{"id":"https://openalex.org/W7213563138","doi":"https://doi.org/10.64898/2026.09.16.26363231","title":"Sickle Cell Disease Care in Jamaica: Enablers and Barriers to Healthcare Access and Hydroxyurea Utilization","display_name":"Sickle Cell Disease Care in Jamaica: Enablers and Barriers to Healthcare Access and Hydroxyurea Utilization","publication_year":2026,"publication_date":"2026-09-17","ids":{"openalex":"https://openalex.org/W7213563138","doi":"https://doi.org/10.64898/2026.09.16.26363231"},"language":"en","primary_location":{"id":"doi:10.64898/2026.09.16.26363231","doi":"https://doi.org/10.64898/2026.09.16.26363231","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.16.26363231","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/17/2026.09.16.26363231.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/17/2026.09.16.26363231.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5034304738","display_name":"Zachary Ramsay","orcid":"https://orcid.org/0000-0001-7935-4247","observed_orcids":["https://orcid.org/0000-0001-7935-4247"]},"institutions":[{"id":"https://openalex.org/I4210129319","display_name":"University of the West Indies","ror":"https://ror.org/03fkc8c64","country_code":"JM","type":"education","lineage":["https://openalex.org/I137799390","https://openalex.org/I4210129319"]}],"countries":["JM"],"is_corresponding":true,"raw_author_name":"Zachary Ramsay","raw_affiliation_strings":["Caribbean Institute for Health Research - Sickle Cell Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica"],"raw_orcid":"https://orcid.org/0000-0001-7935-4247","affiliations":[{"raw_affiliation_string":"Caribbean Institute for Health Research - Sickle Cell Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica","institution_ids":["https://openalex.org/I4210129319"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5060513126","display_name":"Shelly McFarlane","orcid":"https://orcid.org/0000-0002-7691-9174","observed_orcids":["https://orcid.org/0000-0002-7691-9174"]},"institutions":[{"id":"https://openalex.org/I4210129319","display_name":"University of the West Indies","ror":"https://ror.org/03fkc8c64","country_code":"JM","type":"education","lineage":["https://openalex.org/I137799390","https://openalex.org/I4210129319"]}],"countries":["JM"],"is_corresponding":false,"raw_author_name":"Shelly McFarlane","raw_affiliation_strings":["Caribbean Institute for Health Research - Tropical Metabolism Research Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica"],"raw_orcid":"https://orcid.org/0000-0002-7691-9174","affiliations":[{"raw_affiliation_string":"Caribbean Institute for Health Research - Tropical Metabolism Research Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica","institution_ids":["https://openalex.org/I4210129319"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5092613938","display_name":"Onome Braimah","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210129319","display_name":"University of the West Indies","ror":"https://ror.org/03fkc8c64","country_code":"JM","type":"education","lineage":["https://openalex.org/I137799390","https://openalex.org/I4210129319"]}],"countries":["JM"],"is_corresponding":false,"raw_author_name":"Onome Braimah","raw_affiliation_strings":["Caribbean Institute for Health Research - Sickle Cell Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Caribbean Institute for Health Research - Sickle Cell Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica","institution_ids":["https://openalex.org/I4210129319"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5006739054","display_name":"Vanessa Cumming","orcid":"https://orcid.org/0000-0003-3186-5632","observed_orcids":["https://orcid.org/0000-0003-3186-5632"]},"institutions":[{"id":"https://openalex.org/I4210163957","display_name":"Ministry of Health","ror":"https://ror.org/059v3b755","country_code":"JM","type":"government","lineage":["https://openalex.org/I4210163957"]}],"countries":["JM"],"is_corresponding":false,"raw_author_name":"Vanessa Cumming","raw_affiliation_strings":["North-East Regional Health Authority, Ministry of Health & Wellness, Kingston, Jamaica"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"North-East Regional Health Authority, Ministry of Health & Wellness, Kingston, Jamaica","institution_ids":["https://openalex.org/I4210163957"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5002066861","display_name":"Jennifer Knight\u2010Madden","orcid":"https://orcid.org/0000-0002-0939-1648","observed_orcids":["https://orcid.org/0000-0002-0939-1648"]},"institutions":[{"id":"https://openalex.org/I4210129319","display_name":"University of the West Indies","ror":"https://ror.org/03fkc8c64","country_code":"JM","type":"education","lineage":["https://openalex.org/I137799390","https://openalex.org/I4210129319"]}],"countries":["JM"],"is_corresponding":false,"raw_author_name":"Jennifer Knight-Madden","raw_affiliation_strings":["Caribbean Institute for Health Research - Sickle Cell Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica"],"raw_orcid":"https://orcid.org/0000-0002-0939-1648","affiliations":[{"raw_affiliation_string":"Caribbean Institute for Health Research - Sickle Cell Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica","institution_ids":["https://openalex.org/I4210129319"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5152069099","display_name":"Julian Bailey","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210129319","display_name":"University of the West Indies","ror":"https://ror.org/03fkc8c64","country_code":"JM","type":"education","lineage":["https://openalex.org/I137799390","https://openalex.org/I4210129319"]}],"countries":["JM"],"is_corresponding":false,"raw_author_name":"Julian Bailey","raw_affiliation_strings":["Caribbean Institute for Health Research - Tropical Metabolism Research Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Caribbean Institute for Health Research - Tropical Metabolism Research Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica","institution_ids":["https://openalex.org/I4210129319"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5037212519","display_name":"June Harris","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210129319","display_name":"University of the West Indies","ror":"https://ror.org/03fkc8c64","country_code":"JM","type":"education","lineage":["https://openalex.org/I137799390","https://openalex.org/I4210129319"]}],"countries":["JM"],"is_corresponding":false,"raw_author_name":"June Harris","raw_affiliation_strings":["Caribbean Institute for Health Research - Sickle Cell Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Caribbean Institute for Health Research - Sickle Cell Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica","institution_ids":["https://openalex.org/I4210129319"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5124892676","display_name":"Julia Rowe-Porter","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210163957","display_name":"Ministry of Health","ror":"https://ror.org/059v3b755","country_code":"JM","type":"government","lineage":["https://openalex.org/I4210163957"]}],"countries":["JM"],"is_corresponding":false,"raw_author_name":"Julia Rowe-Porter","raw_affiliation_strings":["Family Health Unit, Ministry of Health & Wellness, Kingston, Jamaica"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Family Health Unit, Ministry of Health & Wellness, Kingston, Jamaica","institution_ids":["https://openalex.org/I4210163957"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5033734393","display_name":"Monika Asnani","orcid":"https://orcid.org/0000-0002-7184-138X","observed_orcids":["https://orcid.org/0000-0002-7184-138X"]},"institutions":[{"id":"https://openalex.org/I4210129319","display_name":"University of the West Indies","ror":"https://ror.org/03fkc8c64","country_code":"JM","type":"education","lineage":["https://openalex.org/I137799390","https://openalex.org/I4210129319"]}],"countries":["JM"],"is_corresponding":false,"raw_author_name":"Monika Asnani","raw_affiliation_strings":["Caribbean Institute for Health Research - Sickle Cell Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica"],"raw_orcid":"https://orcid.org/0000-0002-7184-138X","affiliations":[{"raw_affiliation_string":"Caribbean Institute