Faculty of Medicine

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Browsing Faculty of Medicine by Subject "Africa"

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    Access to the World Health Organization-recommended essential diagnostics for invasive fungal infections in critical care and cancer patients in Africa: A diagnostic survey
    (Journal of Infection and Public Health, 2023-08-16) Tufa, Tafese Beyene; Bongomin, Felix; Fathallah, Akila; Luísa S.M., Ana; Hashad f, Rola; Soussi Abdallaoui g, Maha; Ahmed Nail h, Abdelsalam; Adetona Fayemiwo, Samuel; Penney, Richard O.S.; Orefuwa, Emma; Denning, David W.
    Background: Invasive fungal infections (IFIs) contribute to significant morbidity and mortality among patients with haemato-oncological conditions, seriously ill hospitalised patients and those in intensive care (ICU). We surveyed for the World Health Organization-recommended essential diagnostic tests for IFIs in these risk groups in Africa. Methods: The Global Action For Fungal Infections (GAFFI) evaluated the different levels of access to both diagnostics for IFIs for populations in Africa, with the aim of building a comparative dataset and a publicly available interactive map. Data was collected through a validated questionnaire administered to a country leader in relevant topics (i.e., HIV, laboratory coordination) and/or Ministry of Health representatives and followed up with 2 rounds of validation by video calls, and later confirmation by email of findings. Results: Initial data was collected from 48 African countries covering 99.65 % of the population.Conventional diagnostics such as blood cultures, direct microscopy and histopathology were often used for diagnosis of IFIs in more than half of the facilities. Bronchoscopy was rarely done or not done in 20 countries (population 649 million). In over 40 African countries (population > 850 million), Aspergillus antigen testing was never performed in either the public or private sectors. Computed tomography (CT) imaging is routinely used in 27 (56 %) of countries in the public sector and 21 44 %) in the private sector. However, magnetic resonance imaging remains relatively uncommon in most African countries. Conclusions: There are critical gaps in the availability of essential diagnostics for IFIs in Africa, particularly Aspergillus antigen testing and modern medical imaging modalities. Early diagnosis and commencement of targeted therapy of IFIs are critical for optimal outcomes from complex cancer therapies
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    Factors associated with malaria in pregnancy among antenatal care mothers at Gulu Regional Referral Hospital in northern Uganda
    (BMC Malaria Journal, 2024) Solomon Oguta; Brian Serumaga; Lameck Odongo; Donald Otika; Jackline Ayikoru; Raymond Otim; Francis Pebolo Pebalo
    Background: All pregnant mothers in Uganda are given sulfadoxine-pyrimethamine (SP, Fansidar ®) for presumptive treatment of malaria in pregnancy from 14 weeks of gestation, every four weeks, until delivery. However, prenatal mothers still fall sick of malaria. This study aimed to assess the factors associated with malaria in pregnancy among antenatal care mothers at Gulu Regional Referral Hospital. Methods: This was a cross-sectional study at Gulu Regional Referral Hospital antenatal clinic from July to August 2023. Consecutive sampling was used. An interviewer-administered questionnaire was used to collect sociodemographic characteristics, physical examination findings and blood samples taken for rapid diagnostic test (RDT) for malaria. A positive RDT was taken as the presence of malaria infection in pregnancy. Data was pre-processed in STATA ®15, and logistic regression analysis was done in RStudio 4.2.2. Variables with p < 0.05 were taken as independently associated with malaria in pregnancy and reported as adjusted risk ratios (aRR). Results: Three hundred fifty (350) pregnant women were recruited; 96% of them slept under mosquito nets daily, while more than half of them (51.7%) had not yet taken SP (IPTp) during their current pregnancy. Prevalence of anaemia (Hb < 11.0 g/dl) was 46.0%. Twenty-four per cent of the mothers were in the first trimester, 56.3% in the second and 19.7% in the third. The prevalence of malaria in pregnancy was 39.7% (95% CI 34.5–45.1%), equally distributed throughout the trimesters. Anaemia (aRR = 4.99, 95%CI 3.10–8.05, p < 0.001) and tertiary level of education (aRR = 0.29, 95% CI 0.14–0.62, p = 0.001) were significantly associated with malaria in pregnancy. Not sleeping under a mosquito net (aRR = 3.79, 95% CI 0.95–15.16, p = 0.059) may be a factor associated with malaria in pregnancy. Conclusion: Four in every ten mothers had malaria infection, with anaemia being a risk factor, while a tertiary levelof education was protective against malaria in pregnancy.
