 We're still on the breakfast this morning. Let's look at the issue of sickle cells, as June 19 was officially designated as World Sickle Cells Awareness Day. The International Awareness Day is observed annually with the goal to increase public knowledge and understanding of sickle cells disease and the challenge experienced by patients and their families and caregivers. Now, some 300,000 children are born with sickle cells disease in an annual basis and around three-quarter of them are in Africa. We'll be looking at the efforts to combat the spread of disease in Niger, the worst affected country on the continent. And we do have Dr. Chima Oduka, who's a public health physician Lagos University Teaching Hospital. Dr. Chima, it's good to have you join us this morning. Thank you very much. Thank you for having me. So let's talk about sickle cells now and according to reports, Nigeria in the sub-Saharan Africa is what's hit. Why is that? We have a very huge population. A lot of Africans, a lot of Africans and Nigerians, you know, we are called the giants of Africa. And one of the reason why I call the giants of Africa is because of our population. So this also translates to the number of people with the sickle cell anemia in our country. Okay. Well, it's okay, a very valid point that you have raised right now. But what do we need to know about, you know, the sickle cells' disease? Okay, sickle cell disease is a disease of abnormal hemoglobin. Hemoglobin is a protein in our red blood cells, our blood cells, you know, the blood cells carry blood and oxygen to all the tissues of the body without oxygen in your tissues in the body. You cannot, a person cannot function adequately. And the red blood cell with hemoglobin, which is a protein, helps to carry these oxygen and everything the tissue needs. So in sickle cell anemia, this hemoglobin in the red blood cell is abnormal. So normally it's usually shaped like a disc, it's spherical in shape, a normal red blood cell. It's usually round or spherical. However, with somebody that has sickle cell anemia, instead of it being round in shape, it becomes like a sickle or lucent shape, like a crescent. So this abnormal shape affects how it transports oxygen through the blood. So oxygen is not able to, a normal red blood cell that is round is very flexible, is able to pass through the vessels. You know, we have a lot of veins and capillaries that serve as like a conduit or a tube through which the red blood cell passes. And so it is very important for the red blood cells to be able to pass through these vessels. And the round shape enables this to happen. But in people with sickle cell anemia, because of the abnormal sickle shape, it's not able to pass through the blood vessels. And so tissues do not get the needed oxygen that they need. And so it causes a lot of problems in the body. And this is what leads to all the symptoms they have. So it's actually a very severe condition. It can lead to anemia. Also because of the abnormal shape of the red blood cell, normally you have the red blood cell, which the normal one last thing for about 120 days in the body before it dies. But an abnormal sickle cell last for only 10 to 20 days. And so it's self-destruct. And so the person doesn't have enough red blood cell, doesn't have enough blood. So the people with sickle cell anemia are always anemic. They don't have enough blood because the tissues do not receive blood when they should. There's a lot of problems like pain, it can affect the... Yes, thank you for showing that image, which explains it clearly. So you can see how a normal red blood cell looks is red and I mean, it's round. And then like the sickle cell, like I said, it's crescent shaped. So that abnormal shape accounts for everything that happens. Most of the things that happen is sickle cell anemia. So it is a really very terrible disease. Most people that have it, if they are not treated, they do not live as long as their contemporaries. They battle with constant pain, constant anemia. It can lead to stroke. It can affect the vessels, the eyes, the kidney. So it's really a very serious condition that we should not take lightly. And people that have the condition also suffer a lot. We can actually prevent this and that's why I am here. So I'll move. Yes, okay. So before we get to that point of, you know, preventing sickle cell, let's talk about what could be responsible. We have practitioners saying that it could be hereditary. I mean, what is really responsible for sickle cell? Is it hereditary or it could be caused by several actions and behavior? No, no, no, it's not something you get by your behavior. It is hereditary. So due to people in Africa, black people tend to get sickle cell more often than other people because, you know, there's malaria in this region and a way to protect, over time, the blood vessel found a way to protect itself from malaria and mutated to form an abnormal gene which now confers the sickle cell gene. So it's not something you get because of your behavior. It is something you inherit from your parents. So there's something called the sickle cell traits. So that, I'm sure you would have heard of people say it was your genotype. So your genotype talks about the kind of red blood cell you have. Are you AA, are you AS, are you SS? So there's something called sickle cell traits where people are AS. They have that S, that abnormal sickle cell traits in their blood, but they don't have the disease. They just have one, just