BP, Buchanan GR, Afenyi-Annan AN, Ballas SK, Hassell KL, James AH, et al. Management of sickle cell disease: summary of the 2014 evidence based report by expert panel members. JAMA. 2014;312(10):1033 48. doi:10.1001/jama.2014.10517.
- 8. World Health Organization. WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. Geneva: WHO; 2019.
- 9. Charache S, Terrin ML, Moore RD, Dover GJ, Barton FB, Eckert SV, et al. Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia. N Engl J Med. 1995;332(20):1317 22. doi:10.1056/NEJM199505183322001.
- 10. Tshilolo L, Tomlinson G, Williams TN, Santos B, Olupot-Olupot P, Lane A, et al. Hydroxyurea for children with sickle cell anemia in sub Saharan Africa. N Engl J Med. 2019;380(2):121 31. doi:10.1056/NEJMoa1813598.
- 11. Jonathan A, Tutuba H, Lloyd W, Ndunguru J, Makani J, Ruggajo P, et al. Healthcare workers’ knowledge and resource availability for care of sickle cell disease in Dar es Salaam, Tanzania. Front Genet. 2022;12:773207. doi:10.3389/fgene.2021.773207.
- 12. Brandow AM, Farley RA, Panepinto JA. Early initiation of opioids and aggressive pain management for children with sickle cell disease and vaso occlusive crisis. Am J Hematol. 2020;95(6):E140 3. doi:10.1002/ajh.25780.
- 13. Vichinsky EP, Neumayr LD, Earles AN, Williams R, Lennette ET, Dean D, et al. Causes and outcomes of the acute chest syndrome in sickle cell disease. N Engl J Med. 2000;342(25):1855 65. doi:10.1056/NEJM200006223422502.
- 14. Ohene-Frempong K, Weiner SJ, Sleeper LA, Miller ST, Embury S, Moohr JW, et al. Cerebrovascular accidents in sickle cell disease: rates and risk factors. Blood. 1998;91(1):288 94.
- 15. Andemariam B, Sullivan S, Carter J, Heggen C. Advancing care of patients with sickle cell disease through a transformative quality improvement initiative.
References
1. Hegemann L, Narasimhan V, Marfo K, Kuma-Aboagye P, Ofori-Acquah S, Odame I. Bridging the access gap for comprehensive sickle cell disease management across sub-Saharan Africa: learnings for other global health interventions? Ann Glob Health. 2023;89(1):76. doi:10.5334/aogh.4132.
2. Piel FB, Steinberg MH, Rees DC. Sickle cell disease. N Engl J Med. 2017;376(16):1561 73. doi:10.1056/NEJMra1510865.
3. Hebbel RP, Osarogiagbon R, Kaul D. The endothelial biology of sickle cell disease: inflammation and a chronic vasculopathy. Microcirculation. 2004;11(2):129 51. doi:10.1080/10739680490278403.
4. McCormick M, Osei-Anto HA, Martinez RM. Addressing Sickle Cell Disease: A Strategic Plan and Blueprint for Action. Washington, DC: The National Academies Press; 2021. p. 1 496. doi:10.17226/26012.
5. Connor J, Flenady T, Massey D, Dwyer T. Clinical judgement in nursing—An evolutionary concept analysis. J Clin Nurs. 2023;32(13 14):3328 40. doi:10.1111/jocn.16469.
6. Gordon RD, Welkie RL, Quaye N, Hankins JS, Kassim AA, Thompson AA, et al. Burden of employment loss and absenteeism in adults and caregivers of children with sickle cell disease. Blood Adv. 2024;8:1143 50. doi:10.1182/bloodadvances.2023012002.
7. Yawn BP, Buchanan GR, Afenyi-Annan AN, Ballas SK, Hassell KL, James AH, et al. Management of sickle cell disease: summary of the 2014 evidence based report by expert panel members. JAMA. 2014;312(10):1033 48. doi:10.1001/jama.2014.10517.
8. World Health Organization. WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. Geneva: WHO; 2019.
9. Charache S, Terrin ML, Moore RD, Dover GJ, Barton FB, Eckert SV, et al. Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia. N Engl J Med. 1995;332(20):1317 22. doi:10.1056/NEJM199505183322001.
10. Tshilolo L, Tomlinson G, Williams TN, Santos B, Olupot-Olupot P, Lane A, et al. Hydroxyurea for children with sickle cell anemia in sub Saharan Africa. N Engl J Med. 2019;380(2):121 31. doi:10.1056/NEJMoa1813598.
11. Jonathan A, Tutuba H, Lloyd W, Ndunguru J, Makani J, Ruggajo P, et al. Healthcare workers’ knowledge and resource availability for care of sickle cell disease in Dar es Salaam, Tanzania. Front Genet. 2022;12:773207. doi:10.3389/fgene.2021.773207.
12. Brandow AM, Farley RA, Panepinto JA. Early initiation of opioids and aggressive pain management for children with sickle cell disease and vaso occlusive crisis. Am J Hematol. 2020;95(6):E140 3. doi:10.1002/ajh.25780.
13. Vichinsky EP, Neumayr LD, Earles AN, Williams R, Lennette ET, Dean D, et al. Causes and outcomes of the acute chest syndrome in sickle cell disease. N Engl J Med. 2000;342(25):1855 65. doi:10.1056/NEJM200006223422502.
14. Ohene-Frempong K, Weiner SJ, Sleeper LA, Miller ST, Embury S, Moohr JW, et al. Cerebrovascular accidents in sickle cell disease: rates and risk factors. Blood. 1998;91(1):288 94.
15. Andemariam B, Sullivan S, Carter J, Heggen C. Advancing care of patients with sickle cell disease through a transformative quality improvement initiative.