Exploring the Barriers and Facilitators Towards Adherance to Sickle Cell Treatment Guidelines Among Medical Doctors at Mulago Hospital, Uganda

Abstract

Background: Sickle Cell Disease (SCD) is a major global health issue, affecting over 4.4 million people, with 10%-40% of Africa's population suspected to be impacted. SubSaharan Africa accounts for 80% of cases, and the mortality rate for children under 5 is 90%, contributing to 7.3% of under-5 deaths in Africa in 2018. Uganda, with a national prevalence of 0.9%, faces a significant burden, especially in high-prevalence areas where rates reach 45%. Despite this, Uganda struggles with managing SCD, particularly due to non-adherence to treatment guidelines. This study examined the barriers and facilitators affecting medical doctors’ adherence to treatment protocols at MNRH. Method: This study used a phenomenological design, data was collected through key informant and in-depth interviews with the doctors working at the Sickle Cell Clinic of MNRH. These included the JHOs, SHOs, Medical Officers, and specialists/consultants. Participants were purposively selected, and the data was thematically analyzed through coding. Findings: Key facilitators to adherence included clinical experience, knowledge, continuous medical education, collaborative networks, supportive leadership, and accessible treatment guidelines. Barriers included individual factors like burnout, fatigue, and low motivation, as well as systemic issues such as lack of physical guidelines, fragmented care, heavy workload, inadequate staffing, and resource constraints, all of which impacted adherence to treatment guidelines. Discussion: Despite medical doctors’ awareness of the treatment guidelines, factors like burnout, inadequate infrastructure, lack of physical guidelines, and resource shortages prevent consistent long-term adherence. The study highlighted the need for improved resource allocation and infrastructure, better access to essential medications and equipment, and continuous education for healthcare workers to enhance adherence to the treatment guidelines.