Commentary: Rehabilitation: a key service, yet highly underused, in the management of young patients with sickle cell disease after stroke in DR of Congo
Résumé
Current situation in Benin I read the article by Boma et al. (1) describing the current situation and future solutions in the management of young patients with sickle cell disease (SCD) after stroke in Democratic Republic (DR) of Congo (DR of Congo). Thiseir publication has inspired in me comments on this important public health topic that dangerously gnaws at our societies in sub-Saharan Africa. In Benin, recent data estimated at 22.3% the prevalence of sickle cell trait (hemoglobin S), 10.21% for hemoglobin C and 4% of the population in Benin would be affected by hemoglobin SS homozygosity and hemoglobin SC double heterozygosity (2,3). With an estimated population of 13 millions, the absolute number of population concerned by this problem in our countryBenin would be estimated over four millions. Unfortunately, to date, to the best our knowledge, no studyies hasve been published on the prevalence of stroke in people with SCD in Benin. Overall, in addition to the neurological manifestations symptoms that people with SCD may experience, there are also hip or knee osteoarthritis that are common, leading to chronic pain which in turn can interfere with many aspects of the patient's life, including education, employment and psychosocial development. For companies, communities and for the state consequences are in terms of lost of productivity, and in term of important economic burden.In Benin, as in most sub-Saharan African countries, systematic screening for SCD is not a common practice as most of carriers of sickle cell trait often are asymptomatic. This lack of systematic screening increases maintains the rate risk of high-risk marriages and thus maintains the prevalence of the disease in the population (4,5). Therefore, the first challenge in the fight against the SCD remains primary prevention through strategies toward systematic screening of (SCD) in the population and this in strict compliance with ethical standards rules. Second, there is a need for improvement of health education programs for the population public, more efforts in counseling couples, and a good management of timing of screening could decrease high-risk marriages and ultimately reduce the prevalence of the disease. more efforts in counseling high risk couples, and changes in the strategy of timing of screening in relation to marriage, which hopefully will ultimately decrease high-risk marriages. In this perspective, public authorities as well as religious, and traditional authorities can both play important roles (3)(4)(5)(6).Beside preventive measures, one should also train health professionals for the management of the symptomatic cases and the management of the long term clinical symptomsmanifestations of the SCD, including knee and hip hosteoarthritis and stroke sequelae for the stroke cases. As mentioned by Boma et al. (1), in Benin we also face the problem of scarcity of the qualified professionals in the field of rehabilitation, in particular those specialized in the rehabilitation of children with neurological conditions. Current guidelines recommand that following a stroke, rehabilitation should start as early as possible when the medical state of the patient allows it (7). In children, rehabilitation should be especially playful while being intensive. It is therefore expected that the professionals involved in the rehabilitation of children will have specifical competence. Currentely, approximately 200115 physiotherapists are working in Benin ( 8) and only few are specialisedspecialist in neurological rehabilitation (n = 148) including two five specialispecialistzed in rehabilitation of childreenchildren and young with cerebral palsy. It is therefore importance to create more training programs for specialisation for physiotherapists, and but also for other rehabilitation disciplines as their number is very poor in the country (9). For example, there is no occupational therapists in the country, and only eight speech language therapists, all working in Cotonou, the capital.Third, I definitively agree with Boma et al.( 1) that mobile technologies and virtual reality (VR)represents a new promizing perspective for the rehabilitation of young with SCD given the scarcity of rehabilitation professionals and the playful aspects of this means, making them fully suitable for this population (10,11).Fourth, the promotion of a regular physical exercise life style in young and adults with SCD would also be a promizing way to prevent and reducelimit the negative effects of the disease including, hip or knee osteoarthritis, chronic pain, and stroke. Especially, walking and swimming are more suitable, more affordable, and overallgenerally acceptable in most cultures (12,13).Public health authorities in sub-Saharan African countries need to invest more in stroke prevention and in the management of stroke cases by setting up national insurance systems to reduce the cost. In addition, researchers and clinicians in the regions need to develop South-South and North-South partnerships to increase patient access to stroke care in particular in young and adolescents with with SCD. In Benin, we envision to develop a knowledge centre for technology-supported rehabilitation center, including affordable technology and mHealth solutions at Parakou University Hospital, in northern of the country. This important project is being implemented set up in close collaboration with Hasselt University (Belgium). In view of the findings in DR of Congo, we believe that a collaborative effort between Belgium, DR of Congo and Benin would have a significant impact in the region in terms ofregarding the rehabilitation of young and adults with SCD victims of stroke.
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