Letter of the Day | World Sickle Cell Day and India

THE EDITOR, Madam:

Wednesday, June 19, is World Sickle Cell Day but it wasn’t until a patient from Mocho, Clarendon, called up to thank the local sickle cell organisations for their care over the years that I was reminded of it – such is the passage of time during ‘retirement’.

That call led me to ponder whether there had been any developments in sickle cell worthy of discussion and wonder whether your readers will be aware of developments in India. Many may not realise the geographical extent of sickle cell disease worldwide and of the increasing challenges of developing services for sickle cell disease to a huge population such as India which, after Nigeria and the Democratic Republic of the Congo, is the third most affected with over 44,000 births with sickle cell disease annually.

Confined to a broad swathe across central India encompassing Gujarat, Madhya Pradesh, Maharashtra, Chhattisgarh and western Odisha, the disease affects predominantly disadvantaged communities such as the scheduled castes with a smaller focus among the tribal peoples in Tamil Nadu in the south of the country. There are many challenges to the development of services for this population and Indian colleagues have drawn heavily on Jamaican experience over the last 40 years.

One of the objectives has been to define the needs of this population and the ‘natural history’ of Indian sickle cell disease which shows several important differences from the disease seen in peoples of African origin.

To begin to document the true natural history of Indian sickle cell disease, two major studies based on newborn screening are under way in Nagpur, Maharashtra and in Valsad, Gujarat. The Nagpur study was closely based on that commenced at Victoria Jubilee Hospital, Kingston, since 1973 and in which the oldest patients have now passed their 50th birthdays. Much will be learnt from these Indian studies but perhaps the greatest challenge of all was issued by the Prime Minister of India, Narendra Modi, when he launched the National Sickle Cell Anaemia Elimination Mission on July 1, 2023 at Shahdol, Madhya Pradesh. This mission aims to eradicate sickle cell disease from India by 2047 by undertaking screening, prevention and management in all highly prevalent areas, planning to screen a 70-million population age 0-40 years in three years, and had screened 10 million by January 2024. An ambitious project but one which will tell the world much about the control of sickle cell disease.

GRAHAM R SERJEANT, MD,

FRCP

Emeritus Professor,

Faculty of Medical Sciences,

University of the West Indies,

Mona.