THE ROLE OF PREVENTIVE MEDICINE IN SICKLE-CELL DISEASE

Homozygous sickle cell disease is one of the most common genetic abnor malities in the world; it affects approximately 100,000 births annuall y in Nigeria alone. With this scale of public health problem, the newe r high technology approaches to prevention, such as antenatal diagnosi s, or to treatment, such as bone marrow transplantation, are unlikely to be affordable or to have a discernible population impact. Experienc e in Jamaica suggests that many low technology affordable procedures c an markedly reduce the morbidity and mortality of the disease. Further more, certain aspects of current management in the United Kingdom, suc h as frequent hospital admission and transfusion, not only consume sca rce resources but may increase morbidity. Prophylactic penicillin to p revent pneumoccocal complications, education of parents so as to reduc e the mortality from acute splenic sequestration, awareness of the fea tures and epidemic pattern of aplastic crises, and exchange transfusio n for the acute chest syndrome represent cost-effective measures which may markedly influence outcome. Reducing dependency on inpatient faci lities might actually reduce morbidity and save resources that could b e used to improve day care and outpatient management.