Special Issue-(2nd ICTSA-2022) International Journal of Innovative Science and Research Technology

ISSN No:-24562165

The Prevalence of Sickle Cell Trait Among School

Students Males and Females in Taiz City-Yemen
Abdullah AbdulGabbar Ahmed Al-alimi1 Safia Ali Saad2
Head of Department of Medical Laboratory, Department of Medical Laboratory,
College of Medical Health Science, College of Medical Health Science,
Aljanad University for Science and Technology Aljanad University for Science and Technology
Taiz, Yemen. Taiz, Yemen.
Vice Dean of postgraduate center
Hodiedah University Yemen.

Marwa Bassam3 Rofaida Ameen4

Department of Medical Laboratory, Department of Medical Laboratory,
College of Medical Health Science, College of Medical Health Science,
Aljanad University for Science and Technology Aljanad University for Science and Technology
Taiz, Yemen. Taiz, Yemen.

Afnan Abu Baker 5 Abrar Hassan6

Department of Medical Laboratory, Department of Medical Laboratory,
College of Medical Health Science, College of Medical Health Science,
Aljanad University for Science and Technology Aljanad University for Science and Technology
Taiz, Yemen. Taiz, Yemen.

Osama Lotf7 Akram Salah Al-Mugahles8

Department of Medical Laboratory, Department of Medical Laboratory,
College of Medical Health Science, College of Medical Health Science,
Aljanad University for Science and Technology Aljanad University for Science and Technology
Taiz, Yemen. Taiz, Yemen.

Galal F.Albani9
Department of Nursing,
College of Medical Health Science,
Aljanad University for Science and Technology
Taiz, Yemen

Abstract:- Sickle cell disease (SCD) is the most common difference (p=0.007). FBC results of SCT students showed
inherited disorders of hemoglobinopathies in the significantly lower compared to normal students(p=0.01).
worldwide and represents a major public health problem In conclusion: SCT carrier is highly prevalence among
in Arab countries especially Yemen. One of the most SCD population in Taiz city as well as other parts of Yemen,
is the asymptomatic heterozygotes (HbSA) sickle cell trait these could be contributed to the highest degree of first-
(SCT) carriers. The aim of the current study was to cousin consanguineous marriage and endemic malaria in
determine the prevalence of SCT, gender differences, and this city.
Full blood cells (FBC) parameters among school students
in Taiz city, Yemen. A cross-sectional study was Keywords;- Sickle Cell Diseases (SCD), Sickle Cell Trait
conducted on two hundred and seventy blood samples (SCT), Students, School, Taiz, Yemen.
were subjected to sickling and FBC tests. One hundred
thirty seven boys (50.7%) and one hundred thirty three I. INTRODUCTION
girls (34.8%), nineteen blood samples were found sickling
test positive, thirteen boys (68%) and six girls (32%) with Sickle cell disease (SCD) is on the top of a global
overall prevalence of SCT among all students was 7.0% health problems worldwide presents important challenges to
(4.8% boys and 2.2 % girls). 77% of boys and 33% of our healthcare systems by causing a significant morbidity and
girls SCT carriers were found their parents having mortality. It is group an autosomal recessive inherited genetic
consanguineous marriage with statistically significant disorders of the erythrocytes, resulting in prevalence of a

