Sickle Cell Anemia Control Program

Sickle Cell Anemia (also known as Sickle Cell Disorder or Sickle Cell Disease) is a
genetic blood disorder, where the blood cells contain abnormal sickle shaped hemoglobin
(HbS) called sickle hemoglobin. The prevalence of Sickle Cell Anemia is highly common
in the tribal belt of Central and Southern India. The public health implications of Sickle
Cell Anemia are significant leading to poor quality of life, lower life expectancy and higher
rates of infant mortality.
According to one of the hypothesis, this mutation has occurred to prevent the
entry of Malaria parasites into the cell wall of Red blood Cells. In doing so, the cell wall of
Red Blood Cell has become rigid and brittle, and turns round biconcave disc like Red
Blood Cells into the shape of Sickle.
Problem Statement
As symptomatology of Sickle Cell Anemia is very similar to any other anemia, Sickle Cell
Anemia patients are frequently misdiagnosed and mistreated. It is also noteworthy that
sickle cell disease is incurable.
The main objectives of Sickle Cell Anemia Control program are reducing burden of Sickle
Cell Disease, among tribal population through 1) Early Screening of patients 2)
Administering of treatment and 3) counselling for managing the disease and
preventing transmission of disease to next generation..
SCACP holistically offers complete range of services by aiming at early diagnosis of the
disease through New Born Screening (NBS) and Antenatal Screening, followed by
treatment and counselling of Sickle Cell Disease patients including prevention by
marriage counselling and prenatal diagnosis. The Government of Gujarat has developed
all required facilities for Premarital Screening, Antenatal Diagnosis and even Newborn
Screening for Sickle Cell Anemia.
Activities Carried Out in Program
 Screening facilities at all PHI in tribal districts
 Antenatal Screening
 Prenatal diagnosis
 New Born Screening
 Necessary Lab investigations
 Counselling, Treatment and Follow up.
Screening
The screening under this program covers the all age group from new born to old age
people. The main target group for screening is the adolescents, antenatal and new borne.
Our all Antenatal mothers in the tribal area are screened for Sickle Cell Anemia at “Mamta

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Divas”- a special immunization day in village. If mother is found positive for sickle gene,
her husband is also screened. If husband and wife both found positive for sickle gene,
they are advised for pre-natal diagnosis. If fetus is found to have sickle cell disease, legal
MTP is advised.
All adults and geriatric persons are screened in mass screening camps held in community
with the help of tribal development department.
Thus sickle cell anemia screening program covers the whole life cycle. This is the unique
feature of the program.
Counseling:
Counseling is the key object of this program. All the Sickle Cell traits and Sickle Cell
Disease patients are counseled regularly by our trained counselors. Family counseling is
done at the door step of this community. All the Adolescents are counseled for their
marraige and future pregnancy. All the tribal persons are given color coded card
according to their Sickle Cell Status, which will help them in marriage decision. After
distributing above cards, adolescents are advised to avoid marriages between two yellow
card holders to avoid Sickle Disease child birth.
Treatment
So far more 9502470 tribal have been screened under this program and out of which 30,319
have been detected with Sickle Cell Disease and 7, 03010 as Sickle Cell Trait.
All 30,319 Sickle cell disease patients diagnosed till now were put in to the comprehensive care
system and have been regularly supplied basic medications like Folic Acid and Pain Killers
through sub centers and PHCs. IV fluids, antibiotics etc. are also provided at PHCs, CHCs and at
higher referral centers. Many of these patients with severe disease were put on Hydroxyurea
therapy. Counsellors are trained to provide them care & support with follow up.
Arrangements were created for supply of free blood and blood products to all these patients as
and when required in emergency through Regional Blood Centers and First referral Units.
Prophylactic pneumococcal vaccine to all SCD patients- first time in India- 15381 SCD patients
covered. 3413 sickle crisis patients have been given treatment in year current year.
What is new or different in this practice? :
 Sickle Cell Anemia is a major public health problem in India however country does
not have any health program at national level to address it. This program provides
care and support to socioeconomically and medically underserved populations.
 Pre-natal diagnosis is offered to Sickle Cell positive couples. If fetus is found to have
sickle cell disease, legal MTP is advised.
 Sickle Cell Anemia screening program covers the whole life cycle. This is the unique
feature of the program.
 Non-tribal population of tribal districts are also being screened now as this disease
may also be seen among non-tribal too.

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 DTT Test Was Selected as screening tool at mass Level Considering cost-effectiveness
and easy testing method at sub canter, HWC,PHC,CHC,SDH.
 HPLC Was Selected as confirmatory test considering high sensitivity and specificity
and can be carried out by at surat,navasri,tapi,valasd,vadoadara,GMERS sola
 The Standard Treatment Guideline for Sickle Cell Disease patients have been
developed. Pneumococcal Vaccine is given to all SCD patients as this are the main
factors of mortality.
 Sickle cell Day care canter Started at Valsad,Navasari &Dang.
 Students in Ashram Schools in tribal area are screened in schools, hostels and
counseled regularly for this diseases.
 The Tribal People are most benefited. Today they get regular free medicine at their
door step, hence there is marked reduction in crisis.
 The Fruits of the Program have reached to the door step of under-served– The Tribal
People.

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