Socioeconomic Determinants of Sickle Cell Disease Management and Health Outcomes in Nigeria: A Systematic Review

Abstract

Background: Sickle cell disease management in Nigeria is influenced by household resources, insurance, service capacity and social conditions, but the evidence is dispersed across clinical, economic and psychosocial studies. Objective: To synthesise evidence on socioeconomic determinants of management and health outcomes among people with sickle cell disease in Nigeria, their caregivers and relevant services. Methods: Openly accessible PubMed, PubMed Central, African Journals Online, publisher, registry and broader scholarly records were searched on 9 July 2026 for reports published from 1 January 2000 to 30 June 2026. Quantitative, qualitative, mixed-methods and facility studies were eligible. One reviewer completed screening, extraction and design-appropriate appraisal. Findings were grouped and synthesised without statistical pooling. Results: Ninety-eight records were captured, 24 duplicates removed and 74 screened. Fifty reports were assessed; 39 reports representing 38 studies were included. Recurrent findings concerned out-of-pocket cost, catastrophic expenditure, low effective insurance coverage, distance and service gaps, and the affordability and monitoring burden of hydroxyurea. Income, education, employment, social support, stigma and institutional accommodation were associated with depression, quality of life, school or work participation and selected clinical outcomes. Most evidence was cross-sectional and facility based, with substantial confounding and reporting limitations. Confidence was moderate for substantial household financial burden and low to low-moderate for other domain-level conclusions. Conclusions: Socioeconomic determinants act across the entire Nigerian sickle cell care pathway. Integrated financial protection, reliable medicines and monitoring, competent decentralised care, psychosocial support and school or workplace accommodation are warranted, while longitudinal and implementation research is needed to establish causal effects and national generalisability.