Indications for hospitalisation and predictors of 30- day re- admission of patients with sickle cell disease in Uganda: a retrospective study

Abstract

Background: Sickle cell disease (SCD) is associated with significant mortality and morbidity, especially in low- and middle- income countries. Objectives: We determined the indications for hospitalisation and predictors of 30- day re- admission among patients with SCD in Northern and Central Uganda. Design: Retrospective chart review. Setting: Mulago National Referral Hospital in Kampala, St. Mary’s Hospital Lacor in Gulu and Gulu Regional Referral Hospital in Gulu, Uganda. Participants: Patients with confirmed SCD admitted between January 2020 and January 2025 were included. Outcomes: Primary outcome: indication for hospitalisation. Secondary outcomes: rate and predictors of 30- day hospital re- admission. Socio- demographic, clinical history and hospitalisation data were extracted using a pretested data extraction tool. Results: We enrolled 505 patients, accounting for 714 hospital admissions, with a mean age of 8.1±6.2 years. Most participants (n=489, 96.8%) had less than four admissions per year, with a median of 1 admission (IQR: 0–2). The most common indications for hospitalisation were infection (n=375, 52.5%), painful crisis (n=366, 51.3%) and anaemia (n=186, 26.1%). Malaria was the most prevalent infection (n=244, 65%). The median length of hospital stay was 4 days (IQR: 3–6), with a 30- day re- admission rate of 6.9% (n=49). Admission with painful crisis (adjusted OR (AOR): 0.45, 95% CI: 0.23 to 0.89, p=0.021), receiving a blood product (AOR: 0.32, 95% CI: 0.16 to 0.66, p=0.002) and having four or more admissions per year (AOR: 0.84, 95% CI: 0.04 to 0.17, p<0.001) were inversely associated with re- admission within 30 days of last admission. Conclusions: Infections, especially malaria, and painful crises were the leading causes of hospitalisation among Ugandan patients with SCD. Frequent admissions, painful crises and blood transfusions were associated with lower 30- day re- admission risk. There is an urgent need to strengthen malaria prevention strategies and optimise access to disease- modifying therapy, such as hydroxyurea, to improve patient outcomes.