Clinical Clusters of Sickle Cell Anemia: Exploring the Impact of Lifestyle, Environmental, and Socioeconomic Influences in Cameroon
Ngoe Samuel Bakia *
Department of Pharmaceutical Sciences, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon.
Mbappe Herguel Epoh
Department of Hematology, Oncology and Gastro-Enterology, Yaoundé Central Hospital, Cameroon.
Grâce Bissohong
Department of Pediatrics, Cite-Vert District Hospital, Yaoundé, Cameroon.
Pouth Guy Hott
Department of Pediatrics, Centre D’animation Sociale et Sanitaire Yaoundé, Cameroon.
Eustace Bongang Berinyuy
Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon.
Chetcha Bernard Chenmagni
Department of Hematology, Oncology and Gastro-Enterology, Yaoundé Central Hospital, Cameroon and Department of Microbiology, Parasitology, Hematology and Infectious Diseases, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon.
Charles Fokunang *
Department of Pharmaceutical Sciences, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon.
*Author to whom correspondence should be addressed.
Abstract
Background: Despite growing evidence that exogenous factors such as environmental conditions, influence the clinical severity of sickle cell anemia, their impact remain poorly understood in Cameroon. This study explores clinical clusters of sickle cell anemia and their associations with lifestyle, environmental, and socioeconomic factors among patients in Cameroon’s cosmopolitan Centre region.
Methods: We enrolled 185 participants from four hospitals in Yaoundé between October 2023 and September 2024. We collected data on lifestyle factors (stress, anxiety, nutritional habits, physical activity, and routine checkups), environmental influences (seasonal variations, weather changes, and exposure to pollutants), and socioeconomic factors (household income, household size, and parental education level) over the 12 months preceding enrollment using self-reported questionnaires. Clinical data were retrieved from patients’ medical records. KAy-means for Mixed Large Data (KAMILA) was used to cluster patients based on similar clinical characteristics. Associations between clinical clusters and exogenous factors were evaluated using association plots, chi-square tests, and relationships were quantified using regression analysis.
Results: Two distinct clinical clusters were identified (Cluster 1 and Cluster 2) sharing common symptoms and sickle-related complications, but differing significantly in disease severity, with Cluster 1 exhibiting a higher burden of hospitalizations, transfusions, painful episodes and pain severity. Lifestyle factors (stress, anxiety, physical inactivity, and routine checkups) and environmental conditions (sensitivity to wind, humidity, dust and smoke) were significantly associated with cluster membership, and contributed to the greater clinical burden observed in Cluster 1.
Conclusion: The study provides a foundation for further research into the multifactorial drivers of disease severity in Cameroon and highlights the importance of patient and caregiver education on lifestyle optimization and the health risks of environmental exposures, with potential benefits for healthcare burden reduction among sickle cell patients.
Keywords: Sickle cell disease, clinical cluster, lifestyle factors, environmental conditions, socioeconomic factors