Haemophilia care in Zimbabwe
Adewuyi, J.O.; Coutts, A.M.; Levy, L.; Lloyd, S.E.
Central African Journal of Medicine 42(5): 153-156
1996
ISSN/ISBN: 0008-9176 PMID: 8771937 Document Number: 465578
A retrospective study was conducted to evaluate the status of hemophilia care in Zimbabwe. Parirenyatwa Hospital in Harare has the only hemophilia clinic in Zimbabwe. This monthly clinic facilitates diagnosis, registration, and long-term management of hemophilia. In mid 1993, there were 190 registered hemophilia cases in Zimbabwe. During 1991-1993, only 70 patients were seen more than once in the clinic. The National Blood Transfusion Service (NTSB) supplies blood products for hemophiliacs. Solvent-detergent treated Factor VIII and IX (FVIII and FIX, respectively) concentrates are imported from South Africa. They are the most common blood products used in Harare. Laboratory staff screen fresh frozen plasma and cryoprecipitate for HIV antibody and hepatitis B surface antigen. Five NTSB branches also distribute blood products. Blood products are expensive. Most hemophiliacs are covered by a social welfare program. 45 hemophiliac cases had been receiving home care since 1987. 67% of 24 home care patients receiving FVIII did not store FVIII packs in a refrigerator. Most home care patients injected blood products 0-6 hours from onset of symptoms (e.g., nosebleed). About 33% did not know how to calculate the dose required. All home care patients were satisfied with treatment. In 1992, Parirenyatwa Hospital registered 3 deaths of hemophiliacs. When considering only the 70 regular clinic attenders, the mortality rate for 1992 was 5.7%. Of the 73 hemophiliac cases tested for HIV infection, 32% tested positive. All HIV-positive hemophiliac cases began treatment for hemophilia before 1986, the year before HIV testing of hemophiliacs started. So far, about 33% of hemophiliacs tested positive for hepatitis C. The only social support system for hemophiliacs is the Zimbabwe Hemophilia Association. None of the 38 hemophiliacs screened for coagulation factor inhibitors had any inhibitors. Hemophilia care in Zimbabwe has a good start and can be used as a model for other developing countries. Expansion and close supervision of the effective home treatment program is advised.