SynthesisBMJ open2020
Implementation of the therapeutic use of hydroxyurea for sickle cell disease management in resource-constrained settings: a systematic review of adoption, cost and acceptability.
Synthesis in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 24 citations in OpenAlex.
- Systematic review of end stage renal disease in Pakistan: Identifying implementation research outcomes.PloS one · 2023Pooled it
- Pooled it
- Beyond the Prescription: Hydroxycarbamide Utilization and Adherence Among Persons Living with Sickle Cell Disease in Rural Ghana.Patient preference and adherence · 2026Article
- Article
- Can platelet to neutrophil ratio (PNR) serve as a viable alternative tool for monitoring sickle cell disease patients on hydroxyurea in low income countries?Annals of hematology · 2025Article
- Health equity in sickle cell disease: overcoming barriers to care in marginalized communities.Annals of medicine and surgery (2012) · 2025Review
- Burden of hemoglobinopathies and hemolytic anemias in the World Health Organization African region, 2000-2021: Findings from the Global Burden of Disease 2021 study.PLOS global public health · 2025Article
- Article
- Article
- Article
- Determinants of hydroxyurea use among doctors, nurses and sickle cell disease patients in Nigeria.PloS one · 2022Article
- Implementation science research for the scale-up of evidence-based interventions for sickle cell disease in africa: a commentary.Globalization and health · 2021Article
- Treating Rare Diseases in Africa: The Drugs Exist but the Need Is Unmet.Frontiers in pharmacology · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesMortality associated with sickle cell disease (SCD) is high in many low- and middle-income countries (LMICs). Hydroxyurea, a medicine to effectively manage SCD, is not widely available in resource-constrained settings. We identified and synthesised the reported implementation outcomes for the therapeutic use of hydroxyurea for SCD in these settings.
designSystematic review. DATA SOURCES: PubMed, Embase, Cochrane, Web of Science Plus, Global Health, CINAHL, and PsycINFO were searched February through May 2019 without any restrictions on publication date. ELIGIBILITY CRITERIA: We included empirical studies of hydroxyurea for management of SCD that were carried out in LMICs and reported on implementation outcomes. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently assessed studies for inclusion, carried out data extraction using Proctor
resultsTwo cross-sectional surveys (n=2) and one cohort study (n=1) reported implementation of hydroxyurea for SCD management, namely regarding outcomes of adoption (n=3), cost (n=3) and acceptability (n=1). These studies were conducted exclusively among paediatric and adults populations in clinical settings in Nigeria (n=2) or Jamaica (n=1). Adoption is low, as observed through reported provider practices and patient adherence, in part shaped by misinformation and fear of side effects among patients, provider beliefs regarding affordability and organisational challenges with procuring the medicine. There was no difference in the cost of hydroxyurea therapy compared with blood transfusion in the paediatric population in urban Jamaica. Risk of bias was low or moderate across the included studies.
conclusionsThis review rigorously and systematically assessed the evidence on implementation of hydroxyurea in resource-constrained settings such as LMICs. Findings suggest that knowledge regarding implementation is low. To address the know-do gap and guide clinical practice, implementation research is needed. Integrating effective interventions into existing health systems to improve hydroxyurea uptake is essential to reducing SCD-associated mortality. PROSPERO REGISTRATION NUMBER: CRD42020155953.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.