High acceptability of newborn screening for sickle cell disease among post-natal mothers in western Kenya

High acceptability of newborn screening for sickle cell disease among post-natal mothers in western Kenya | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search High acceptability of newborn screening for sickle cell disease among post-natal mothers in western Kenya View ORCID Profile John Orimbo , Shehu Shagari Awandu , View ORCID Profile Faith Muhonja , Patrick Owili , Dickens Omondi doi: https://doi.org/10.1101/2024.05.28.24308031 John Orimbo 1 Department of Biomedical and Nursing Sciences, School of Health Sciences, Jaramogi Oginga Odinga University of Science and Technology , Bondo, Kenya Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for John Orimbo For correspondence: jguda006{at}gmail.com Shehu Shagari Awandu 1 Department of Biomedical and Nursing Sciences, School of Health Sciences, Jaramogi Oginga Odinga University of Science and Technology , Bondo, Kenya Find this author on Google Scholar Find this author on PubMed Search for this author on this site Faith Muhonja 2 Department of Public Health, Amref International University Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Faith Muhonja Patrick Owili 3 African Population and Health Research Centre Find this author on Google Scholar Find this author on PubMed Search for this author on this site Dickens Omondi 1 Department of Biomedical and Nursing Sciences, School of Health Sciences, Jaramogi Oginga Odinga University of Science and Technology , Bondo, Kenya Find this author on Google Scholar Find this author on PubMed Search for this author on this site Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Background Sickle cell disease is a genetically inherited blood disorder that manifests early in life with resultant significant health complications. Globally, nearly three quarters of all affected babies are in sub-Saharan Africa. Early identification of babies with sickle cell disease through newborn screening followed by early linkage to care is recommended. However, the program has not been widely adopted in the sub-Saharan Africa. Evidence on acceptability of newborn screening to scale up newborn screening program is scarce. This study assessed factors associated with acceptability of newborn screening among mothers of newborns delivered at Homa Bay county teaching and referral hospital, western Kenya. Methods This study employed a cross-sectional design among postnatal mothers at Homa Bay county teaching and referral hospital with 399 postnatal mothers enrolled into the study. A semi-structured questionnaire was used for data collection. Maternal sociodemographic characteristics, knowledge, and perception were assessed. Babies were also screened for sickle cell disease using Sickle SCAN point-of-care test. The acceptability was calculated as percentage of mothers accepting to have their babies screened. Data were analyzed using logistic regression to explore factors associated with acceptability of newborn screening for sickle cell disease. Results Ninety-four percent of mothers accepted newborn screening for sickle cell disease. Mother’s age and occupation were significantly associated with acceptability of newborn screening for sickle cell disease. Younger mothers (OR=3.01;95%CI=1.16-7.83; p =0.024) and being a student (OR= 6.18; 95%CI= 1.18-32.22; p =0.031) were significant at bivariate regression analysis. Only being a student (aOR= 25.02; 95% CI=1.29-484.51 ; p = 0.033) was significant at multivariate logistic regression analysis. Conclusion The acceptability of newborn screening for sickle cell disease is high in the county. The Homabay county and the Kenyan ministry of health should implement routine newborn screening for sickle cell disease in all level 2-6 hospitals. Introduction Sickle cell disease (SCD) is a major genetically inherited blood disorder, caused by autosomal recessive inheritance, that manifests early in life with resultant significant health complications. Globally, nearly three quarters of all sickle cell disease-affected babies are in sub-Saharan Africa ( Uyoga et al., 2019 ). In 2011, the World Health Organization (WHO) recommended an increased awareness, improved access to health services, and provision of technical support for prevention and management of sickle cell disease ( Makani et al., 2013 ). Programs such as newborn screening for sickle cell disease have shown great success towards preventing and managing the disease ( Nnodu et al., 2018 ). However, only a few countries in Africa have piloted the screening program and none has scaled up the implementation ( Inusa et al., 2015 ; Ohene-Frempong et al., 2008 ; Tshilolo et al., 2009 ). Successful implementation of newborn screening for sickle cell disease followed by early initiation of penicillin prophylaxis, pneumococcal vaccines, and hydroxyurea treatment are likely to reduce the disease burden in low- and middle-income countries (LMICs). Nonetheless, limited data on the prevalence