Social Determinants of Health Among Children and Adolescents with Sickle Cell Disease Attending Two Tertiary Hospitals in Southwest Nigeria

Abstract

Background: Sickle cell disease (SCD) is influenced by the biopsychosocial model of health, which recognises the combined effects of biological, social, and behavioural factors on health outcomes. Social determinants of health are the non-medical factors that influence health and well-being.

Objective: To assess the social determinants of health among children and adolescents with SCD attending paediatric SCD clinics in two tertiary healthcare facilities in a semi-urban area of Nigeria, with emphasis on demographic characteristics, housing and environmental conditions, healthcare access, and pattern of healthcare utilisation.

Methods: Eligible consenting caregivers and adolescents were consecutively recruited into this cross-sectional study. The data were collected using a structured interviewer-administered questionnaire and analysed using appropriate statistical methods.

Results: A total of 99 caregivers of children and adolescents with sickle cell disease participated in the study. More than half of the respondents (51; 51.5%) lived in individual apartments, although only 53 (53.5%) of the children and adolescents had separate sleeping spaces. Most households had access to clean water (93; 93.9%) and sanitation facilities (74; 74.7%). Only 20 (20.2%) of respondents had access to any form of Health Insurance, while more than half (60; 60.6%) travelled over 30 minutes to access healthcare during illness episodes. Housing type and the type of health facility commonly visited during illness were significantly associated with hospitalisation (p<0.001 and p = 0.030, respectively). Conclusion: Improving living conditions, reducing barriers to timely healthcare access, and expanding health insurance coverage may help reduce disease burden and improve health outcomes in this population.