for Health Research - Sickle Cell Unit, The University of the West Indies, Mona Campus, Kingston 7, Jamaica","institution_ids":["https://openalex.org/I4210129319"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5034304738"],"corresponding_institution_ids":["https://openalex.org/I4210129319"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10554","display_name":"Hemoglobinopathies and Related Disorders","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2716","display_name":"Genetics (clinical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10554","display_name":"Hemoglobinopathies and Related Disorders","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2716","display_name":"Genetics (clinical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12823","display_name":"Adolescent and Pediatric Healthcare","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11280","display_name":"Hemophilia Treatment and Research","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2720","display_name":"Hematology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/sickle-cell-disease","display_name":"sickle cell disease","score":1.0},{"id":"https://openalex.org/keywords/hydroxyurea","display_name":"hydroxyurea","score":0.8790000081062317},{"id":"https://openalex.org/keywords/barriers-to-care","display_name":"barriers to care","score":0.9210000038146973},{"id":"https://openalex.org/keywords/pain-management","display_name":"pain management","score":0.4189999997615814},{"id":"https://openalex.org/keywords/patient-education","display_name":"patient education","score":0.42899999022483826},{"id":"https://openalex.org/keywords/transportation-costs","display_name":"transportation costs","score":0.47099998593330383},{"id":"https://openalex.org/keywords/insurance-coverage","display_name":"insurance coverage","score":0.6240000128746033},{"id":"https://openalex.org/keywords/jamaica","display_name":"Jamaica","score":0.4740000069141388},{"id":"https://openalex.org/keywords/resource-limited-settings","display_name":"resource-limited settings","score":0.8730000257492065},{"id":"https://openalex.org/keywords/children-with-sickle-cell-disease","display_name":"children with sickle cell disease","score":0.8180000185966492},{"id":"https://openalex.org/keywords/caregivers","display_name":"caregivers","score":0.550000011920929},{"id":"https://openalex.org/keywords/access-to-emergency-care","display_name":"emergency care access","score":0.5350000262260437},{"id":"https://openalex.org/keywords/waiting-time","display_name":"waiting time","score":0.8230000138282776},{"id":"https://openalex.org/keywords/multidisciplinary-care","display_name":"multidisciplinary care","score":0.7239999771118164},{"id":"https://openalex.org/keywords/disease-modifying-therapy","display_name":"disease-modifying therapy","score":0.6259999871253967}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8112999796867371},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.618399977684021},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.6082000136375427},{"id":"https://openalex.org/C2779978724","wikidata":"https://www.wikidata.org/wiki/Q1436482","display_name":"Worry","level":3,"score":0.6065000295639038},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.522599995136261},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.49790000915527344},{"id":"https://openalex.org/C545542383","wikidata":"https://www.wikidata.org/wiki/Q2751242","display_name":"Medical emergency","level":1,"score":0.3555000126361847},{"id":"https://openalex.org/C83864248","wikidata":"https://www.wikidata.org/wiki/Q177323","display_name":"Developing country","level":2,"score":0.35199999809265137},{"id":"https://openalex.org/C2778620579","wikidata":"https://www.wikidata.org/wiki/Q185034","display_name":"Sickle cell anemia","level":3,"score":0.35120001435279846},{"id":"https://openalex.org/C558461103","wikidata":"https://www.wikidata.org/wiki/Q154430","display_name":"Anxiety","level":2,"score":0.33570000529289246},{"id":"https://openalex.org/C205545832","wikidata":"https://www.wikidata.org/wiki/Q17156455","display_name":"Young