of sickle cell disease at birth in Africa makes it difficult to quantify the magnitude of the disease burden. Additionally, approximately 90% of the children with sickle cell disease die before their fifth birthday, partly because of late diagnosis ( Katamea et al., 2022 ). This can be solved through adequate implementation of newborn screening for sickle cell disease. This implementation however, heavily depends on its acceptability ( Sekhon et al., 2017 ) and socio-cultural settings ( Bediako & Neblett, 2011 ), which vary from one community or region to another. Unacceptability of the screening program for sickle cell disease by the parents or caregivers or authorities in Africa can greatly hinder effective implementation of the program ( Inusa et al., 2015 ). There is need to assess the acceptability of the program before its implementation which may not only promote public participation but also community ownership of the intervention. The prevalence of sickle cell disease varies on the malaria endemicity patterns. The disease burden in Kenya is quite high especially around the lake regions in western as well as the Coastal regions ( Ministry of Health, 2020 ). The prevalence of sickle cell disease around western Kenya is about 4.5% for sickle cell disease, and 18% for sickle cell trait (Wanjiku et al., 2019). Homa Bay county is yet to implement newborn screening for sickle cell disease. This is despite the high prevalence of sickle cell disease among infants who were accessing maternal and child health services in the county, which was found to be at 9.6% ( Wanjiku et al., 2018 ). Routine newborn screening for sickle cell disease is recommended in regions where sickle cell disease prevalence at birth is 0.05% or more ( DeBaun & Galadanci, 2022 ). There is however, paucity of data on the acceptability of newborn screening in the county. Acceptability is important for successful implementation of the intervention program ( Sekhon et al., 2017 ). Additionally, extrapolating data from another county may not be feasible owing to the variable nature of acceptability ( Marsh et al., 2011 ). Here, we assessed the acceptability of newborn screening for sickle cell disease and its associated factors in Homa Bay County, Western Kenya. This is important in promoting the establishment of a systematic newborn screening program for sickle cell disease in Homa Bay County, and subsequently a successful implementation of the intervention ( Sekhon et al., 2017 ). The results of this study are critical to the ministry of health at the county-level for planning of the sickle cell disease screening program in the county. Methods Study design, study population and study setting This study employed a cross-sectional design at the postnatal wards in the Homa Bay county teaching and referral hospital, Homa Bay County, western Kenya. Homa Bay county teaching and referral hospital is the county referral hospital with a wider catchment across the eight sub counties in Homa Bay county. The study involved postnatal mothers in the postnatal wards between 14 th April 2023 and 15 th June 2023. The site has a sickle cell disease clinic however, it lacks newborn screening for sickle cell disease implementation. Sample size and sampling technique Cochran’s formula for calculating the sample when the population is infinite was used. A maximum variability of 50% was used to estimate the maximum sample size required since the acceptability of newborn screening for sickle cell disease was unknown in Homa Bay County. The final sample size was 403 mothers, after adjusting for 5% non-response. Consecutive sampling technique, where all participants meeting eligibility criteria were enrolled until required sample is achieved, was used to select the participants. All postnatal mothers available at the postnatal ward during the study period, and willing to take part in our study and met the inclusion criteria were selected and enrolled. The inclusion criteria were: The postnatal mother giving an informed consent or assent to participate in the study and whose outcome of delivery was an alive infant. Postnatal mothers who were medically unstable to respond to the questionnaire or needed urgent critical care were excluded from participating in the study. Data collection tools Kobo collect tool was used to collect the data using a semi-structured questionnaire with five sub-sections. The first section collected demographic information: Maternal age, marital status, occupation, religion, education level and parity. The second section contained questions on the knowledge (awareness) of the mother about sickle cell disease including ever having heard of or being aware of sickle cell disease, being aware of their haemoglobin status, knowledge about sickle cell disease being a blood disorder, knowledge on transmission of sickle cell disease, when it can be diagnosed and knowledge on the existence of newborn screening for sickle cell disease programs. The third section contained the questions on the