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    Invasive Fungal Diseases in Africa:
    (MDPI, 2022-11-22) Bongomin, Felix; Ekeng, Bassey E.; Kibone, Winnie; Nsenga, Lauryn; Olum, Ronald; Itam-Eyo, Asa; Ngouanom Kuate, Marius Paulin; Pebolo, Francis Pebalo; Davies, Adeyinka A; Manga, Musa; Ocansey, Bright; Kwizera, Richard; Baluku, Joseph Baruch
    Invasive fungal diseases (IFDs) are of huge concern in resource-limited settings, particularly in Africa, due to the unavailability of diagnostic armamentarium for IFDs, thus making definitive diagnosis challenging. IFDs have non-specific systemic manifestations overlapping with more frequent illnesses, such as tuberculosis, HIV, and HIV-related opportunistic infections and malignancies. Consequently, IFDs are often undiagnosed or misdiagnosed. We critically reviewed the available literature on IFDs in Africa to provide a better understanding of their epidemiology, disease burden to guide future research and interventions. Cryptococcosis is the most encountered IFD in Africa, accounting for most of the HIV-related deaths in sub-Saharan Africa. Invasive aspergillosis, though somewhat underdiagnosed and/or misdiagnosed as tuberculosis, is increasingly being reported with a similar predilection towards people living with HIV. More cases of histoplasmosis are also being reported with recent epidemiological studies, particularly from Western Africa, showing high prevalence rates amongst presumptive tuberculosis patients and patients living with HIV. The burden of pneumocystis pneumonia has reduced significantly probably due to increased uptake of anti-retroviral therapy among people living with HIV both in Africa, and globally. Mucormycosis, talaromycosis, emergomycosis, blastomycosis, and coccidiomycosis have also been reported but with very few studies from the literature. The emergence of resistance to most of the available antifungal drugs in Africa is yet of huge concern as reported in other regions. IFDs in Africa is much more common than it appears and contributes significantly to morbidity and mortality. Huge investment is needed to drive awareness and fungi related research especially in diagnostics and antifungal therapy.
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    Liver and renal biochemical profiles of people with sickle cell disease in Africa: a systematic review and meta‑analysis of case‑control studies
    (BMC, 2024-10-15) Silvia Awor; Felix Bongomin; Mark Mohan Kaggwa; Francis Pebalo Pebolo; Jackie Epila; Geoffrey Maxwell Malinga; Christine Oryema; Proscovia Nnamuyomba; Acaye Ongwech; David Musoke
    Background: Sickle cell disease (SCD) is a genetic blood disorder characterized by a painful vaso-occlusive crisis due to the sickling of red blood cells in capillaries. Complications often lead to liver and renal dysfunctions, contributing to morbidity and mortality, particularly for children under 5. This systematic review and meta-analysis aimed to evalu ate the liver and renal functions of people with SCD (HbSS) compared to those without it (HbAA) in Africa. Methods: The protocol was registered with PROSPERO (CRD42022346771). We searched PubMed, Embase, Web of Science, and Google Scholar using the keywords “liver function”, “renal function”, “sickle cell disease”, and “Africa” on 6th May 2023 for peer-reviewed articles with abstracts in English. We included case-control studies compar ing SCD (HbSS) with controls without hemoglobinopathies (HbAA). We used the random-effect model to calculate the pooled average values for the blood tests of people with SCD in RStudio version 4.2.2. Systematic review registration PROSPERO CRD42022346771 Results: Overall, 17 articles were analyzed from five African countries involving 1312 people with SCD and 1558 controls. The pooled mean difference of liver enzymes aspartate transaminase (AST) was 8.62 (95% CI − 2.99–20.23, I2 = 97.0%, p < 0.01), alanine transaminase (ALT) 7.82 (95% CI − 0.16–15.80, I2 = 99%, p < 0.01) and alkaline phos phatase (ALP) − 2.54 (95% CI − 64.72 – 59.64, I2 = 99%, p < 0.01) compared to controls. The pooled mean difference for the renal biochemical profiles creatinine − 3.15 (95% CI − 15.02; 8.72, I2=99%, p < 0.01) with a funnel plot asym metry of t = 1.09, df = 9, p = 0.3048 and sample estimates bias of 6.0409. The pooled mean difference for serum urea was − 0.57 (95% CI − 3.49; 2.36, I2 = 99%, p < 0.01), and the estimated glomerular filtration (eGFR) rate was 19.79 (95% CI 10.89–28.68 mL/min/1.73 m2, I2 = 87%, p < 0.01) compared to controls. Conclusion: People with SCD have slightly elevated liver enzymes and estimated glomerular filtration rates com pared to controls in Africa. With all the heterogeneity (I2) > 50%, there was substantial variation in the reported articles’ results.
