Implementation of Sickle Cell Disease Management Protocols in Secondary Healthcare Facilities in Osun State, South West Nigeria

This study assesses the implementation of national sickle cell disease (SCD) management protocols in secondary healthcare facilities across Osun State, South West Nigeria. While SCD management guidelines exist at the federal level, their consistent application in secondary facilities is poorly monitored, and gaps in protocol adherence significantly compromise patient outcomes. A cross-sectional professional evaluation was conducted at 15 secondary health facilities in Osun State, using structured facility assessments, key informant interviews with health workers, and medical record reviews of 200 SCD patient files. Facilities were scored against the Federal Ministry of Health SCD Management Protocol criteria covering diagnosis, hydroxyurea use, pain management, infection prophylaxis, and follow-up scheduling. Only 33 percent of facilities met criteria for adequate SCD diagnostic capacity. Hydroxyurea was prescribed in only 12 percent of eligible patients. Pneumococcal vaccination documentation was absent in 78 percent of paediatric SCD records. Folic acid prescription compliance was high (87%), but structured crisis management protocols were present in only 27 percent of facilities. Key barriers identified included staff training deficits, drug availability gaps, and inadequate patient record systems. The study recommends structured training programmes for secondary health workers on SCD protocols, decentralised hydroxyurea supply chains, and SCD patient registries at secondary facility level to improve protocol adherence across Osun State. Keywords: sickle cell disease, management protocols, secondary healthcare, Osun State, hydroxyurea.