Newborn screening for sickle cell disease in Caluquembe, southwestern Angola, 2024–2025

Abstract

Objectives Angola is one of the countries with the highest prevalence of sickle cell disease (SCD). Neonatal SCD testing is recommended by the Angolan government, but it is not routinely performed. Nearly all previous studies of SCD have been conducted in cities. We implemented a neonatal SCD screening program in a referral hospital in Huíla province to examine the epidemiology of SCD in this Umbundu-speaking population and to demonstrate the feasibility of using point-of-care (POC) tests for SCD in a rural setting. Methods Between October 2024 and February 2025, we screened 353 infants less than one month old at Hospital Evangélico de Caluquembe for the hemoglobin S (HbS) gene using HemoTypeSC rapid diagnostic tests. We also reviewed all pediatric outpatient visits from 2024 to identify newly-diagnosed SCD cases. Results Twenty-one (6.0%) of the 353 neonates had sickle cell trait (HbAS); none had SCD (HbSS). The outpatient register review identified 26 incident cases of SCD. Conclusions The prevalence of HbS is lower in Caluquembe than in Luanda and Cabinda, but the combined results of our newborn screening and pediatric records provide evidence that there is a burden of disease from SCD in Caluquembe and the surrounding areas. Sickle cell screening and treatment programs should be available in all high-burden areas, not just large cities. The per-test costs may still be too expensive for universal newborn screening to be scaled up nationwide, but our pilot study demonstrates that POC tests can be a cost-effective method that yields immediate results.