1. Samia Jaffar, MPH Student Belize Cancer Center Dangriga April 2017
Sickle Cell Disease: Creating a Model for Screening in Resource Limited Settings A Pilot Study of Sickle Cell Anemia in Belize
Samia Jaffar, MPH Student
Belize Cancer Center Dangriga
April 2017

2. Sickle Cell Disease in Belize
Population: 380,010 (September, 2016)
As of 2009, an estimated 41% of the population lives in poverty.
Limited Data is Available on the prevalence of Sickle Cell Disease in Belize, or in Central America.
Study Purpose: Screen a suspected high risk population in Belize to determine the feasibility of using the Sickle SCAN test.
Ethnic Distribution:
Latin American
53%
Creole
26%
Maya
11%
Garifuna (Black Caribbean's) 6%
Mennonite 4%
East Indian
African
~1%

3. Sickle cell in sickle cell disease in Latin America and the U.S.
Pediatric Blood & Cancer. Volume 62, Issue 7, pages , 2 MAR 2015 DOI: /pbc

4. Sickle Scan
Utilizes a chromatographic immunologic approach to qualitatively identify the presence of normal and mutated hemoglobin molecules (HbA, HbS, HbC).
Testing is rapid and results can be obtained in less than 6 minutes
Results are highly reliable with a sensitivity and specificity of 99%
Cost Effective: price of each test is $4.50
Effective at distinguishing between trait and disease.
Minimally invasive, testing samples can be obtained via finger- stick.

5. Sickle SCAN
Testing Kits consist of the lateral flow device, pre-treatment buffer, and capillary sampler. Supplies required but not included are lancets.
Procedure requires uL of blood.
Blood samples are dispensed into the buffer solution and 5 drops are dispensed onto the testing cartridge.
The first line that appears on the cartridge serves as a control. It demonstrates that the test is functioning properly. The next line(s) to appear indicate the type of Hemoglobin present in the blood sample.

6. Objectives and methods
This descriptive, feasibility study was conducted to determine the effectiveness of conducting testing using the Sickle SCAN rapid tests.
Testing took place over the course of 4 days in the towns of Dangriga and Hopkins, Belize.
Advertisements on the local news and radio stations were used to recruit participants to receive SS screening.
A questionnaire was administered to all participants or their parents to collect demographic information, assess knowledge, family history, and past diagnosis of the disease.
Participants positively identified as having sickle cell trait were offered counseling. Those positively identified as having sickle cell disease were referred for preventative care.

7. Results
N= 87
African
Creole
Creole/Garifuna
East Indian
Garifuna
Latino
Maya
Results %
Negative
<1
11.8
7.4 --
35.3
1.5
Sickle Cell
13.2
Trait 3 24
87 participants were screened, however only 68 participants reported their ethnicity:
12 (13%) were found to have Sickle Cell Anemia.
22 (25%) were found to have Sickle Cell Trait
Average age= 16,
Men: N=35 Women: N=56
74% of the participants who had prior knowledge of SCD did not have a prior diagnosis.
52% of the participants had a family member with the disease

8. Future Work
This simple, rapid, low cost test is ideal for diagnosing sickle cell disease in resource starved areas.
Ethnicity of the population, as suspected, influences the prevalence of SS disease
We are continuing to conduct screening in Belize amongst:
Reproductive age adults
Newborns
And children <5 for penicillin intervention

9. References http://www.sib.org.bz/
Huttle, A., Maestre, G. E., Lantigua, R. and Green, N. S. (2015), Sickle cell in sickle cell disease in Latin America and the United States. Pediatr Blood Cancer, 62: 1131–1136. doi: /pbc.25450

10. Belize Cancer Center Dangriga Staff: Nurse Obi and Nurse Pauline
Acknowledgements
Dr. Ellsworth Grant
Dr. Kelly Jones
Belize Cancer Center Dangriga Staff: Nurse Obi and Nurse Pauline