Renal care readiness and gaps in early detection of sickle cell nephropathy in children in North Kivu Province, Democratic Republic of the Congo: an exploratory cross-sectional study.

BACKGROUND

Sickle cell nephropathy is a common and progressive complication of sickle cell disease in children and a major contributor to early morbidity and long-term chronic kidney disease. Although early renal screening is essential to prevent irreversible damage, its implementation remains limited in resource-constrained settings. This study assessed healthcare provider readiness for the early detection and management of sickle cell nephropathy in North Kivu Province, Democratic Republic of the Congo.

METHODS

We conducted an exploratory cross-sectional study among medical and paramedical healthcare providers involved in the care of children with sickle cell disease. Data were collected using a structured electronic questionnaire evaluating knowledge, attitudes, practices, and diagnostic availability related to renal screening. Composite scores were constructed for these domains, and factors associated with adequate renal care readiness were examined using multivariable logistic regression.

RESULTS

Two hundred providers were included. Adequate knowledge was observed in 50.5% of participants, while only 21.0% demonstrated favorable attitudes. Reported practices were poor, with good practice identified in only 4.1% of respondents. Diagnostic availability was limited (mean score 39.8 ± 23.5), particularly in primary and secondary facilities. Overall renal care readiness was suboptimal, and adequate diagnostic availability emerged as the main independent determinant. Key barriers included recurrent shortages of diagnostic supplies, financial constraints, and high workload, whereas standardized protocols and institutional support were reported as facilitators.

CONCLUSIONS

Despite moderate knowledge levels, early renal screening for children with sickle cell disease is insufficiently implemented in North Kivu. Health system capacity, especially access to essential diagnostic tools, is central to effective renal care readiness. Strengthening diagnostic availability, standardizing care pathways, and reinforcing targeted training may substantially improve early detection and prevention of kidney disease in resource-limited settings.