Academic achievement in Ugandan children with sickle cell anaemia: A cross-sectional study
Authors: Naggayi Shubaya Kasule , Bangirana Paul , Opoka Robert O. , Ouma Simple , Nyangoma Betty , Birabwa Annet , Nambatya Grace , Kabatabaazi Maxencia , Nakitende Ann Jacqueline , Kalibbala Dennis , Munube Deogratias , Kasirye Phillip , Mupere Ezekiel , Ssenkusu John M. , Green Nancy S. , Idro Richard 
Published: July 2024

ABSTRACTObjectiveAcademic achievement in school-age children is crucial for advancing learning goals. Children with sickle cell anaemia (SCA) in Sub-Saharan Africa may be at risk of disease-associated school difficulties. Limited data exist on the academic achievement of children with SCA in the region. This study aimed to assess academic achievement of children with SCA in Uganda compared to siblings without SCA.Design and settingA cross-sectional study conducted at Mulago Hospital SCA Clinic in Uganda.ParticipantsSchool-going children (6-12 years) with SCA and age-matched sibling controls without SCA.Outcome measuresAcademic achievement was tested using the Wide Range Achievement Test, Fourth Edition (WRAT4). Outcome measures were spelling, mathematical computation, word reading, and sentence comprehension by age-normalized Z-scores on the WRAT4 test.ResultsAmong 68 SCA and 69 control, the mean age (standard deviation) was 9.44 (2.04) and 9.42 (2.02) years and males were 55.9% and 46.4% respectively. Mean haemoglobin was 7.9 (SD 0.89)g/dL in the SCA group versus 12.8 (SD 0.89)g/dL in the controls, (p<0.001). Children with SCA scored lower in spelling, (mean difference [95% confidence interval] - 0.36 [−0.02 to −0.69],p=0.04) and mathematical computation, (mean difference [95% confidence interval] −0.51 [−0.17 to −0.85],p=0.003) than the controls. In the SCA group, lower scores in spelling correlated with age, while males performed better than females in mathematical computation.ConclusionSchool-aged children with SCA are at risk of poor performance in spelling and mathematical computation. Our findings support the need for educational evaluation and possible support, especially in these two areas.ARTICLE SUMMARYArticle focusUsing a standardized assessment tool, this report provides data on academic achievement in school-age children with sickle cell anaemia (SCA) in Uganda compared to sibling controls.Key messagesSchool-aged children with SCA may experience academic challenges in key areas of spelling and mathematical computation. These findings suggest a role for educational evaluation and possible support for school-aged children with SCA especially in spelling and mathematics.Strengths and limitations of this studyThis is one of few studies to investigate academic achievement among children with SCA in sub-Saharan Africa, and the first in East Africa.The study used the widely recognised and validated assessment tool, the Wide Range Achievement Test, Fourth Edition (WRAT4), to standardize the measurements and permit regional comparisons.Selection of age-matched sibling controls minimised the potential confounding effects of age, socioeconomic status, and environmental factors.However, data on school absenteeism, which can affect academic achievement and which is more common in children with SCA, were not collected in this study.