Hydroxyurea therapy in sickle cell disease: knowledge and prescription patterns among care providers in a low-and middle income setting

Abstract

Background: Hydroxyurea is a safe, effective, and well-tolerated disease-modifying therapy for patients with sickle cell
disease (SCD), leading to reduced morbidity, mortality, and an improved quality of life. However, its underutilization, driven
by inadequate knowledge and variability in use among SCD care providers, may limit its benefits. This study assessed the
knowledge and prescription patterns of hydroxyurea among SCD care providers in Jos, Nigeria.
Methodology: A cross-sectional survey of 132 physicians managing SCD was conducted to collect data on socio
demographics, hydroxyurea knowledge, and prescription patterns using a proforma. Knowledge was assessed using 17
questions (maximum score: 17). Scores above 12 (50th percentile) were classified as “good,” while scores of 12 or below were
categorized as “poor.” Prescription patterns were evaluated against the National Institutes of Health (2014) and British Society
for Haematology (2018) guidelines. Data were analyzed using descriptive and inferential statistics.
Results: Sixty-seven (50.8%) of the 132 physicians had inadequate knowledge of hydroxyurea’s clinical benefits and safety.
Only 35 (26.5%) were aware of available treatment guidelines, and 32 (24.2%) had ever prescribed hydroxyurea. Among
prescribers, nine (28.1%) used inappropriate criteria to initiate treatment and six (18.8%) prescribed below recommended
doses. The median maximum daily prescribed dose was 750mg, whereas five (15.6%) physicians did not exceed 200mg,
irrespective of patient weight. Treatment guidelines were not followed by 25 (78.1%) of prescribers.
Conclusion: This study revealed a high prevalence of inadequate knowledge and inconsistent hydroxyurea prescription
practices among SCD care providers. Targeted training is essential to enhance hydroxyurea utilization and ensure adherence to
standardized treatment guidelines, ultimately improving patient outcomes.