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Impact of Community-Based Sickle Cell Screening on Sickle Cell Trait Detection among Adolescents in Nigeria

Abstract

Sickle cell disease remains an important public health challenge in Nigeria, which has a substantial burden of sickle cell disorders and a large population carrying the sickle cell trait. Early detection of sickle cell trait among adolescents is important because knowledge of haemoglobin genotype can support informed health decisions, appropriate counselling, and awareness of the risk of having children affected by sickle cell disease in the future. Community-based sickle cell screening provides an opportunity to identify adolescents who may not have access to routine genetic or haemoglobin testing through healthcare facilities. Such screening can be conducted through schools, youth centres, community health programmes, outreach services, and other community platforms, thereby improving access to genotype testing and early identification. However, inadequate screening coverage, limited availability of trained personnel, insufficient diagnostic resources, low awareness, fear of stigma, misconceptions about sickle cell conditions, and limited linkage to counselling services may reduce the effectiveness of community-based screening programmes. Sickle cell trait detection refers to the identification of individuals carrying one sickle haemoglobin gene, particularly haemoglobin AS, through appropriate haemoglobin genotype testing. Against this background, this study investigates the impact of community-based sickle cell screening on sickle cell trait detection among adolescents in Nigeria. The study will be anchored on the Health Belief Model, Community Health Theory, and Health Systems Framework. The Health Belief Model explains how adolescents' perceptions of susceptibility to sickle cell conditions, perceived severity, perceived benefits of screening, perceived barriers, and cues to action may influence participation in sickle cell screening. Community Health Theory emphasizes the importance of delivering health interventions through accessible community structures and engaging local populations in disease prevention and health promotion activities. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, and governance as essential components of effective screening and healthcare programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based sickle cell screening may influence the detection of sickle cell trait among adolescents in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise adolescents aged approximately 10–19 years residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, schools or youth centres, and eligible adolescents. Community-based sickle cell screening will be measured using indicators such as screening availability, screening coverage, frequency of screening activities, accessibility of screening sites, number of adolescents screened, availability of trained screening personnel, availability of genotype testing services, and community outreach activities. Sickle cell trait detection will be assessed using indicators such as the number of adolescents tested, haemoglobin genotype results, proportion identified with sickle cell trait, confirmation of screening results, and linkage to appropriate genetic counselling or health information services. Data will be collected using structured questionnaires, screening registers, laboratory records, genotype testing reports, community health records, school health records, and relevant programme documents. Descriptive statistics will be used to summarize adolescents' characteristics, screening coverage, genotype testing patterns, and sickle cell trait detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the impact of community-based sickle cell screening on sickle cell trait detection. Where appropriate, detection rates before and after community screening activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based sickle cell screening has a significant positive impact on sickle cell trait detection among adolescents in Nigeria. Adolescents who have access to community-based screening are expected to have a higher likelihood of knowing their haemoglobin genotype and being identified as carriers of sickle cell trait than adolescents without access to such services. Community-based screening may improve accessibility by bringing genotype testing closer to adolescents through schools, community centres, outreach programmes, and other convenient locations. Early identification may also provide opportunities for appropriate counselling and health education regarding sickle cell inheritance and future reproductive health decisions. Conversely, inadequate screening coverage, limited diagnostic capacity, poor community awareness, fear of stigma, concerns about confidentiality, and insufficient follow-up may reduce participation and limit the effectiveness of screening programmes. The study therefore expects expanded and well-organized community-based sickle cell screening to contribute significantly to improved detection of sickle cell trait among adolescents in Nigeria. The study is expected to contribute to the literature on sickle cell screening, sickle cell trait detection, adolescent health, genetic health, community-based screening, preventive healthcare, maternal and reproductive health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, schools, community health organizations, sickle cell control programmes, healthcare providers, development partners, and policymakers regarding strategies for improving early detection of sickle cell trait. The study will also provide evidence-based recommendations for expanding community-based screening programmes, improving access to affordable genotype testing, strengthening adolescent health education, increasing community awareness of sickle cell conditions, ensuring confidentiality during screening, strengthening referral and counselling services, improving availability of trained screening personnel, and integrating sickle cell screening into existing adolescent and community health programmes across Nigeria.

Keywords: Community-based sickle cell screening, sickle cell trait detection, adolescents, sickle cell trait, sickle cell disease, haemoglobin genotype, genetic screening, adolescent health, community health, Nigeria, preventive healthcare, public health.