adult","level":2,"score":0.32820001244544983},{"id":"https://openalex.org/C27415008","wikidata":"https://www.wikidata.org/wiki/Q7256382","display_name":"Psychological intervention","level":2,"score":0.3151000142097473},{"id":"https://openalex.org/C22467394","wikidata":"https://www.wikidata.org/wiki/Q849359","display_name":"Multidisciplinary approach","level":2,"score":0.3100999891757965},{"id":"https://openalex.org/C2778048844","wikidata":"https://www.wikidata.org/wiki/Q12156","display_name":"Malaria","level":2,"score":0.28929999470710754},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.28540000319480896},{"id":"https://openalex.org/C124306116","wikidata":"https://www.wikidata.org/wiki/Q2512965","display_name":"Ambulatory care","level":3,"score":0.28459998965263367},{"id":"https://openalex.org/C2775860198","wikidata":"https://www.wikidata.org/wiki/Q7257872","display_name":"Public hospital","level":2,"score":0.2734000086784363},{"id":"https://openalex.org/C187212893","wikidata":"https://www.wikidata.org/wiki/Q123028","display_name":"Pediatrics","level":1,"score":0.26930001378059387},{"id":"https://openalex.org/C3020110884","wikidata":"https://www.wikidata.org/wiki/Q695416","display_name":"Outpatient clinic","level":2,"score":0.2678999900817871},{"id":"https://openalex.org/C2779302386","wikidata":"https://www.wikidata.org/wiki/Q79871","display_name":"Anger","level":2,"score":0.26750001311302185}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.09.16.26363231","doi":"https://doi.org/10.64898/2026.09.16.26363231","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.16.26363231","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/17/2026.09.16.26363231.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.09.16.26363231","doi":"https://doi.org/10.64898/2026.09.16.26363231","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.16.26363231","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/17/2026.09.16.26363231.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being","score":1.0},{"id":"https://metadata.un.org/sdg/10","display_name":"Reduced inequalities","score":0.7578999996185303}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7213563138.pdf","grobid_xml":"https://content.openalex.org/works/W7213563138.grobid-xml"},"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W7126331290","https://openalex.org/W7135066564","https://openalex.org/W7128930333","https://openalex.org/W4399038430","https://openalex.org/W2983624227","https://openalex.org/W4226312266","https://openalex.org/W7069991066","https://openalex.org/W4293175945","https://openalex.org/W3217397589","https://openalex.org/W7162774124"],"abstract_inverted_index":{"Abstract/Summary":[0],"Sickle":[1],"cell":[2],"disease":[3,12],"(SCD)":[4],"is":[5,22,28,32,48,482],"a":[6,87],"significant":[7],"contributor":[8],"to":[9,20,61,313,397,399,463,484],"the":[10,33,51,166,181,194,401,450],"global":[11],"burden,":[13],"particularly":[14],"in":[15,39,67,193,232,350,377],"developing":[16],"countries":[17],"where":[18,46],"access":[19,63,223],"care":[21,27,156,177],"limited,":[23],"and":[24,64,73,86,104,128,137,147,169,208,218,251,264,269,277,285,302,318,323,326,354,367,381,384,413,429,438,442,444,456,468,474,488],"coordinated":[25],"multidisciplinary":[26],"often":[29],"unavailable.":[30],"Hydroxyurea":[31,257],"only":[34],"readily":[35],"available":[36],"disease-modifying-drug":[37],"therapy":[38],"many":[40],"resource-limited":[41],"settings,":[42],"such":[43],"as":[44],"Jamaica":[45,68],"it":[47],"subsidized":[49],"through":[50],"National":[52,195],"Health":[53,196],"Fund":[54,197],"(NHF).":[55],"This":[56],"cross-sectional":[57],"study":[58,112],"assessed":[59],"barriers":[60,224],"healthcare":[62,100,222,414],"hydroxyurea":[65,102,273,308,345,436],"use":[66,369,446],"among":[69,282,295,372,406,425],"adults":[70,115,207,263,301,317,325,407],"with":[71,79,125,151,165,185,340,431,476],"SCD":[72,80,89],"parents":[74,467],"or":[75,237,247],"caregivers":[76],"of":[77,133,142,149,206,287,300,304,470],"children":[78,138,143,305,320,328,428],"from":[81],"four":[82],"regional":[83],"health":[84,361,487],"authorities":[85],"specialized":[88],"centre.":[90],"Participants":[91],"completed":[92],"an":[93],"interviewer-assisted":[94],"questionnaire":[95],"collecting":[96],"information":[97],"on":[98],"sociodemographics,":[99],"access,":[101],"utilization":[103],"associated":[105,339],"barriers.":[106],"All":[107],"analyses":[108],"were":[109,279,330,370,375],"exploratory.":[110],"The":[111],"recruited":[113],"173":[114],"(mean":[116,131],"age":[117,132,472],"34.0\u00b111.4":[118],"years,":[119,140],"73.6%":[120],"female,":[121,144],"48.6%":[122],"urban,":[123,146],"75.1%":[124],"secondary":[126,152],"education)":[127],"189":[129],"parents/caregivers":[130,134,150,286],"37.2\u00b110.2":[135],"years":[136],"7.1\u00b14.8":[139],"55.0%":[141,270],"50.3%":[145],"64.3%":[148],"education).":[153],"Overall,":[154,298],"emergency":[155],"was":[157,178,202,214,259,292,338,393,404,423],"most":[158,394],"commonly":[159,174,395],"accessed":[160,179],"at":[161,180,494],"public":[162],"hospitals":[163,171],"(87.3%),":[164],"SCU":[167,182],"(21.5%)":[168],"private":[170],"(7.7%)":[172],"less":[173],"reported.":[175],"Routine":[176],"by":[183,204,216,261],"85.9%,":[184],"28.6%":[186],"also":[187,293],"attending":[188],"hospital":[189],"outpatient":[190],"clinics.":[191],"Enrolment":[192],"(NHF)":[198],"drug":[199],"subsidy":[200],"programme":[201],"reported":[203,215,260,271,306,409],"50.9%":[205],"36.0%":[209],"parents/caregivers,":[210,266,365],"while":[211,267,290],"insurance":[212,362],"coverage":[213,358],"34.7%":[217],"31.8%,":[219],"respectively.":[220,275],"Common":[221],"included":[225],"not":[226],"being":[227,415],"seen":[228],"quickly":[229],"enough":[230],"when":[231],"pain":[233],"(77.8%":[234],"adults),":[235],"worry":[236],"fear":[238],"(47.2%":[239],"overall),":[240,245,250],"long":[241],"wait":[242,496],"times":[243],"(39.2%":[244],"frustration":[246],"anger":[248],"(29.3%":[249],"high":[252],"transportation":[253,489],"costs":[254],"(22.4%":[255],"overall).":[256],"awareness":[258,291,437],"62.4%":[262],"67.6%":[265],"45.0%":[268],"receiving":[272],"education,":[274],"Awareness":[276],"education":[278,439,454],"both":[280],"higher":[281],"adult":[283],"females":[284],"older":[288],"children,":[289,421],"greater":[294,424],"tertiary-educated":[296,432],"adults.":[297],"30.2%":[299],"39.4%":[303],"initiating":[307],"(p=0.18).":[309],"Among":[310,334,364,420],"patients":[311,469],"advised":[312],"take":[314,400],"hydroxyurea,":[315],"68.4%":[316],"77.1%":[319],"initiated":[321],"(p=0.18),":[322],"50.0%":[324],"73.4%":[327],"(p=0.001)":[329],"currently":[331],"using":[332],"it.":[333],"adults,":[335],"lower":[336,371,405,477],"initiation":[337,366,443],"reporting":[341],"insufficient":[342],"knowledge":[343],"about":[344,386],"(odds":[346],"ratio,":[347],"OR=0.1),":[348],"disinterest":[349],"another":[351,378],"medication":[352,379],"(OR=0.1),":[353],"having":[355],"neither":[356],"NHF":[357,457],"nor":[359],"other":[360],"(OR=0.1).":[363],"current":[368],"those":[373,430,475],"who":[374,408],"disinterested":[376],"(OR=0.1":[380],"0.02,":[382],"respectively)":[383],"concerned":[385],"side":[387],"effects":[388],"(both":[389],"OR=0.2).":[390],"Poor":[391],"adherence":[392,422],"attributed":[396],"forgetting":[398],"medication.":[402],"Adherence":[403],"inadequate":[410],"social":[411],"support":[412,481],"too":[416],"expensive,":[417],"including":[418],"co-pay.":[419],"females,":[426],"younger":[427],"parents.":[433],"Findings":[434],"suggest":[435],"are":[440],"inadequate,":[441],"continued":[445],"remain":[447],"suboptimal,":[448],"highlighting":[449],"need":[451],"for":[452],"improved":[453],"strategies":[455],"enrolment.":[458],"Strategies":[459],"should":[460],"be":[461],"tailored":[462],"better":[464],"engage":[465],"males,":[466],"different":[471],"groups,":[473],"educational":[478],"attainment.":[479],"Greater":[480],"needed":[483],"address":[485],"mental":[486],"challenges,":[490],"alongside":[491],"protocols":[492],"aimed":[493],"reducing":[495],"times.":[497]},"counts_by_year":[],"updated_date":"2026-11-09T13:22:03.289127","created_date":"2026-09-18T00:00:00"}
