Abstract
INTRODUCTION: Sickle cell disease (SCD) remains a significant health concern, particularly in Ghana and Sub-Saharan African countries. School-based ocular screenings provide a unique opportunity for early detection of sickle cell retinopathy (SCR). METHODS: Students from five major schools in the Kumasi Metropolitan District of Ghana were included. Research assistants educated students on SCD and type 1 diabetes (T1DM) during school-wide assemblies, emphasising destigmatisation and vision health. Students completed questionnaires to self-report SCD or T1DM. Those who self-reported underwent in-depth interviews and dilated fundus exams (DFE). RESULTS: Of 17 987 total student population, 8168 students completed the survey (45.4% response rate) of which 2.4% of students were aware of their SCD status, while most 69.3% were unaware. No students reported having T1DM. 24 students identified as having SCD (14 haemoglobin SS and 10 HbSC) resulting in a prevalence of 0.07% and 0.05% for SS and SC, respectively. Among the SCD cohort, four had Proliferative SCR (PSCR). Of the students with stage 3 PSCR, one was 15 years old with SS genotype and bilateral stage 3 PSCR; another was 18 years old with SC disease, unilateral stage 3 PSCR. Only one SCD patient (SS genotype) had a history of previous DFE. 20.8% of SCD students were aware of SCD ocular complications and 75% felt uncomfortable sharing their SCD status. CONCLUSIONS: We conclude (1) an alarmingly low rate of self-reporting SCD (11× and 24× lower than expected for SS and SC-SCD, respectively), (2) low health literacy given 0% of students with SC-SCD had previously undergone a DFE and (3) 17% of students had PSCR and 8% of students had treatment-warranted PSCR (stage 3). These findings highlight the need for universal SCD screening, improved health education on the ocular complications of SCD and routine school-based vision screenings for patients with SCD.