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    Long COVID in Uganda: Electrographic findings among patients at risk
    (Wiley, 2023-03-13) Semulimi, Andrew Weil; Batte, Charles; Iraguha, Daniel; Okwir, Pamela Apio; Atuhaire, Hope; Lipoto, Chelsea; Muwonge, Tonny; Namirembe, Norah; Lubega, Grace Biyinzika; Ainembabazi, Provia; Mukisa, John; Bongomin, Felix; Ssinabulya, Isaac; Okello, Emmy
    Background: COVID-19 has a significant cardiovascular involvement. An electrocardiographic (ECG) abnormalities among people at a risk of Long COVID in Uganda was investigated. Methods: A cross-sectional study was conducted from February to June 2022 at the post COVID-19 clinic in Mulago National Specialized Hospital, Kampala. A standard resting ECG was performed on individuals at least 2 months following acute COVID-19, with a negative SARS-CoV-2 reverse-transcription polymerase chain reaction. Socio-demographic and clinical characteristics as well as vital signs were recorded for all study participants. Results: Of the 244 study participants, 117 (47.9%) were female. The median age of all the participants was 33.0 (interquartile range: 26.0–43.5) years. Twenty-five (10.2%) participants had a history of smoking, whereas 117 (48%) had a history of alcohol intake. In total, 46 (18.9%) had abnormal ECG findings (95% Confidence Interval [CI]: 14.39–24.29), and nonspecific T-wave inversion (n = 16, 34%) was the most frequent ECG abnormality. The proportion of participants with ECG abnormalities was 48% lower among females (adjusted prevalence ratio [aPR]: 0.52, 95% CI: 0.28–0.96, p value <0.05) and twofold greater for those with a history of smoking (aPR: 2.03, 95% CI: 1.096–3.776, p value <0.05). Conclusion: One in five Ugandans who were checked at the clinic at a risk of Long COVID showed ECG abnormalities. ECG screening is suggested to be integrated into the follow-up care of those at a risk of Long COVID
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    Prediction of low birth weight at term in low resource setting of Gulu city, Uganda: a prospective cohort study
    (PAMJ, 2022-11-08) Silvia Awor; Rosemary Byanyima; Benard Abola; Paul Kiondo; Christopher Garimoi-Orach; Jasper Ogwal-Okeng; Annettee Nakimuli; Dan Kabonge Kaye
    Introduction: despite the widespread poverty in Northern Uganda resulting in undernutrition, not all mothers deliver low birth weight babies. Therefore, we developed and validated the risk prediction models for low birth weight at term in Northern Uganda from a prospective cohort study. Methods: one thousand mothers were recruited from 16 - 24 weeks of gestation and followed up until delivery. Six hundred and eighty-seven mothers delivered at term. The others were either lost to follow-up or delivered preterm. Used proportions to compute incidence of low birth weight at term, build models for prediction of low birth weight at term in RStudio. Since there were few low birth weight at term, were generated synthetic data using ROSE-package in RStudio by over-sampling low birth weights and under sampling normal birth weights, and evaluated the model performance against the synthetic data using K (10) - fold cross-validation. Results: mean age was 26.3 years with an average parity of 1.5. Their mean body mass index was 24.7 and 7.1% (49 of 687) had lateral placenta. The incidence of low birth weight was 5.7% (39 of 687). Predictors of low birth weight were gravidity, level of education, serum alanine aminotransferase (ALT), serum gamma-glutamyl transferase (GGT), lymphocyte count, placental location, and end diastolic notch in the uterine arteries. This predicted low birth weight at term by 81.9% area under the curve (AUC), 76.1% accuracy, 72.9% specificity, and 79.1% sensitivity. Conclusion: a combination of gravidity, level of education, serum ALT, serum GGT, lymphocyte count, placental location, and end-diastolic notch in the uterine arteries can be used for screening for low birth weight in prenatal clinics for screening low birth weight at term.
