Ambulatory management of sickle cell disease: evaluation of the first yearfollow up of patients in Lome paediatric hospital.

Background-This study is an evaluation of the first year ambulatory follow up of patients from the sickle-cell care centre of the paediatric ward of t he teaching hospital in Lome-Tokoin. Patients and methods-Togo is situated in the epicentre of the Benin haploty pe. A total of 132 patients (109 SS, 22 SC and 1 S beta degrees thal) follo wed up during one year from their admission date (period of 1st January 199 6 to 31st December 1997). 132 patients were included in the study. Results-The patients' age varied, for the majority, between 2 months and 15 years, but a few adults (15%) were included in the study. Information was collected from the hospital files and health cards, which unfortunately did not have specific entrees for sickle cell disease. Clinical features revea led that the frequency of tooth decay and chronic persistent splenomegaly w as low when compared to the rates in central Africa (Bantu haplotype). Labo ratory findings lead to the conclusion that some analysis are relevant such as the dosage of the G6PD activity (24.1% of patients were deficient), par asitologic analysis of faeces (positive in 22.5%), retinal fluoro-angiograp hy (32.2% of ocular lesions), and cardiologic check-up. On the other hand s canning of biliary tracts and systematic X-rays of the hips seems to be sec ondary. Some positive results were noticed by the scanning of biliary tract s without any therapeutic decisions in non-symptomatic patients; no case of osteonecrosis was detected by the X-rays. The mean haemoglobin level was 7 .4 +/-1.4 g/dl for the SS and 10.7 +/-2.4 g/dl for the SC The mean MCV were 91.3 +/- 10.1 fl and 82.1 +/-7.7 fl, respectively. Specific vaccinations w ere not well performed because of their high cost. Conclusion-In order to carry on and improve the ambulatory management of pa tients with sickle cell disease, it is important in low income countries, s uch as Togo, to target the necessary laboratory tests for an initial and an nual check-up. Solidarity networks for patients should be promoted and effe ctive involvement of the health authorities ensured.