No kits to test sickle cell patients in tribal, rural areas of Maharashtra

Sickle cell is a blood disorder that converts red blood cells into sickle shape, causing weakness and joint pain in patients.

Written by Tabassum Barnagarwala | Updated: November 23, 2016 4:29 am

The state is reeling under a massive shortage of solubility and electrophoresis test kits to diagnose sickle cell disease in tribal and rural areas, putting on hold treatment of patients. According to district officials, there has been no supply for the last six months and it is expected to last another two months.

“We have blood samples of people stored in our laboratories but no means to test them. There is no option but to visit JJ Hospital in Mumbai, where a state-run laboratory tests samples free of cost. But travelling such long distances every few weeks with so many blood samples is not easy,” said M Kotwal, who heads the Navoday Gramin Sansthya that manages the sickle cell programme in Palghar.

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Sickle cell is a blood disorder that converts red blood cells into sickle shape, causing weakness and joint pain in patients. In some cases, delayed treatment may also result in death. The hereditary disease is prevalent mostly in tribal belts of Maharashtra.

The state has set a target to screen at least 45 lakh people in a year for sickle cell through an easy-to-use solubility kit that uses a chemical solution to show whether the blood is infected. A confirmatory test, called electrophoresis, follows after which the patient is put on treatment.

This year, however, the state health ministry is falling short in meeting its target in 21 districts where the sickle cell programme is running. In Wardha, coordinator Ajay Waratkar said the district had a target of 1.2 lakh screenings, of which only 14 per cent has been achieved. “We cannot start treatment before electrophoresis test result confirms the patient has sickle cell. There is a lot of negligence in this programme. For the past few months, the screening has taken a hit,” said Waratkar.

The Directorate of Health Services (DHS) has asked all districts to locally purchase buffer solution to diagnose new patients, but officials involved in the programme complain even the solution is not available easily. “We have granted funds for that until new stock of kits come in December,” said a DHS official. “Unlike solubility kits, the buffer solution is more expensive and not easy to use and transport,” said Waratkar.

In Gadchiroli, which has a yearly target of screening over a lakh tribals, only 20 per cent target has been met. “We do not have kits. Buffer solution is not a good replacement as it has to be prepared every time unlike ready-to-use solubility kits,” said Dr Ramesh Katre, who handles the sickle cell programme in parts of Gadchiroli.

In Maharashtra, Chandrapur, Nandurbar and Gadchiroli are the worst-hit districts when it comes to sickle cell prevalence. Patients show no physical symptoms of sickle cell except joint pain and weakness. In absence of timely diagnosis, several patients continue to proceed into advanced stage with no treatment.

Cases of sickle cell have risen from four in 2008-09 to 2,192 in 2014-15. Estimates, however, are much higher in remote tribal villages. While the target to screen patients has risen from 37 lakh in 2014-15 to 45 lakh in 2015-16, experts doubt the government will be able to meet it. “We have made several requests to the government to make solubility kits available. There is no progress,” said Kotwal.

According to Bio Lab Diagnostics Ltd, a manufacturer of solubility kits in Mumbai, attached with the state government for over three years, the order for kits comes as per demand in various districts. “We have been told there are technical issues in the tender process, which is why there is a delay in order. The last tender was floated one-and-half-years ago,” said manager Balasingham Malak.
According to a DHS official, the process to procure the new stock of kits will be done by December.