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Prevalence, Predictors, and Management of Acute Chest Syndrome in Patients with Sickle Cell Disease at Muhimbili National Hospital, Tanzania: A Retrospective Study

Year: 2026

Type: article

Abstract: Background: Acute Chest Syndrome (ACS) is a potentially life-threatening complication of Sickle Cell Disease (SCD), contributing significantly to hospitalizations and mortality. While extensively studied in high-income settings, there is limited data on its prevalence, associated factors, and treatment patterns in Tanzania. Objective: To determine the prevalence, predictors, and management of ACS among SCD patients admitted at Muhimbili National Hospital (MNH), Dar es Salaam, between January 2019 and December 2024. Methods: A retrospective study was conducted using medical records of 1,257 SCD patients admitted to MNH. Data on demographics, clinical and laboratory characteristics, and treatment interventions were extracted and analyzed. Modified Poisson regression was used to identify factors associated with ACS. Results: The prevalence of ACS was 24.3%. ACS was more likely among children under the age of five years compared to adults above 17 years (adjusted prevalence ratio [aPR] = 2.04, 95% CI: 1.76-2.38), in patients with upper respiratory tract infections (aPR = 1.62, 95% CI: 1.47-1.79) and in those with vaso-occlusive crises (aPR = 2.24, 95% CI: 2.12-2.38), while the use of hydroxyurea (aPR = 0.78, 95% CI: 0.78-0.79) and a history of asthma (aPR = 0.37, 95% CI: 0.27-0.47) were associated with a lower prevalence of ACS. Treatment offered included antibiotics (94.4%), pain management (87.2%), intravenous hydration (76.7%), oxygen therapy (43.9%), simple top-up blood transfusion (42.0%) and mechanical ventilation (9.8%). Exchange transfusion was underutilized (0.7%). Conclusion: ACS remains a common complication among patients with SCD admitted to MNH, particularly among younger patients and those presenting with upper respiratory tract infections or vaso-occlusive crises. Hydroxyurea use and a history of asthma were associated with a lower prevalence of ACS in this cohort. Exchange transfusion was the least utilized treatment modality despite current recommendations. These findings highlight the need to strengthen preventive strategies, improve access to hydroxyurea, and address barriers to advanced ACS management, including exchange transfusion.

Source: Journal of Blood Medicine

DOI: 10.2147/jbm.s603553