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Special Issue-(2nd ICTSA-Conference-2023) International Journal of Innovative Science and Research Technology
ISSN No:-24562165
series of pathological phenotypes due to inherited of SCD is mainly effect on the population whose mostly
hemoglobin-S (HbS) such as sickle cell anemia (SCA)-HbS/S living and ancestors come from sub-Saharan Africa, South
is a homozygous inheritance of two genes mutant and sickle America, Asia and Mediterranean countries [24]. SCT carrier
cell trait (SCT)-HbS/A a heterozygous inheritance one is the most common type of SCD with the highest prevalence
mutant gene [1] and one normal gene of HbA (adult rate in Africa, where up to 1 in 4 individuals having SCT [2,
hemoglobin) are carriers for SCD, also known as sickle cell 3].
trait (SCT). Moreover, when a person inherited heterozygous
gene of sickle hemoglobin (S) with other unusual Globally, 300 million individuals were estimated
hemoglobin gene variants such as D, E , C, Thalassemia [1] heterozygous SCT carrier for SCD with the highest
result in HbS/D, HbS/E, HbS/C and HbS/β thalassemia prevalence rate in parts of Africa and among population with
phenotypes. Individuals with HbS/β thalassemia, HbS/C, origins in equatorial Africa as well as the Mediterranean
HbS/D and HbS/E may develop sickling complications due basin, Saudi Arabia and Yemen (9, 10]. In Yemen at 2020,
to the presence of one HbS gene, while HbS/S individuals Bashanfer et al has demonstrated the prevalence of SCT in
having severe form of sickling complications due to the Hodiedah city was 8.0% among university educated students
presence of two genes homozygous inheritance[4, 5, 25]. [10]; while other studies conducted in 2004 and 2011 by Al-
These SCD phenotypes having a variable clinical signs and Nood et al were carried in Sana’a on 1700 persons and in
symptoms of anemia with the earliest being appearing in Taiz on thalassemia patients, he showed the prevalence of
infancy when sickled erythrocytes becomes deoxygenated SCT was 2.2% and 8.2%, respectively [11, 12, 13].
resulting in polymerization of HbS to become more rigid,
sticky and sickled shape and increasing vaso-oclusion as well However, until today there is no genetic program
as hemolytic crisis [1]. Therefore, the most reasons of provided for neonatal and adult screening to detect and
hospitalization in patients (children, adolescent, adults) with diagnosis hemoglobinopathies or other genetic disorders. On
SCD are suffering from severe pain crises due to acute and the other hand, it is necessary existence vital efforts to
chronic vaso-oclusion which occurs when sickled actually determine the prevalence rate of hemoglobinopathies
erythrocytes block of blood vessels and capillaries, resulting disorders to promote awareness among the people about
in a reduction of oxygenated blood supplied to the tissues mode of inheritance and serious complications. Strong
leads to ischemia, pain, and damage of most organs [26]. awareness is very necessary on SCT carrier status because
carriers can pass their HbS gene to their children. This study
Individuals with SCD (HbS/β thalassemia, HbS/C, aimed to estimate the prevalence the sickle cell trait among
HbS/D and HbS/E) are not frequently have any clinical school students males and females from different parts in
symptoms of anemia or severe pain crisis, however, mild to Taiz city, which is found in parallel with countries of African
moderate anemia and some complications occur under severe equatorial and has the highest prevalence of anemia, malaria
dehydration and hypoxia/or severe infection due to HbS and dengue fever.
polymerization [25]. Similarity, individuals with SCA are
usually having very low hemoglobin level and severe pain II. METHODOLOGY
crisis, strokes, acute chest syndrome and sickling
complications due to intensive HbSS polymerization [4]. A. Study design and Subjects
A cross-sectional study was designed to determine the
Generally, individuals with SCT carriers are usually prevalence of sickle cell disease and trait it among adolescent
appearing healthy (asymptomatic) and almost having normal school students, and to evaluate their blood parameters,
hemoglobin level with less or no clinical symptoms of demographic and socioeconomic information, history of
anemia as well as rarely develop severe sickling family anemia, clinical symptoms and blood transfusion
complications after exposure to severe hypoxia and throughout several tests and questionnaire survey. 270
dehydration [4, 5]. However, mild to moderate pain crisis and adolescent school students were conducted from different
anemia may occur under extensive dehydration, stressful secondary schools, randomly selected between April and July
conditions, hypoxia, and/or severe infection due to occur 2022 after obtained ethical approval from the faculty of
HbS sickling result in some complications of SCD [4, 5, 25]. Medical health Sciences, Aljanad University for Science and
Several studies were indicated to sudden death may be Technology, education office at city and their parents.
happened due to severe life-threatening sickling
complications such as acute chest syndrome, venous Students participants were informed about the
thromboembolic events, renal papillary necrosis, splenic objectives of the study, types of tests and their participation
infarction and hyposthenuria, especially when carriers were totally voluntarily before starting blood sample
severely exposed to hypoxia during heavy exercise and collection. The questionnaire were given to all volunteer
severe dehydrated conditions [6, 7, 8]. Additionally, students to fill up at home to obtained their parents’ consent
asymptomatic bacteriuria in pregnancy and non-pregnancy to participate in this study. 3 ml of venous blood were
women as well as pyelonephritis and urinary tract infection collected from each student, drawn into anticoagulant
were also a well-defined complications in carriers patients ethylene diamine tetra acetic acid (EDTA) tube and used to
compared to controls [8]. analyze blood parameters and carried out screening sickling
test.

