Abstract
INTRODUCTION: Academic proficiency is crucial for advancing learning goals, school advancement, and future economic security. Children with sickle cell anemia (SCA) in sub-Saharan Africa (SSA) may be at risk of disease-associated learning difficulties. Limited data exist on this topic among school-age children in the region. We aimed to assess academic proficiency in a sample of children with SCA in Uganda compared with unaffected controls. METHODS: This cross-sectional study was conducted in Kampala, Uganda. Participants were school-going children with SCA, aged 6-12 years, attending Mulago Hospital SCA Clinic, and age-matched sibling controls without SCA. Academic proficiency was assessed by the Wide Range Achievement Test, Fourth Edition (WRAT4) using outcome measures of spelling, mathematical computation, word reading, and sentence comprehension by age-normalized z-scores. RESULTS: Among 68 children with SCA and 69 controls tested; the mean age for each group was 9.4±2.0 years; 38 (55.9%) with SCA and 32 (46.4%) controls were male. Mean hemoglobin was 7.9 ± 0.9 g/dL for the SCA group versus 12.8 ± 1.0 g/dL for controls (p < 0.001). Compared with the control sample, children with SCA scored significantly lower in mathematical computation (median [interquartile range]: -0.47 [-1.11 to 0.08] versus -0.02 [-0.46 to 0.61], p = 0.0012). Spelling but not mathematic proficiency decreased with age in the SCA group. No significant differences by group were found in spelling, word reading, or sentence comprehension. DISCUSSION: School-aged children with SCA are at risk of poor academic proficiency, especially in mathematical computation. Our findings suggest that children with SCA in Uganda need educational evaluation and may benefit from support for learning.