perceptions of the newly delivered mothers. The perception was measured by asking question on their opinion on to when screening for sickle cell disease should be done, ethical issues and the perceived effectiveness of the newborn screening for sickle cell disease. The perception was considered good when in line with the national government newborn screening policy. The fourth section of the questionnaire explored the possible intervening variables mainly, the cultural issues around newborn screening and the role of the male partner in making the decision as to whether to accept newborn screening for sickle cell disease. The fifth section collected data on their intent/willingness to have their newborns screened and those who were willing had their newborns screened using sickle SCAN kit (BioMedomics Inc, NC, USA). The sickle SCAN test kit is capable of identifying Hemoglobin A, S and C variants in blood samples. The sex of the newborns was also captured here. Enrollment and Data collection A total of 399 participants were enrolled into the study, representing 99% response rate. Eligible participants provided written informed consent for mothers who were 18 years and above. Minor mothers also were provided with a signed assent. The participants were provided with a copy of the signed consent form and another copy retained by the investigator. After consenting, a semi-structured questionnaire was administered to each participant by the research assistants. The research assistants comprised of 1 clinical officer/physician assistant, 2 nurses, 1 laboratory technician and 2 counsellors. The principal investigator trained the research assistants prior to the start of the study and supervised data collection. The mothers were finally questioned on their intent/willingness to have their newborns screened. Willing participants had their babies screened for sickle cell disease using the Sickle SCAN® point-of-care test following manufacturer’s instructions (BioMedomics Inc.,NC, United States). The results were interpreted as sickle cell trait with 3 lines visible at the control, HbA and HbS; sickle cell disease when two lines appeared at the control and HbS or no haemoglobinopathy when two lines at the control and HbA. The laboratory technician conducted the screening test by the bedside following the manufacturer’s instructions. The newborns’ heels were pricked using 1.2mm lancet pricker, and 2 drops of blood collected directly into the device. The results were ready in 3-5 minutes. The counsellors offered psychological counselling to all the mothers pretest and to mothers whose babies had sickle cell trait or sickle cell disease post-test. The mothers whose newborns screened positive for sickle cell disease were referred to the sickle cell disease comprehensive clinic and also received psychological counselling from the study team. Statistical analyses The data were entered into excel for cleaning before analysis using STATA version 16.0 (StataCorp, 2019). The level of acceptability of newborn screening for sickle cell disease was analyzed using descriptive statistics only. Even though acceptability is a multidimensional construct, in this study it was defined as the willingness of the mother to accept newborn screening for sickle cell disease. The percentage acceptability, calculated as the percentage of mothers who agreed to have their newborns screened for sickle cell disease, was calculated. The factors associated with acceptability of newborn screening for sickle cell disease were analyzed using both descriptive statistics and inferential statistics. Descriptively, proportions of acceptability among various factors were calculated and represented in a table. Inferentially, Chi-square and Fisher’s exact test (where at least a cell has a count less than 5) were used to assess the association between the sociodemographic, maternal knowledge and maternal perception characteristics and the acceptability of newborn screening for sickle cell disease. The factors that had statistically significant association with acceptability were further analyzed using logistic regression analysis to establish the point estimate and the magnitude of association. After the unadjusted analysis, statistically significant variables, were fit into a multivariate logistics regressions model using forward stepwise regression approach. Both unadjusted and adjusted odds ratio (OR) and 95% confidence intervals (95% CI) were reported. The results of the newborn screening were used to calculate the prevalence of sickle cell disease and sickle cell trait among the newborns. Results Summary of participant characteristics The mean age of the mothers was 26.2 years (SD 6.07) with 25-34 years being modal age-group, comprising 44.1% of the respondents. Majority (300/399; 75%) of respondents were married; 59.7% (238/399) had one or 2 children; 41.4% (165/399) had attained secondary level education while, 70% were engaged in either informal or no employment. Only 2 mothers (0.5%) reported to have had