one. So they have a mixture of normal people with sickle cell traits who are AS have a mixture of good red blood cells and abnormal or sickle red blood cells. So, however, because of the good red blood cells they have, they don't usually come down with symptoms of the disease. They're protected from the disease. However, they can pass on this abnormal sickle cell gene to their children. So we keep saying you should know your genotype so that it can help you in your choice of who you get married to, to prevent it from happening to your children. So it is not something you do. It doesn't come from an abnormal behavior or something you fail to do. It's a condition you get from your parents what the kind of gene they pass down to you. So let's also talk about how to prevent it now at this point. Now that we know that Hadiditrid has nothing to do with behavior or patterns, how can we prevent it? Now for those who are suffering this disease, is it preventable? Can it be cured? Okay. First and foremost, yes, it can be prevented and knowledge has made this possible. So we know what causes it. We know it's something you inherit from your parents when you inherit the abnormal gene. We know that people that have AS, so it's more of if you did biology in school and the theories of the Mendelian theories of inheritance and all. If you have AA, there's this chart they draw for us when they show you a mom has AA and a father has AA. So the father will give an A gene, one gene to the child, the mother gives another. So it's easy, if you have AS and you marry, you are advised to marry someone that has a very complete normal gene, which is AA, so that the chances of any of the children having sickle cell is zero. None of your children will have sickle cell if you marry someone with AA because the person will have another S gene to give you. However, if you are AS and you get married to someone with AS as well, there is a 25% chance that you will give your child one abnormal gene, which can be S, and the father or the mother, the other partner gives a child another abnormal gene, which is SS. So SS is the one that causes the disease, sickle cell disease, sickle cell anemia SS, which is what we're trying to prevent. So if you want to prevent your child from having sickle cell disease, it is very important that you check your, you go for testing to know what your genotype is. If you are AS, it means you carry the gene for sickle cell anemia. You do not have it. You do not have the disease, but you are a carrier and can transmit it to your child. So if you are AS, it is very important that your partner must be AA. That is non-negotiable. Your partner must be AA because if your partner is AS, you have a 25% chance of transferring, both of you transferring the S gene that leads to SS genotype for your child. I hope I'm not confusing anybody. But if you are, say AA, you have nothing to fear. You can marry anybody because you do not have an abnormal gene. And people that have the abnormal gene actually need you. Then if you already have SS gene that you already have the disease, then of course you cannot marry a carrier. That is somebody with AS. You have to get married to someone with AA. It's just a matter of you have been counseling, genetic counseling. If this is complicated, I'm sorry, but the message I want you to go with, check your genotype, go for testing, know what it is. If you have AS, then you are a carrier. You need some genetic counseling as to the partner you get married to, who has to be AA. If you have SS, of course, you cannot get married to someone with AS. It has to be AA. So that's the only way of prevention for now that we know of. All right, so Doctor, you're saying that the way to prevent all of this, I mean, talking about sickle cells is that we know our genotype and we're very cautious that we did not get much with those who have the S, the traits that can be passed on. Any of the SS, yes. Any of the SS. Actually, if you already have a SS. Okay, well, I'm hoping that we have time. We get to the point and look at all the issues. I mean, the hurdles, the challenge that we're faced with when we talk about preventing all of this. But another issue is for those who are living with the, I mean, those who are living with it, we're talking about the SS now. They are already patients, they are carriers of this. What can they do? I mean, those who are infants and those who are already adults. Most times, we find other persons with this, diseases don't even live long. So even when they have children and then they get old at some point, their life has been cut short. But is there anything that they can do so they can have longevity? I mean, they can live long and be like regular people. Yes, of course, of course, definitely. With healthcare, modern science has afforded us ways. Since we know more causes, they are illness, they need to go to the hospital, they need to be counseled as to how to be. So they need to be counseled as to their diet, take a lot of water, drink lots of water. So people with sickle cell disease, they need counsel to take a lot of water. So when you drink a lot of water, it helps the blood flow better, we are advised. So there's a lot of lifestyle changes. So we say, okay, don't stay in very cold environment or very hot environment. And of course there are drugs that we have now that can increase chances of living longer. So let's take it in two dimensions. They're not pharmaceutical. You have talked about water, and then we