Paediatric Sickle Cell Disease in Nigeria: From Burden Characterisation to Bridging the Implementation Gap – A Critical Policy Review

Background: Nigeria bears the world's highest burden of sickle cell disease (SCD), with approximately 150,000 affected infants born annually, yet outcomes remain poor.This review synthesises evidence on epidemiology, clinical phenotype, treatment gaps, and mortality to inform implementation priorities.Methods: We reviewed published literature from January 2000 to May 2026 on Nigerian paediatric SCD, extracting data on prevalence, clinical complications, intervention coverage, and survival.Implementation barriers were mapped using the Consolidated Framework for Implementation Research (CFIR).Results: National pooled prevalence is 4.0%, reaching 7.0% in the North-West, with SCD accounting for 10.0% of paediatric admissions across 10 tertiary healthcare facilities (range, 2.1%-16.3%).The phenotype is severe and early-onset, characterised by vaso-occlusive crises (66-81%), severe bacterial infections (24-32%), and acute chest syndrome (11-27%).Access to key interventions remains limited: hydroxyurea coverage is approximately 13%, penicillin prophylaxis is prescribed by fewer than 40% of paediatricians, and transcranial Doppler screening is available in only 3 of 18 specialised clinics.CFIR identified infrastructure deficits, out-of-pocket costs, weak policy implementation, and clinician hesitancy as major barriers.Conclusion: Closing the implementation gap, rather than further characterising disease burden, is the urgent priority for improving SCD outcomes in Nigeria.