a previous child with Sickle cell disease. Majority (371/399; 93%) of the respondents had ever heard about sickle cell disease; only 4% knew their sickle cell disease status with only 2% having ever been screened for sickle cell disease before; over 90%(362/399) knew the cause of sickle cell disease; only 7%(28/399) of respondents believed that sickle cell disease was as a result of God’s will with less than 2%(5/399) believing sickle cell disease was due to God’s punishment or evil spirits and majority (386/399;96.7%) belived the best timing for sickle cell disease testing was during the postnatal period ( Table 1 ). View this table: View inline View popup Table 1: Characteristics of Postnatal Mothers (N=399) at Homay Bay County Teaching and Referral Hospital, western Kenya Level of acceptability of newborn screening for sickle cell disease among postnatal mothers at Homabay County Teaching and Referral Hospital, western Kenya Out of the total 399 mothers interviewed, 375/399 (94.0%) agreed to have their newborns screened for sickle cell disease using the sickle scan point of care kit ( Fig. 1 ). The level of acceptability was therefore 94.0%. Download figure Open in new tab Figure 1: Pie chart showing acceptability of New Born Screening for Sickle Cell Disease among postnatal mothers in Homa Bay County Teaching and Referral Hospital, western Kenya Association between sociodemographic characteristics and acceptability of newborn screening for Sickle cell disease among postnatal mothers at Homabay County Teaching and Referral Hospital, western Kenya Chi-square method was used to assess association between the sociodemographic characteristics of the respondents and their acceptability of newborn screening for sickle cell disease. Maternal occupation (p= 0.026) and maternal age ( p= 0.023) were the only factors that had statistically significant association with the acceptability of newborn screening for sickle cell disease. Respondents who were students and those younger than 25 years were more likely to accept newborn screening for sickle cell disease. The student as an occupation category comprised mothers who were school going and therefore not in any other occupation. Characteristically in this study, about 90% (65/72) were younger than 25 years. Majority of the students 91%(66/72) had post primary education, with the modal group in secondary schools. The odds of accepting newborn screening for sickle cell disease among student postnatal mothers was higher than those in formal employment (OR=6.18; 95%CI=1.18-32.22; p= 0.031). Mothers younger than 25 years of age had higher odds of accepting newborn screening for sickle cell disease than older mothers (OR=3.01;95%CI=1.16-7.83; p= 0.024). No significant association was found between acceptability of newborn screening for sickle cell disease and other sociodemographic characteristics. ( Table 2 ). View this table: View inline View popup Table 2: Association between acceptability of newborn screening for sickle cell disease and Sociodemographic characteristics of postnatal mothers at Homabay County Teaching and Referral Hospital, western Kenya Association between maternal knowledge and acceptability of newborn screening for sickle cell disease among postnatal mothers at Homabay County Teaching and Referral Hospital, western Kenya Fisher’s exact method was used to assess the association between maternal knowledge, measured by finding what they know about sickle cell disease as shown in table 3 below, and the acceptability of newborn screening for sickle cell disease since the criteria for chi-square was not met. Most of the cells had values less than 5. No statistically significant association was found between maternal knowledge dimensions and acceptability of newborn screening for sickle cell disease. Most of the mothers had ever heard about sickle cell disease and knew it is a non-contagious blood disorder. However, only few mothers had ever been screened for sickle cell disease nor knew their sickle cell disease status. Most had good knowledge of the inheritance patterns of sickle cell disease and nearly two thirds had never heard about newborn screening for sickle cell disease before ( Table 3 ). View this table: View inline View popup Table 3: Association between acceptability of newborn screening for sickle cell disease and knowledge of postnatal mothers at Homabay County Teaching and Referral Hospital, western Kenya Association between acceptability of newborn screening for sickle cell disease and perception of postnatal mothers at Homabay County Teaching and Referral Hospital, western Kenya Fisher’s exact method was used to assess the association between maternal perception and the acceptability of newborn screening for sickle cell disease since the criteria for chi-square test was not met. Most of the cells had values less than 5. No statistically significant association was found between maternal perceptions and acceptability of newborn screening for sickle cell disease. Postnatal mothers however