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Special Issue-(2nd ICTSA-Conference-2023) International Journal of Innovative Science and Research Technology
ISSN No:-24562165
B. Hematological Parameters Testing
FBC was performed to determined haemoglobin (Hb)
concentration, red blood cells count (RBCs), hematocrit
(Hct), mean corpuscular volume (MCV), mean corpuscular
hemoglobin (MCH), mean corpuscular hemoglobin
concentration (MCHC), white blood cell count (WBC), red
cell distribution width (RDW) and platelets by using Auto
Hematology Analyzer (Model: RT. 7600 , made in
Germany).

All students blood samples were screened for sickle cell

disease carriers by sickling test according to previously
described protocol using reducing agents sodium-
metabisulfite [13-6]. One drop was placed on a slide of
sodium metabisulfite (2%) mixed well with a drop of EDTA
venous blood, and covered with cover slip and edges of cover Fig 1 Shows an Example Positive Sickling Test Result.
slip was carefully sealed using candle wax and allowed to
stand at room temperature in a moist petri dish. After 30 Table 1 shows 13 (9.5 %) out of 137 of school students
minutes each slide was observed and examined under the boys and 6 (4.5%) out of 133 school students girls were had
microscope using (objective 40x), then after 2 and 24 hours, positive sickling test, there was found statistically significant
the presence of sickle-shape RBC indicate positive sample, (p=0.002) difference in the prevalence rate of sickle cell SCT
while negative sample no changes was observed in shape of among affected boys and girls students. The highest
RBC. Actually, we didn’t have any budget or support to prevalence rate was found 69% and 50.0% at age 14-16 year
further examination of all positive samples and some normal followed by 31% and 17% at age 16-18 year and at age 18-
samples by electrophoresis so for validation purposes one 20 year 0.0% and 33% for boys and girls students,
sickle positive sample and one control sample were further respectively. Statistically there was found a significant
examined by Hb electrophoresis. (P=0.038) difference in the prevalence rate among students
aged groups. Moreover, 10 (77%) of boys and 2 (33%) of
C. Statistical Analysis girls were found their parents having consanguineous
Statistical analysis was achieved using Statistical marriage. 6 (46 %) out of 13 boys and 2 (33%) out of 6 girls
Package for Social Sciences (SPSS) version 20. All students were found having awareness of anemia compared
quantitative variables were examined for normality by to 65 (52%) of normal boys and 81 (64%) of normal girls
Shapiro-Wilks test before analysis. Continuous variables students with no significant difference (p=0.20). While 46 %
were presented as proportions, mean and standard deviations and 50% of boys and girls students have family history of
using independent “t” test for hematological parameters of anemia compared to 18% and 21% of boys and girls normal
sickle cell trait and compare with normal students. Statistical students, respectively, with a higher significant difference
significance was identified at 0.05 levels. Nonparametric (p=0.004). Similarity, 46 % of boys and 50% of girls
variables were analyzed using cross-tabulation test and chi- students have history clinical symptoms of anemia compared
square used to determine the significant difference (p-value to 19 % of normal boys and 28 % of normal girls students,
<0.05) in history of family anemia, clinical symptoms, blood with significant difference (p=0.024). Also 4 (31%) of boys
transfusion and socioeconomic status for sickling and normal and 1 (17%) of girls were found having history of SCD,
students. however, there was no statistical significant difference
(P=0.52) among boys and girls. Whereas, 3 (23%) of boys
III. RESULTS and 1 (17%) of girls were be found have history of blood
transfusion for once time with no statistically significant
Two hundred seventy school students were screened for difference (P=0.20).
sickle cell trait by sickling test, 137 of school students boys
(50.8%) and 133 of school students girls (49.2 %). 19 blood Table II shows the comparison of the hematological
samples were found positive for sickling test and 251 parameters results for sickle cell trait students versus normal
samples were negative with overall the prevalence of sickle students. There was found a lower significant (p=0.01) in the
cell trait among all students was 7.0% (4.8% boys and 2.2 % means ±SD levels of Hb (14.0 ±1.1 g/dl and 12.5 ±0.5 g/dl)
girls) as showed in “fig. I”. for boys and girls students with sickle cell disease than the
means ±SD levels of Hb (15.3 ± 3.3 g/dl and 13.4 ±1.4 g/dl)
of normal boys and girls, respectively. Moreover, sickle cell
trait boys and girls had a lower significant (p=0.01) in the
means levels of RBCs, Hct, MCV, MCH and RDW
comparing to normal boys and girls students, whereas, the
mean level of RDW was significantly (p=0.01) higher in
sickle cell trait students comparing to normal students.

