Caregivers' beliefs about hydroxyurea influence its usage among children with sickle cell disease: a cross-sectional study in Dar-es-Salaam, Tanzania

Abstract

Introduction: hydroxyurea (HU) is a proven, safe, and effective treatment for sickle cell disease (SCD) but is underutilized in Tanzania. Caregivers´ beliefs influence medication usage in children with chronic diseases. This study assessed caregivers´ beliefs about HU and their effect on HU use among children with SCD in Dar-es-Salaam. Methods: a cross-sectional study enrolled 374 caregivers from four hospitals in Dar-es-Salaam. We adapted the "Belief About Medication Questionnaire" to assess caregivers´ beliefs about HU necessity and concerns. Scores of ≥15 indicated high necessity/concerns. Caregivers were categorized into four belief patterns: positive (high necessity, low concerns), negative (low necessity, high concerns), ambivalent (high necessity, high concerns), and indifferent (low necessity, low concerns). Results: seventy percent of caregivers reported HU usage, 63% exhibited positive beliefs, with 95% of them reporting HU use. Caregivers with an indifferent belief category made up 43% of those with non-positive beliefs, and only 7% of them reported HU use. Thirty-eight percent of caregivers were concerned about HU's long-term effects, whereas 67% perceived that HU protects their children´s health from worsening. Caregivers with positive beliefs were 14 times more likely to report HU use than those with indifferent HU beliefs (IRR 14.3, 95% CI: 5.5 - 36.9). Participants from national hospitals were three times more likely to have positive beliefs than those attending regional hospitals (aOR 3.3, 95% CI 2.1 - 5.1). Conclusion: health-care level and caregivers´ education impact HU beliefs and use. Targeted interventions to address specific obstacles across different caregiver subgroups are essential to improve HU beliefs and usage.