had good perception about sickle cell disease. Most of the postnatal mothers had good perception of what causes sickle cell disease, with most believing that the best time to screen for sickle cell disease is during the newborn period (0-6 weeks). Majority of the postnatal mothers believed newborn screening for sickle cell disease was morally right and would be useful in controlling the disease ( Table 4 ). View this table: View inline View popup Table 4: Association between acceptability of newborn screening for sickle cell disease and perception of postnatal mothers at Homabay County Teaching and Referral Hospital, western Kenya Multivariate logistic regression analysis of factors with significant association with acceptability of newborn screening for sickle cell disease at bivariate analysis Only being a student (aOR= 25.02; 95% CI=1.29-484.51 ; p = 0.033) was significant at multivariate logistic regression analysis, though with a wide confidence interval. Male partner support was found to be a strong modifying factor with positive effect (coef=7.50; std error=1.31;95%CI=4.94-10.07; p<0.001) . In the multivariate model, the coefficient of determination(r 2 ) was found to be 63.9% ( Table 5 ). View this table: View inline View popup Table 5: Bivariate and Multivariate logistic regression analysis model of acceptability of newborn screening for sickle cell disease Discussion The acceptability of newborn screening for sickle cell disease observed in the current study sample was relatively high (94%). Comparatively, a similar study conducted at the postnatal wards at Kisumu county referral hospital, Kenya, previously observed newborn screening for sickle cell disease acceptability of 99.4% ( Kuta et al., 2019 ). This informed successful implementation of routine NBS for SCD in Kisumu County. The two studies are both hospital-based with similar design and thus the comparable acceptability. Studies from Nigeria ( Oluwole et al . 2020 ; Nnodu et al . 2018 ) observed 86% acceptability of NBS which is below the acceptability in this current study but is still comparable. The difference between the current study and that of Nnodu and team in Nigeria was target population of postnatal mothers while that in Nigeria was conducted in health institutions and University with diverse target groups. Similar studies conducted in Gabon ( Mombo et al., 2021 ) showed low acceptability rates of about 30% despite satisfactory knowledge among the respondents, demonstrating wide variabilities ( Marsh et al., 2011 ). The reason for the huge difference in the level of acceptability was that most mothers in Gabon feared blood collection from their newborns ( Mombo et al., 2021 ). This was not the case in Homabay. There were obvious variations across socio-economic and demographic stages, with younger single mothers being more receptive. Awareness and knowledge levels as well as availability and access to services in high burden areas have been observed to influence acceptability ( Nnodu et al., 2018 ). Despite the high willingness of the service recipient, other factors not explored in this study such as cost barriers and service availability remain import factors in the overall evaluation of the intervention acceptability. It is important for policy development to make the intervention universally available and accessible in the county ( Gates et al., 2021 ). Such a policy is currently not in place in the county even though health is a devolved function. Awareness about the intervention or the existence of the intervention helps improve acceptability since those with low knowledge or awareness are less likely to accept the interventions. It will be important that prior to implementation of the newborn screening programme in the county, adequate awareness creation is created, and cost barriers eliminated. This has improved acceptability in the HIV care set up ( Izizag et al ., 2018 ) and can be extrapolated to sickle cell disease care. Primary interventions such as newborn screening programme are highly recommended to avert disease complications and early deaths. Acceptance of health technologies is necessary for progressive adoption and continued use by consumers as well as for its implementation at scale ( Kuta et al., 2019 ). Despite the relatively high acceptability rate, which might imply higher willingness for newborn screening by the recipients, recent studies in Africa show that acceptance for newborn screening is diverse and variable over time across different population groups as well as the implementation contexts (Sekhon et al., 2017; Katamea et al., 2022). This might be accounted for by the fact that health technology acceptance is a dynamic concept, and evolves sequentially through a continuum of stages including, pre-use acceptability; initial use acceptability and sustained use acceptability. However, few studies exist on the pre-use health technology acceptance in Africa ( Sekhon et al., 2017 ). The current study examined pre-use acceptability. Whether high