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Special Issue-(2nd ICTSA-Conference-2023) International Journal of Innovative Science and Research Technology
ISSN No:-24562165
For validation the results of the previous sickling test, carried out to determine the prevalence rat of SCT in the
“fig. II” shows an example of hemoglobin electrophoresis Northern part of Yemen in Sana’a (Capital city) on
results of two samples (HbA/A normal on the left and individuals having SCA co-exiting with thalassemia [13, 15]
HbS/Trait on the wright) . and other study carried out in the West of Yemen (Hodiedah
city) on university educated students [10].
IV. DSCUSSION
So our study was designed to survey the prevalence of
Yemen is the poorest country in the worldwide have sickle cell trait carrier among school students resident in the
next to not yet implemented programs based on population Taiz city aged between 14-20 years. The majority of sickle
screening for the detection of haemoglobinopathies or any cell trait students (69% boys and 50% girls) were had been
other genetic disorders. On the other hand, until today we are found at aged 14-16 years. The current results indicate to the
not known the exactly the prevalence of hematological overall prevalence of sickle cell trait was 7.0% among
disorders among our population, not only that, there is no students, with a higher significant (p=0.002) distribution
policy to supporting of researches to insuring health among boys (4.8%) compared to girls students (2.2%). These
surveillance data that is essential for healthcare providers and finding very similar
public health planning. However, there were very few studies

Table 1 The Distribution of Sickle Cell Trait and Normal Students According to Socio demographic
Information and Clinical Symptoms
Characters Sickle Cell Trait Students Normal students P-
Boys Girls Boys Girls value
No. (%) No. (%) No. (%) No. (%)
Gender 13 (9.5%) 6 (4.5%) 124 (90.5%) 127 (95.5) 0.002
14-16 9 (69%) 3 (50%) 44 (36%) 51 (40%)
Age (years) 16-18 4 (31%) 1 (17%) 71 (57%) 71 (56%) 0.038
18-20 0 (0.0%) 2 (33%) 9 (7%) 5 (4%)
Consanguineous Parents Yes 10 (77%) 2 (33%) 53 (43%) 50 (39%)
No 3 (23%) 4 (67%) 71 (57%) 77 (61%) 0.007
Study Level Primary School 6 (46%) 2 (33%) 53 (43%) 29 (23%)
Secondary School 7 (54%) 1 (17%) 57 (46%) 47 (37%) 0.70
Tertiary School 0 (0.0%) 3 (50%) 14 (11%) 51 (40%)
Awareness of Anemia Yes 6 (46%) 2 (33%) 65 (52%) 81 (64%) 0.20
No 7 (54%) 4 (67%) 59 (48%) 46 (36%)
Family History Anemia Yes 6 (46%) 3 (50%) 22 (18%) 26 (21%)
No 7 (54%) 4 (50%) 102 (82%) 101 (79%) 0.004
Symptoms of Anemia Yes 6 (46%) 3 (50%) 24 (19%) 36 (28%)
(Pallor, Fatigue) No 7 (54%) 4 (50%) 100 (81%) 91 (72%) 0.024
History Blood Transfusion Yes 3 (23%) 1 (17%) 20 (16%) 17 (14%)
No 10 (77%) 5 (83%) 104 (84%) 110 (87%) 0.20
History Affected by SCD Yes 4 (31%) 1 (17%)
No 9 (69%) 4 (83%) 0.52