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    Prediction of low birth weight at term in low resource setting of Gulu city, Uganda: a prospective cohort study
    (PAMJ, 2022-11-08) Silvia Awor; Rosemary Byanyima; Benard Abola; Paul Kiondo; Christopher Garimoi-Orach; Jasper Ogwal-Okeng; Annettee Nakimuli; Dan Kabonge Kaye
    Introduction: despite the widespread poverty in Northern Uganda resulting in undernutrition, not all mothers deliver low birth weight babies. Therefore, we developed and validated the risk prediction models for low birth weight at term in Northern Uganda from a prospective cohort study. Methods: one thousand mothers were recruited from 16 - 24 weeks of gestation and followed up until delivery. Six hundred and eighty-seven mothers delivered at term. The others were either lost to follow-up or delivered preterm. Used proportions to compute incidence of low birth weight at term, build models for prediction of low birth weight at term in RStudio. Since there were few low birth weight at term, were generated synthetic data using ROSE-package in RStudio by over-sampling low birth weights and under sampling normal birth weights and evaluated the model performance against the synthetic data using K (10) - fold cross-validation. Results: mean age was 26.3 years with an average parity of 1.5. Their mean body mass index was 24.7 and 7.1% (49 of 687) had lateral placenta. The incidence of low birth weight was 5.7% (39 of 687). Predictors of low birth weight were gravidity, level of education, serum alanine aminotransferase (ALT), serum gamma-glutamyl transferase (GGT), lymphocyte count, placental location, and enddiastolic notch in the uterine arteries. This predicted low birth weight at term by 81.9% area under the curve (AUC), 76.1% accuracy, 72.9% specificity, and 79.1% sensitivity. Conclusion: A combination of gravidity, level of education, serum ALT, serum GGT, lymphocyte count, placental location, and end-diastolic notch in the uterine arteries can be used for screening for low birth weight in prenatal clinics for screening low birth weight at term.
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    Prediction of Preeclampsia Using Routinely Available Care: A Review of Literature
    (Journal of African Interdisciplinary Studies, 2022-01) Silvia Awor; Rosemary Byanyima; Benard Abola; Annettee Nakimuli; Christopher Garimoi Orach; Paul Kiondo; Dan Kaye; Jasper Ogwal-Okeng
    Women of Afro-Caribbean racial origin are at increased risks of adverse pregnancy outcomes including preeclampsia. This is probably related to low socio-economic status among these communities. With limited resources allocated for health care, there has been a growing need to predict preeclampsia to enable frequent follow up of those at risk, for early diagnosis and treatment to minimize adverse outcomes. Risk prediction models have been developed in some parts of Africa, using maternal history and physical examination, uterine artery Doppler sonography, maternal full haemogram, liver and renal function tests with at least 50% accuracy and 70% AUC. The study concludes that routine prediction of preeclampsia in Africa is limited, although with a potential to save lives.