acceptability across these stages necessarily translates to scalability remains a multidimensional challenge. This study found out that occupation was strongly associated with acceptability of newborn screening for sickle cell disease. Those in formal employment were less likely to accept newborn screening for sickle cell disease when compared to the students and those in other occupations. This is comparable to the findings of Nnodu et al. in a multicenter survey in Nigeria ( Nnodu et al., 2018 ). The similarities in both studies was the cross sectional design. The study in Nigeria was however a multicenter study both in health institutions and universities. This provides a diverse context to confirm the finding. However, contrasting findings were found by Katamea et al.in DRC ( Katamea et al., 2022 ) and Ahmed et al. in Nigeria (Ahmed et al., 2021) where occupation was not associated with acceptability. This current study differed with the DRC study in that this was hospital-based study with only postnatal mothers responding to the questionnaire while that of DRC had all adults participate and it was a community survey. This could have contributed to the differences in findings since not all those adults interviewed were having children. Either, most students are usually younger and thus they may have been left out of the survey disproportionately. The students in this study were predominantly younger and younger age has been associated with increased acceptability of newborn screening for sickle cell disease. Maternal age was found to be a strong predictor of acceptability of newborn screening for sickle cell disease. Mothers who were younger than 25 years were found to be 3 times more likely to accept newborn screening than those older. This finding is comparable to the findings of Mombo et al. in a study done in Gabon where mothers younger than 29 years were more likely to accept newborn screening than those older than 29 years ( Mombo et al., 2021 ). Similarly, a study by Nnodu et al. in Nigeria found that mothers younger than 21 years were more likely to accept newborn screening for SCD than older ones ( Nnodu et al., 2018 ). Younger women were thought to be less culturally bound and therefore more likely to accept newborn screening for SCD ( Mombo et al., 2021 ). All the 3 studies above had an aspect of hospital-based interviews thus likely the similarity in finding about the age. Male partner support was found in this study to improve the odds of acceptability of newborn screening for SCD across the various occupational categories. Male partner support may reflect not only mutual consensus on decisions regarding the health interventions but also, potential influence ( Dsouza et al., 2022 ). It is therefore important to involve males in planning of implementation of health interventions such as this ( Mboane & Bhatta, 2015 ). The multivariate model in this study had the significant factors explaining up to 63% of the variable relationships. The unexplained 37% is likely due to unexplored factors. Review of previous similar studies conducted ( Katamea et al., 2022 ; Mombo et al., 2021 ) shows diverse factors may be involved but there is no consensus on how different factors interact to influence or potentially affect maternal acceptability of the newborn screening for SCD. The study also found that the confidence intervals for most of the odds ratios of the associated factors were very wide. This typically occur due to reasonably high variability in the factor characteristics within the community of study ( Marsh et al., 2011 ) and likely lower sample size, even though this was above the minimum calculated sample size. However, this may also, result from study limitations in that, in as much as acceptability is a multidimensional aspect, only willingness was assessed. The study limitations included sampling from one health facility within the county thus the mothers coming from near the health facility could have contributed disproportionately in numbers. However, conducting the study at the county referral hospital was to allow for a representation from all other 8 sub counties within the county with each subcounty contributing at least 5% of the total sample. The assessment of acceptability in a unidimensional approach as opposed to the multidimensional approach was another limitation. However, this was done to allow the comparison with other similar studies. Conclusion The acceptability of Newborn screening for Sickle cell disease among the postnatal mothers in Homa Bay County was high, mainly among younger mothers. Male partner support was a strong motivating factor for newborn screening acceptability with positive effect. The high acceptability is indicative of a willingness for screening for sickle cell and is necessary for scaled up programming. Implementation of routine newborn screening program for sickle cell disease is highly recommended in view of the good user acceptability and high prevalence of sickle cell disease at birth in the