Sexual Maturation and Psychiatric Morbidity among Persons with Sickle Cell Anaemia in a Nigerian Teaching Hospital

Abstract

Background:

Sickle Cell Anaemia (SCA), an inherited HbSS disease, is common in Nigeria with attendant high morbidity and mortality most especially in the setting of poor health care services. Impaired physical and sexual development is one of the prominent complications of SCA; and with attendant secondary psychiatric sequelae.

Methods:

A cross-sectional study was carried out at the haematology clinic of Lagos University Teaching Hospital (LUTH), among adolescent attendees (10–19 years) with SCA. Age and sex-matched controls were recruited from Action Health Incorporated (AHI), an NGO to promote adolescent health advocacy. The haemoglobin genotypes SS for subjects and AA for controls were confirmed with gel electrophoresis. Each subject and control was physically examined for the assessment of external genitalia (sexual) maturation using Tanner Staging Method, and were also evaluated with General Health Questionnaire—version 12 (GHQ-12).

Results:

In all, 136 adolescents with SCA and of equal sex distribution and equal number of controls were studied, with mean ages of 14.3 α 2.8 and 13.5 α 2.6 years, respectively. On GHQ assessment, 113 (83%) subjects and 25 (18.4%) controls had GHQ scores of ≥ 5, indicating probable presence of psychopathology. For both males and females, the subjects significantly lagged behind the controls in different areas of sexual maturation, with corresponding significant higher GHQ scores among the subjects. For example, in sexual maturation rate (SMR) stage 1 of pubic hair development, the mean ages for male subjects and controls were 11.9 α 1.5 and 10.7 α 0.9 years, respectively, with significant “t” of 5.06 at p < 0.03*; for females: 13.0 α 2.6 and 10.4 α 0.6 years for subjects and controls respectively with significant “t” of 4.36 at p < 0.04*. The corresponding GHQ scores were for subjects: < 5 for 6 and ≥ 5 for 20 of the subjects respectively; and for controls, the GHQ scores were < 5 for 9 and nil of controls for ≥ 5 score. The difference in GHQ scores for subjects and controls in this stage 1 pubic hair maturation was significant with χ² = 16.15, df = 1, p = 0.00*.

Conclusion:

It is concluded that SCA subjects had significantly delayed sexual maturation and increased risk of psychiatric morbidity when compared to controls. The need for genetic counseling to reduce the prevalence of SCA was emphasized.