Sickle Cell Anemia Drives Heaviest Burden Among Hospitalized Children in Angola

Sickle cell anemia has emerged as the single leading chronic disease among children admitted to a major pediatric hospital in Angola, according to a retrospective study published in BMC Pediatrics that offers one of the most detailed pictures yet of how inherited blood disorders strain pediatric healthcare in sub-Saharan Africa. The research, conducted at Clínica Sagrada Esperança in Luanda, found that children with sickle cell anemia accounted for just over a third of all pediatric admissions involving chronic disease, yet consumed a disproportionate share of hospital resources, spending more days in intensive care, requiring more blood transfusions, and returning to the hospital far more often than children hospitalized with other chronic conditions.

The study team, led by Rosalon Guvengue Caputo Pedro of Clínica Sagrada Esperança and the Universidade da Beira Interior in Portugal, examined electronic medical records from all children aged one month to fifteen years admitted to the hospital’s Department of Pediatrics between January and December 2024. Of 1,169 pediatric admissions during that twelve-month window, 262 involved chronic diseases and met the eligibility criteria. Within that group, 97 children — 37.0 percent — carried a diagnosis of sickle cell anemia, making it the most common chronic condition on the ward and a dominant driver of pediatric inpatient care at the facility.

Sickle cell anemia is the most severe common form of sickle cell disease, a group of inherited disorders caused by a single mutation in the gene encoding hemoglobin, the oxygen-carrying protein inside red blood cells. The mutation causes hemoglobin molecules to polymerize into stiff rods when oxygen levels drop, deforming the normally pliable disc-shaped red cells into rigid crescents. These sickled cells clog small blood vessels, break down prematurely, and deprive tissues of oxygen, producing the disease’s hallmark complications: episodic vaso-occlusive pain crises, chronic hemolytic anemia, stroke, acute chest syndrome, and heightened vulnerability to serious infections. Sub-Saharan Africa carries the heaviest global burden of the disease, and Angola sits squarely within the high-prevalence belt that stretches across the continent.

What makes the new findings striking is how sharply the clinical profiles of the two patient groups diverged. Children with sickle cell anemia had a median of two previous hospitalizations before the admission captured in the study, with an interquartile range stretching from zero to five, while children with other chronic diseases had a median of zero, with an interquartile range of zero to one. That difference, highly statistically significant, underscores a pattern familiar to hematologists: sickle cell anemia is not a single catastrophic event but a relapsing condition that repeatedly pulls children back into hospital beds throughout childhood.

The intensity of each admission also differed. Children with sickle cell anemia spent a median of seven days in the pediatric intensive care unit, compared with three days for children with other chronic conditions, and their overall hospital stays ran longer, with a median of five days versus four. Both differences reached statistical significance. In practical terms, a single child with sickle cell anemia could occupy scarce pediatric intensive care capacity for twice as long as a peer admitted with another chronic illness, a sobering calculation for any health system weighing how to allocate limited beds, ventilators, and nursing staff.

Laboratory data told a parallel story of physiological stress. On admission, children with sickle cell anemia had markedly lower hemoglobin levels than their counterparts with other chronic diseases, reflecting the chronic hemolysis that defines the disorder. Their white blood cell counts and C-reactive protein levels were also higher, consistent with the inflammatory flare-ups and infections that frequently precipitate sickle cell admissions. When the researchers used median regression to adjust for age and sex, the hemoglobin gap persisted: children with sickle cell anemia had an adjusted median hemoglobin concentration 4.47 grams per deciliter lower than the comparison group, a difference so large it approaches the threshold at which transfusion becomes medically urgent.

Treatment patterns mirrored the underlying severity. Seventy-six percent of children with sickle cell anemia received analgesia during their admission, compared with 45 percent of children with other chronic diseases, reflecting the prominence of vaso-occlusive pain as a reason for hospitalization. More dramatically, 26 percent of the sickle cell group required blood transfusion, five times the rate seen in the other chronic disease group. Every one of these differences was statistically significant. For a country where safe blood supplies depend on voluntary donation and cold-chain logistics, a transfusion demand concentrated in a single disease category represents both a clinical challenge and a public health planning problem.

Notably, in-hospital mortality was low in both groups and did not differ significantly between them. The authors are careful to place an important caveat on that encouraging figure. The study was conducted in a well-resourced private tertiary hospital serving a predominantly insured population in Luanda, and the outcomes observed there cannot be assumed to represent the experience of most Angolan children. Across the wider region, where diagnosis may come late, follow-up may be fragmented, and disease-modifying therapy such as hydroxyurea may be inaccessible, mortality from sickle cell disease remains far higher. The low death rate in this cohort is best read as a portrait of what good tertiary care can achieve, not as a measure of the national situation.

The retrospective design carries its own limitations. Because the analysis relied on routinely collected electronic medical records, it captured only children who reached and were admitted to this particular hospital, potentially missing the sickest children who never arrived and the milder cases managed as outpatients. The single-center, single-year window limits generalizability, and the comparison group of children with other chronic diseases was heterogeneous, spanning a range of conditions with different natural histories. Still, the study’s strength lies in its direct head-to-head comparison of resource utilization, an angle rarely quantified in African pediatric settings where data on chronic childhood illness remain scarce.

The authors argue that their findings should sharpen priorities for Angolan child health policy. Strengthening early diagnosis — most powerfully through newborn screening programs that identify affected infants before their first crisis — building structured follow-up, expanding access to disease-modifying therapy such as hydroxyurea, and ensuring equitable access to comprehensive pediatric sickle cell care should remain national priorities. Globally, the study adds to a growing body of evidence that sickle cell disease, long overshadowed by infectious diseases in global health funding and research agendas, is a chronic condition whose burden on hospitals, families, and health budgets in Africa is enormous and measurable. As survival improves with better care, more children with sickle cell anemia will live into adolescence and adulthood, making the investment case for systematic, lifelong disease management stronger with every study that documents its weight on the wards.

Subject of Research: Hospital burden of sickle cell anemia among children in Angola

Article Title: Burden of sickle cell anemia among hospitalized children in Angola: a retrospective study

Article References: Pedro, R. G. C., Caputo, E. O., Valente, G. B., Cassule, L. A., & Jorge, A. M. M. (2026). Burden of sickle cell anemia among hospitalized children in Angola: a retrospective study. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07666-w

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07666-w

Keywords: sickle cell anemia, pediatrics, Angola, hospitalization, chronic disease, anemia, blood transfusion, healthcare utilization, morbidity, sub-Saharan Africa, retrospective study, pediatric intensive care