talk about the pharmaceutical. So can you take that in that, you know? Okay, so the amount from your physical lifestyle changes like drinking lots of water, so you're always hydrated. People that dehydration, you don't have enough water, tends to increase the tendency for the bloods to even not flow as well as it should. So drink lots of water, avoid very cold or hot temperature that can affect the blood cells. Go constantly for checkups to know your PCV, Pactel volume, because people with sickle cell anemia tend to have low blood, circulating blood. And anemia, of course, can kill. So you need to check your Pactel volume regularly. And of course there are multivitamins to take that can help you to increase your blood level. The whole idea is you need to see a doctor. You need to have a doctor that is managing you because I can't tell you all the things you need to do now. Just go to a clinic, a hospital, and your doctor counsel you based on your own situation. So some people tend to have ulcers, neck ulcers. Some people tend to have acute chest syndrome. There are a lot of things involved. So see a doctor, your doctor, who counsel you appropriately, but there are definitely measures you can take. There are also drugs, now I'm going to be pharmaceutical. There are also drugs, which I cannot even tell you now because you cannot buy them for the counter. A doctor needs to prescribe it for you. So there are also drugs you can take, science has told us that can help those abnormal cells to convert back to fit-out hemoglobin that do not suffer the same thing as the abnormal one does. So there are drugs you need to take. So the same thing goes to your doctor. So there are sickle cell clinics where there are clinics dedicated to just sickle cell anemia. So these professionals, they know all about the physiology, the pathology. So they are in the best position to advise you. Also, during pain episodes, sickle cell anemia patients have a lot of pain. So there are some drugs you can take for pain relief. Your doctor will also tell you that. So how about, yes, some people say that bone marrow transplant is also another way to cover it. Yeah, that's curate. So there's no cure right now, but there's no, all these drug things I'm telling you are just conservative management, but the definitive treatment is the bone marrow transplant, stem cell transplant, but it has its own isks also. So before that is done, like I said again, it is a possibility. It gives some cure, 100% cure rate. So yes, there is a cure, but it has its own risks. It has its own risks. And so before that decision is made, the clinician or the doctor has to review your case and see if the risks outweigh the benefits for you. Well, but what's the cost of managing patients with the sickle cell disease in few seconds? Of course. Because we're out of time. I mean the cost, you have a lot of people complaining about the fact that it's quite expensive. I like you to tell us just in no time. No, I can't deal with the figure. Because this also, I can't deal with the figure. Of course it will be expensive because you have to go for free. It depends on where you are taking your treatment from. If you are going to a private facility or you're going to a government hospital. So I can't give you a cost. But of course it's going to cost some money to have good care. And the stem cell transplant too, if you choose to do that, it's very expensive. But I can't give you a cost per se. No, I can't do that. So in other words, you're saying that it's very expensive? The average, our healthcare system can give you a care. It's not out of reach. It's not like people have sickle cell anemia. They're surviving. Poor people have sickle cell anemia. They're surviving. But of course, where you access treatment from determines the cost. So I cannot tell you this is the cost. There's no disease. I can actually tell you that this is the cost. Everything depends on your unique situation or what you are having. Everybody's case is not the same. Well, we have to let you go at this point in time. It's an interesting conversation. And hoping that we have more time to talk about this and look at all the issues. I mean, when we talk about how to prevent it, number one, you have talked about knowing your blood type. I mean, you know, where the category, where you belong, genotype, or however it is, you put it. We also have religious and, you know, traditional sentiments regarding all of that. But it will be a conversation for another day. Thank you so much. Dr. Chima Oduko. I hope I got that correctly. Yes, you did. Dr. Chima Oduko. Thank you so much, Dr. Chima Oduko, for being part of the breakfast this morning and shedding light on the issue of sickle cell. Thank you. Well, Dr. Chima Oduko is a public health physician, passionate about improving the health and well-being of women, adolescent children. And she does this via medical outreach. She is an outstanding personality. Also, publishing an author and health speaker. Thank you once again for being part of the breakfast. That's the much we can take today on the show. We'll definitely return tomorrow with more interesting conversation. I hope you had a great time. I did have a great time this morning. I am Messy Boko, follow us on Facebook, Twitter and Instagram and do subscribe to our YouTube channel to be part of the conversation. This is Plus TV Africa and Plus TV Africa Lifestyle. Have a great day. The news continues or comes through you at 9 o'clock. Stay with us.