county. Additionally, there is need to explore other determinants of acceptability and how they impact on acceptability and actual uptake. Data Availability Data available Declarations Ethical approval and consent to participate The proposal was approved by the board of postgraduate studies of Jaramogi Oginga Odinga University of Science and Technology. Ethical approval for the study was obtained by JOOUST Ethics Committee (ERC 36/02/23-33) and the NACOSTI permit obtained the National Commission of Science, Technology and Innovation (Research License 101836). Using the approvals from the Ethic Committee (EC) and NACOSTI, the County authorization was obtained from the County Health Management Team and the County Director of Medical Services and notice issued to the Hospital management and the relevant department. The research assistants signed a confidentiality agreement form before starting the data collection and were adequately trained to minimize any potential harm to the participants. Informed consent was obtained from the study participants prior to any study procedure. The data collected was kept confidential and, in a password-protected computer. Data was entered directly into the password-protected computer with limited access. The access of the research assistants was terminated immediately data cleaning was complete. No paper data was intended for the study. Key personal identifying information such as name of the participant were not captured in order to deidentify the participant and minimize chances of harm from breach of confidentiality. Mothers of newborns who were willing to have their newborns screened were offered psychological counselling pre and post the test and those whose newborns screened positive and need advanced psychological counseling were referred to the counselling department of the Homa Bay County Teaching and Referral hospital. The newborns who screened positive for SCD were linked with the SCD clinic of the Homa Bay County Teaching and Referral Hospital for early initiation of comprehensive care, usually initiated at the age of 2 months. The mothers of the newborns who were found to have SCT were offered genetic counselling. The risk to the newborns screened for SCD included minimal pain, swelling and bruise at the sample collection site due to the prick but this was minimized by having the blood sample collected by adequately trained and professional research assistants with experience in neonatal blood sampling from the heels. The heel prick was done while maintaining the infection prevention control measures like adequate sterilization of the prick site to minimize chances of prick site infection. Consent for publication Not applicable Competing interests The authors declare they have no competing interests Funding This data collection for Msc program was funded by The European and Developing Countries Clinical Trials Partnership (EDCTP) through the African Population and Health Research Centre (APHRC), Lund University, Jaramogi Oginga Odinga University of Science and Technology and Amref International University. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Authors Contributions JO conceptualized the idea, drafted the protocol, collected data, did data analysis and wrote the manuscript. SA did critical review of the protocol and guided its writing, reviewed data collection tools, did data analysis and reviewed the manuscript. FM did critical review of the protocol and guided its writing, reviewed data collection tools, did data analysis and reviewed the manuscript. PO did critical review of the protocol and guided its writing, reviewed data collection tools, did data analysis and reviewed the manuscript. DO did critical review of the protocol and guided its writing, reviewed data collection tools, did data analysis and reviewed the manuscript. Acknowledgment We acknowledge the postnatal mothers who consented to take part in the study which may improve the policy on newborn screening and the care of patients with sickle cell disease and the research assistants who helped with data collection. List of abbreviations aOR Adjusted Odds Ratio CI Confidence Interval EC Ethics Committee JOOUST Jaramogi Oginga Odinga Teaching University of Science and Technology NACOSTI National Commission Of Science, Technology and Innovation NBS Newborn Screening OR Odds Ratio SCD Sickle Cell Disease SCT Sickle Cell trait SSA Sub-Saharan Africa References ↵ Bediako , S. M. , & Neblett , E. W . ( 2011 ). Optimism and Perceived Stress in Sickle-Cell Disease: The Role of an Afrocultural Social Ethos . Journal of Black Psychology , 37 ( 2 ), 234 – 253 . doi: 10.1177/0095798410385681 OpenUrl CrossRef ↵ DeBaun , M. R. , & Galadanci , N. A . ( 2022 ). Sickle cell disease in sub-Saharan Africa . 39 . ↵ Dsouza , J. P. , Van Den Broucke , S. , Pattanshetty , S. , & Dhoore , W. ( 2022 ). Factors explaining men’s intentions to support their partner’s participation in cervical cancer screening . 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