Running head: SICKLE-CELL TRAIT IN WESTERN NIGERIA 1

Annotated Bibliography (Sickle-cell Trait in Western Nigeria)

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Lecturer

University

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References

D.B Jelliffe, J. H. (1952). The Sickle-cell Trait in Western Nigeria: A Survey Of 1,881 Cases In

The Yoruba. The British Medical Journal, 405-406. Retrieved 1 16, 2021, from

https://www.jstor.org/stable/25378020

This study was conducted in Yorubaland which occupies the western part of Nigeria.

This area is located north of the Lagos lagoon, south of River Niger, east of the Dahomey

frontier, and west of Benin. The study was conducted among 1,881 Yoruba participants. The

participants were tested for the trait using the Scriver and Waugh method. The participating

group also included newborn children, school-going children, and the elderly. After testing, none

of the 51 newborn babies were found to have the sickle-cell trait. Among the young adults, the

prevalence was found to be at 19.2%, whereas among the children aged between 1 and 4 years

old, the prevalence was found at 28.3%. Among the participants of the other age groups, the trait

was found at an equal prevalence.

This survey had been conducted following the fact that there were very few surveys

conducted in this field during this time in Nigeria despite the increased number of people

diagnosed with sickle cell anemia in this region. The report also takes note of the various studies

conducted in other west African countries such as Angola. It compares its rather high findings to

these findings from previously conducted studies in other countries to verify its authenticity. In

the other surveys, the investigators found a figure ranging between 15% and 30%, which is in the

same range as its finding of 45%.

The report emphasizes the fact that the sickle-cell trait is common among dwellers of the

tropical African regions.

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It also points out that there is little data associated with sickle-cell disease. It compares data from

West Africa, which shows high numbers of sickle-cell trait and lower numbers of sickle-cell

disease, with data from African Americans who have shown lower numbers in sickle-cell trait

but rather higher numbers in sickle cell disease. The investigators point out that the ratio of the

sickle-cell disease to the sickle-cell trait is 1: 50 compared to that in America which is 1: 1,000.

Whereas this data indicates a high disparity among people considered to have a similar genetic

origin, the report points out that some experts have associated these differences with the

intermarriage between African Americans and Caucasians. Others have indicated that the

differences are because the west African healthcare system is still highly underdeveloped. They

also point out that the lack of awareness of sickle cell disease brought by the lack of adequate

testing has left many unaware of whether or not they have sickle-cell disease.

The survey, however, concluded that there was a lesser occurrence of the sickle-cell

disease among people in tropical Africa compared to the large number of people in this region

who were found to have the sickle-cell trait. Among the 1,881 investigated cases, none were

found to have the sickle-cell disease (Hemolytic anemia). However, this finding could not be

regarded as scientific because the investigators did not conduct a careful clinical examination of

the participants, nor was a full hematological investigation conducted among the subjects.

However, this finding was backed by the region's data which indicated that out of the 100,000

cases of sickle-cell trait in Ibadan, there were only 12 cases of sickle cell disease reported.

the report does not seem to have a clear outline of the mode of inheritance of the sickle-

cell trait. However, a later report on the same subject has explained how the inheritance takes

place. The investigator found it rather strange that among the 51 newborns investigated in the

study, none of them was found to have the sickle cell trait. Their attempt to investigate the trait
SICKLE-CELL TRAIT IN WESTERN NIGERIA 4

among the children after three days was also returning the same results. However, as the

investigators continued to vary the time, the cases of sickle-cell trait began to appear among the

newborns. The first batch of results containing positive cases came from the investigation

conducted after 216 hours. The results indicated that 12 specimens showed no sign of the trait.

However, 5 of the samples were hemolyzed with 1 case showing the presence of less than 5% of

sickle cells.

In its explanation, the report points out that the absence of the sickle-cell trait among the

newborns was due to the nature of the fetal blood. It pointed out that the hemoglobin of normal

blood differs physiochemically from that with sickle-cell anemia. And that a subject with the

sickle cell trait has hemoglobin with two different characteristics. The absence of the sickle-cells

in newborns was attributed to the absence of sickle-cell hemoglobin in the fetal blood. However,

after birth, it begins to form in the subject’s body resulting in the formation of the sickle cells.

The report points out that the biophysical properties of fetal blood differ significantly from that

found in adults. The report indicates that fetal hemoglobin persists in the newborn’s body for

days after birth. Some investigators have also claimed the persistence of the hemoglobin

continues for months after birth. As it diminishes, the sickle-cells increase with an increase in the

production of the sickle-cell hemoglobin.

Following the study, the report suggested that the sickle cell trait only develops when the

hemoglobin is in a degenerated state. However, this claim is also unscientific since there was as

it did not explain whether or not the sickle cells could develop in the fetal hemoglobin. The

survey did not investigate whether the blood of the newborns found to have the sickle cells still

contained the fetal blood hemoglobin. The report acknowledged that there was a need for further

investigations concerning the matter of when and the circumstances around which the sickle cell
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trait begins to express itself among newborns that have inherited it from their parents. This

conclusion was established on the fact that a report was released concerning Cooley's anemia.

The study revealed that by 8 years, 40-60% of the hemoglobin might still be fetal. Whereas this

finding contradicts the hypothesis forwarded by this study report, it points out that there was less

relationship between the fetal hemoglobin and the expression of the sickle-cell trait.

In conclusion, the report has indicated that in Yorubaland, there was an estimated 23.7%

prevalence of the sickle cell trait. The report also revealed that children that inherit the sickle cell

trait are not born with the sickle cells present in their blood. However, the cells begin to form a

few days after birth. The reports attempt to associate the lack of sickle cells among newborns

with the presence of fetal blood has failed. Its hypothesis has contradicted others forwarded by

investigators in other studies. However, the report makes indicates that more research on the

condition was needed especially relating to the mode of inheritance as well as the expression of

the trait in newborns.