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    Prediction of stillbirth low resource setting in Northern Uganda
    (BMC, 2022-11-19) Silvia Awor; Rosemary Byanyima; Benard Abola; Paul Kiondo; Christopher Garimoi Orach; Jasper Ogwal‑Okeng; Dan Kaye; Annettee Nakimuli
    Background: Women of Afro-Caribbean and Asian origin are more at risk of stillbirths. However, there are limited tools built for risk-prediction models for stillbirth within sub-Saharan Africa. Therefore, we examined the predictors for stillbirth in low resource setting in Northern Uganda. Methods: Prospective cohort study at St. Mary’s hospital Lacor in Northern Uganda. Using Yamane’s 1967 formula for calculating sample size for cohort studies using finite population size, the required sample size was 379 mothers. We doubled the number (to>758) to cater for loss to follow up, miscarriages, and clients opting out of the study dur‑ ing the follow-up period. Recruited 1,285 pregnant mothers at 16–24 weeks, excluded those with lethal congenital anomalies diagnosed on ultrasound. Their history, physical findings, blood tests and uterine artery Doppler indices were taken, and the mothers were encouraged to continue with routine prenatal care until the time for delivery. While in the delivery ward, they were followed up in labour until delivery by the research team. The primary outcome was stillbirth 24+weeks with no signs of life. Built models in RStudio. Since the data was imbalanced with low stillbirth rate, used ROSE package to over-sample stillbirths and under-sample live-births to balance the data. We cross-vali‑ dated the models with the ROSE-derived data using K (10)-fold cross-validation and obtained the area under curve (AUC) with accuracy, sensitivity and specificity. Results: The incidence of stillbirth was 2.5%. Predictors of stillbirth were history of abortion (aOR=3.07, 95% CI 1.11—8.05, p=0.0243), bilateral end-diastolic notch (aOR=3.51, 95% CI 1.13—9.92, p=0.0209), personal history of preeclampsia (aOR=5.18, 95% CI 0.60—30.66, p=0.0916), and haemoglobin 9.5 – 12.1 g/dL (aOR=0.33, 95% CI 0.11—0.93, p=0.0375). The models’ AUC was 75.0% with 68.1% accuracy, 69.1% sensitivity and 67.1% specificity. Conclusion: Risk factors for stillbirth include history of abortion and bilateral end-diastolic notch, while haemoglobin of 9.5—12.1 g/dL is protective.
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    Prevalence of Use of Herbal Medicines for the Treatment of Sickle Cell Disease in Africa: a Systematic Review and Meta-analysis
    (Elsevier, 2023-08-11) Awora, S.; Bongomin, F.; Kaggwa, M.M.; Pebalo, F.P.; Musoke, D.
    Introduction: Several herbal medicines have been reported to ameliorate sickle cell disease (SCD) complications in many African communities. However, no comprehensive review has evaluated the use of herbal remedies for treating SCD crises. Therefore, this study aimed to determine the prevalence of the use of herbal medicines for the treatment of SCD in Africa. Methods: Following registration of the review protocol with PROSPERO (CRD42022346755), searched PubMed, Embase, Africa Journal Online, and Web of Science databases using the keywords ‘herbal medicine,’ ‘SCD,’ and ‘Africa’ on 1st August 2022 for peer-reviewed articles without language restriction. We included articles that reported the prevalence of herbal medicine use for SCD treatment in Africa and excluded qualitative studies, letters to editors, case reports, and editorials. All included papers were assessed using the modified Newcastle Ottawa quality assessment scale for observational studies. We used the random-effect model to calculate the pooled prevalence of herbal medicine use for SCD treatment with STATA 17.0. Results: Overall, 142 research articles were identified. Of this, three cross-sectional studies involving 702 chil dren with SCD from Uganda (n = 1) and Nigeria (n = 2) met the eligibility criteria and were included. Four hundred thirty-four individuals from the included studies used herbal medicines for the management of SCD. The prevalence of current herbal medicine use in individual studies ranged from 36.4% to 78.0%, with a pooled prevalence of 59% (95% confidence interval: 35.0–82.0, I 2 = 97.68%, P < 0.001). Conclusions: Almost three in five persons with SCD in Africa use herbal remedies as a form of treatment. However, there is limited data detailing the magnitude of the prevalence of use of herbal medicines for the treatment of SCD across different regions. Therefore, further studies are encouraged to explore the prevalence of use of herbal remedies for the management of SCD in Africa.
