Prevalence and factors that affect transition from paediatric to adult services among adolescents with Sickle Cell Disease at a level IV health facility in Western Kenya

Abstract

Objective: To determine the proportion of adolescents with Sickle Cell Disease (SCD) who transition from Paediatric to adult services and to explore the factors that affect successful transition.

Study design, setting and duration: A mixed method study utilizing retrospective cohort study and cross-sectional survey. Carried out at Paediatric and Adult medical outpatient clinics at a Level IV public health facility in Western Kenya (Webuye County Hospital) between January 2015- April 2020.

Subjects: Adolescents with a confirmed diagnosis of Sickle Cell Disease who achieved the age 12+ years during the period 2015 – 2020. These children should have been Enrolled in Paediatric outpatient clinics at Webuye County Hospital.

Outcomes: Age at transition to adult clinics, proximity to the hospital, family support, financial constraints, Communication among HCW and adolescents, clinic setting, first-time encounters with adult clinicians and preparation to move to adult clinics.

Results: The median age at first enrolment to the Paediatric clinic was 7yrs (IQR 5-8) years. Only 2% transitioned at the appropriate age as per hospital protocol. Overall, 10% (95% CI 3.8-16.3) successfully sustained transition to adult clinical care. The factors perceived by the adolescents and healthcare workers as barriers to transition included: lack of transition knowledge, financial constraints, fear of leaving Paediatric clinic, stigma, poor preparedness to transition and negative first-time encounters at the adult clinic.

Conclusion: To ensure smooth transition of SCD services, a protocol must be designed to address the unique structural and interpersonal issues of adolescents and healthcare providers.