Knowledge of Healthcare Workers about SCD in India- Barrier to “Elimination of Sickle Cell” Program

Introduction:India ranks second in SCD prevalence worldwide. The disease is more common in rural areas, with a higher density of tribal and socioeconomically challenged populations. With a special focus on the upliftment of these groups, the government has rolled multiple programs, including national sickle cell missions, aimed at early diagnosis and prevention of morbidity and mortality. Knowledge of healthcare workers (HCW) is one of the most important drivers of healthcare interventions, especially when investigations and treatments have been made accessible according to standard treatment guidelines. This study was undertaken to assess the extent of knowledge of healthcare professionals about SCD, its treatment, and management, in various parts of India, including the areas with high prevalence and low prevalence.

Methods:This was an observational cross-sectional study. The questionnaire was a slightly modified DFConhecimento instrument (Deniz et al.) and was sent to HCW using a web tool to be filled through a link. The questions were in a multiple-choice setup, and participants had to choose the best response for each question. The instrument scores were calculated with one being assigned for correct answers and zero for incorrect answers (Total score-0-13) for the 13 questions copied from the original instrument. To calculate the overall knowledge of SCD, the sum of all correct answers was calculated considering the following knowledge score ranges: >7 (more than 54 % accuracy)as good or adequate knowledge and ≤ 7(54 % or less accuracy) as poor or inadequate knowledge. A minimum sample size of 384 participants was required for this study. Standard statistical methods were used for the statistical analysis.

Result: A total of 416 HCW participated in this survey. The median age of the participants was 34 years, and 190 participants (45.7%) were male. Two hundred seventy-four (65.8%) participants reported providing healthcare services to patients with SCD. Fifty-nine participants (14.2%) received SCD training. The majority had experience of working long term in medical facilities-38.2 % (159/416) were working for more than 10 years. On assessing the knowledge, 52 (12.5 %) had good(adequate) knowledge and 364 (87.5%) had poor(inadequate) knowledge. In the prevalent zone, 14.7% of the HCW had adequate knowledge, and in the non-prevalent zone, only 2.6% had adequate knowledge. On univariate analysis, male sex (OR (95 CI)= 3.97 (2.04- 7.72)), doctors as HCW( OR (95 CI)= 8.010 (3.787-16.943)), postgraduate educational status(OR (95 CI)= 3.195 (1.753- 5.824)), experience of > 10 years (( OR (95 CI)= 3.550 (1.631- 7.729] ), and healthcare workers who received short training in SCD ( OR (95 CI)= (2.612 (1.313- 5.195] ) were associated with adequate knowledge. On multivariate analysis, doctors as healthcare workers (OR (95 CI)= 4.891(2.174-11)) were associated with adequate knowledge.

Conclusion:According to our survey, a very low number of HCW (only 14.7%) had adequate knowledge. This situation is far from expected, even in areas where SCD is prevalent. This is an alarming situation that requires urgent attention from all the stakeholders. With the government rolling out a massive mission to eliminate SCD, poor knowledge of healthcare workers is likely to serve as a major roadblock. There is an urgent need to focus on skill development, capacity building, and empowerment of HCW in SCD. This will eventually improve the care and prognosis of SCD patients.