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    Safety and efficacy of herbal medicines for the management of sickle cell disease in Africa: a systematic review and meta-analysis
    (PAMJ One Health, 2024-12-16) Awor, Silvia; Bongomin, Felix; Kaggwa, Mark Mohan; Pebalo, Pebolo Francis; Kivumbi, Ronald Muganga; Malinga, Geoffrey Maxwell; Ongwech, Acaye; Nnamuyomba, Proscovia; Oryema, Christine; Abola, Benard; Epila, Jackie; Musoke, David
    This systematic review and meta-analysis evaluated the safety and efficacy of herbal remedies used to manage sickle cell disease (SCD) in Africa. Before the advent of western medicine, people depended on herbal medicines for treating different illnesses. Using herbal medicines to sickle cell disease (SCD) is still common in Africa. However, data on the safety and efficacy of any of these remedies are limited. We searched PubMed, Embase, Google Scholar and Web of Science from inception to 11thJanuary 2024 using the keywords "herbal medicine" and "sickle cell" and the name of each of the countries in Africa without language restrictions. We included cross-sectional studies that reported the safety or efficacy of herbal medicine for managing sickle cell disease. Two reviewers assessed all included studies for suitability for inclusion in this review. All included articles were assessed using ROBINS-1, a tool for assessing the risk of bias in non-randomized studies of interventions. We used the randomeffect model to pool the efficacy and safety profiles of the herbal medicines using RStudio version 4.2.2. Overall, we included five studies involving 1,489 individuals with SCD. Of these, 789 (53.0%) used herbal remedies like Aloe barbadensis (Aloe vera), Zingiber officinale (ginger), Cymbopogon citratus (lemongrass), Forever Living products, Golden Neo-Life Diamite International (GNLD) diet supplements and ginseng products. About 22.9% (181 out of 789) of the participants who used herbal remedies reported side effects, while 38.5% (304 out of 789) reported improving their symptoms. There was a high risk of publication bias in the articles included in this review. The pooled adverse effects of the herbal medicines for SCD treatment were 48% lower (Odds ratio: 0.52, 95% confidence interval (CI): 0.26 - 1.05, I²= 82%, p<0.01) while the pooled efficacy of herbal remedies for treating SCD was nearly 100% higher (odds ratio= 2.07, 95% confidence interval 0.99 - 4.32, I²= 78%, p<0.01) among the users than controls. However, these findings were not statistically significant. Our findings indicate no significant difference in the safety and efficacy of herbal medicines among people with SCD who used or did not use herbal remedies. However, the sample sizes of the primary studies were small. Thus, more extensive controlled studies with better-defined endpoints are required to inform the use of herbal medicines in managing SCD in Africa.
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    “We Cure Sickle Cell Disease with Herbs”: Perspectives of Herbal Medicine Practitioners Treating Sickle Cell Disease in the Acholi SubRegion
    (DovePress, Taylor & Francis Group, 2025-07-28) Awor, Silvia; Opee, Jimmyy; Denis Ocaya,; Ocaya, Jimmy; Abola, Benard; Malinga, Geoffrey Maxwell; Oryema, Christine; Arwenyo, Beatrice; Ongwech, Acaye; Musoke, David; Nnamuyomba, Proscovia; Epila, Jackie
    Background: Sickle cell disease (SCD) is a genetic blood disorder that results in the deformation of red blood cells under low oxygen conditions, causing vaso-occlusive crises and severe complications. While hydroxyurea has been introduced as a treatment for SCD, herbal medicines remain widely used across Africa. Northern Uganda has a high SCD prevalence of 20.5%, yet limited research exists on alternative treatment options within local communities. This study aimed to explore the perspectives of herbal medicine practitioners in the Acholi sub-region. Methods: We conducted in-depth interviews between October and December 2024 involving 24 herbal medicine practitioners in the Acholi sub-region, selected through referrals and non-probability snowball sampling. All data collected were recorded, transcribed verbatim, and analyzed using thematic content analysis, and emerging themes were presented. Results: All participants believed herbal medicine could cure SCD, and the majority reported successfully treating patients. However, some practitioners remembered some patients who reported being sick with sickle cell crises many years after the “cure”. “When they report improvement, I stop medication after some time…” thereafter, “I encourage them to go to the hospital, but they do not. They can stay without falling sick for a long time and declare themselves healed”. Findings suggest herbal medicines are commonly used for SCD management in the Acholi sub-region. Most herbal medicine practitioners rely on the hospital diagnoses, although a few can tell who has sickle cell disease by looking at or touching them. A lot of mistrust exists between herbal medicine practitioners, the government, and researchers. This hinders efforts to integrate traditional medicine into mainstream healthcare and limits opportunities for scientific validation. Conclusion: Herbal medicine practitioners believe herbs can treat sickle cell disease; however, further research is needed to investigate the nature of these herbs and their mechanisms of action, thereby facilitating the integration of herbal medicine into conventional care. We discuss some implications of the study for practice and policy