Table 2 Comparisons of the Hematological Parameters (Hb, Rbcs, Hct, MCV, MCH, and RDW) between Normal Group
(N=251) and Sickle Cell Trait Group (N =19).
Parameters Hb (g/dL) RBCs (1012/L) Hct % MCV (fL) MCH (pg) RDW % P-value
Mean ±SD Mean ±SD Mean ± SD Mean ±SD Mean ±SD Mean ±SD
Normal Males 15.3 ± 3.3 6.0 ± 1.0 48.0 ± 9.0 81.4 ± 6.3 26.3 ± 3.5 12.0 ± 0.5 0.01
SCT Males 14.0 ± 1.1 5.3 ± 0.6 42.0 ± 3.0 73.0 ± 9.6 23.4 ± 3.0 12.3 ± 0.3
Normal Females 13.4 ± 1.4 5.4 ± 0.7 41.0 ± 4.0 80.0 ± 8.0 27.0 ± 2.7 12.1 ±0.47
SCT Females 12.5 ± 0.5 4.6 ± 0.6 38.0 ± 1.8 72.0 ± 5.0 23.0 ± 2.4 12.6 ± 0.3 0.01

Fig 2 Shows an Example HB Electrophoresis for Two Samples One Normal on Left and Other Sample is SCT on the write Figure.

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Special Issue-(2nd ICTSA-Conference-2023) International Journal of Innovative Science and Research Technology
ISSN No:-24562165
To result reported by Bashanfer et al in Hodiedah city highest prevalence of consanguinity marriage reflected the
(8%) as well as in similarity with other study reported by Al- higher frequency prevalence of x-linked genetic disorders
Nood in Taiz city in which reported the prevalence of SCT that is markedly affected not just in our country population
(8.2%) among thalassemia patients, and also a higher than the but in some regions of Middle East in which consanguineous
result reported by the same author in Sana'a city (2.2%) [10, marriage up to 70 % [19] when compared to other parts of
11, 12, 13]. the world.

In addition, when we comparison our finding with the The means levels of Hb, RBCs, Hct, MCV, and MCH
geographical and global prevalence of SCT, our prevalence were found lower among students with sickle cell trait
rate of SCT (7.0%) was a agree to study reported by compared to normal students with statistically difference
Charuhas et al he has been found 7.3% males and 5.9% (p=0.01) this is result shown that students with SCT suffer
females were had SCT [16], also our result agree with study from mild anemia. These findings are in line with the
reported by Sanjay et al in which mentioned the prevalence previously reported findings by Bashanfer et al. and Datar et
of SCT among children was 7.7% [18]. However, our results al, Chikhlikar, and El Ariss , respectively[10, 22, 23, 17].
disagree with study carried out by El Ariss et al where the This significant difference among males and females could
prevalence of SCT carrier for SCD was higher among attributed to change in the demographics, environment,
females (6.5% ) than males (3.2% ) [17]. ethnic, education, type of gene variants, disagreement in the
lifestyle, and other physiological factors such as menstrual
Moreover, there was some constituents and differences cycles in females.
in findings of the current study with several studies reported
from neighboring Arab countries such as 6.5% Iraq, 6.0% V. CONCLUSION
Jordan, 4.8-10% Oman, 3.5% in Algeria,16.4% Bahrain,
4.5% Libya, 4.2-25.9% Saudi Arabia, 4.9% Tunisia [19]. The prevalence of sickle cell trait among school
Therefore, the difference between our findings and so far students of males and females in Taiz city is 7.0%. This is
studies reported may be correlated with sociodemographic findings may put some insight on the incidence of sickle cell
changes, ethnic of the Yemeni population, first-cousin diseases in Taiz city in the absence of health educational
consanguineous marriage, geographical location, population polices and screening programs (newborn preschool and
culture and habits, no neonatal program screening and lack school children, adolescents and adults or premarital couples)
of medical counseling. as well as lack definite data about prevalence of sickle cell
diseases. Also these study highlight the need population
The present results indicate to 46% of boys and 33 % of screening programs for different age levels to determine the
girls with sickle cell trait were found have awareness of carrier rates in our province especially to whom premarital
anemia compared to 52% of boys and 64% of girls normal couples to those at risk of having children with sickle cell
students with no significant difference (p=0.20). In similarity, diseases and reduce the disease incidence in our poor society.
there was found 46% of boys and 33% of girls with sickle
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