Baseline Characteristics and Social Challenges of Children with Sickle Cell Disease in Haiti and after Immigration to the United States: A Comparative Cohort Study.

backgroundHaitians have a high incidence of sickle cell disease. The Comparative Study of Children in Haiti and Miami with Sickle Cell Disease (CSHSCD) assessed clinical and social characteristics of children of Haitian immigrants and African American controls comparing them with Haitian children living in Haiti with the purpose of overcoming differences during follow-up. We hypothesized that at baseline there would be significant differences and that time since migration may correlate with improved access to medical care.

methodsBaseline clinical characteristics and parental self-reported barriers to care were compared. Acculturation measured as English proficiency was assessed among Haitian American parents.

resultsTwo hundred fifty-five children (mean age 38 months) were recruited: 204 Haitians, 32 Haitian Americans and 19 African Americans. African American and Haitian American children with hemoglobin SS were more likely receiving hydroxyurea (p < 0.001) and were less likely to have experienced a vaso-occlusive crisis than children in Haiti (p < 0.001). Being in the United States over 10 years was associated with better English proficiency. Children in Haiti were more anemic, more likely to be malnourished and to lack pneumococcal conjugate vaccinations. Haitian families could not afford treatment.

conclusionsLonger length of stay in the United States was associated with appropriate pneumococcal vaccination, higher parental education, and better English competency. Haitians living in Haiti were at a significant disadvantage in every aspect of care, requiring ongoing assistance with community resources, medications and vaccines. We encourage global partnerships to decrease barriers to care in disadvantaged populations.