Factors Affecting Pain Control in Patients with Sickle Cell Disease at Mwananyamala and Muhimbili Hospitals in Dar es Salaam, Tanzania

Background: Sickle cell disease (SCD) is the most common hemoglobin disorder in the world. Africa has the highest burden of SCD, accounting for up to 75% of the 300,000 annual births of individuals with SCD worldwide. In Tanzania, 11,000 – 14,000 babies are born with SCD each year. Despite treatment advancement, pain is still an attributable cause of admissions among patients with SCD. However, data is still lacking regarding the adequacy of pain control in patients with SCD in Tanzania. Objective: This study aimed to determine factors affecting pain control among patients with SCD presenting with painful events at Mwananyamala Regional Referral Hospital (MRRH) and Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methodology: This was a cross-sectional study conducted at MRRH and MNH which are tertiary referral hospitals in Dar es Salaam, Tanzania. Patients with SCD aged 8 years and above who presented at the hospitals with painful events (from August 2022 to February 2023) were enrolled into the study. A structured questionnaire was used to collect data on participants' socio-demographic characteristics and clinical parameters. The adequacy of pain control was assessed using the WHO Pain Management Index. Multivariable binary logistic regression was used to determine factors associated with pain control. Differences were considered statistically significant when the p-value was < 0.05. Results: A total of 390 patients with SCD were analysed with mean age (± SD) of 15 (± 6) years. Most patients were recruited from outpatient clinics (88.2%). The male-to-female ratio was 1:1, the majority of patients had less than three pain episodes per year (77.9%), and most patients presented to the hospital with mild pain (64.6%) and were on Hydroxyurea (62.3%). Furthermore, one-third of patients had inadequate pain control. Factors associated with inadequate pain control included receiving initial pain management in other health facilities (adjusted odds ratio [aOR] and 95% confidence interval [CI] = 2.5 (1.5- 4.5), p=0.001), presenting to the hospital with moderate pain (aOR = 2.2, 95% CI [1.3-3.8], p=0.006), and presenting to the hospital with a fever (aOR = 3.8, 95% CI [1.1 – 13.9], p=0.04). Having severe pain and receiving initial treatment at MRRH or MNH seemed to be protective factors (aOR = 0.33, 95% CI [0.11- 0.97], p=0.04, and aOR = 0.29, 95% CI [0.14 -0.61], p=0.001, respectively). Conclusion: A considerable proportion of patients with SCD receive sub-optimal pain control. Receiving initial pain management from other healthcare facilities, presenting to the hospital with moderate pain, and having a fever were associated with inadequate pain control. Further research is warranted to elucidate ways of optimising the management of pain in patients with SCD in Tanzania.