High Burden of Sickle Cell Disease and Trait Among Young Children in Western Tanzania: Evidence from a Cross-Sectional Screening Study

Background: Sickle cell disease (SCD) is a major inherited haemoglobin disorder and a leading cause of childhood morbidity and mortality in sub-Saharan Africa. Tanzania carries a high burden, but rural district-level data remain limited. This study assessed the prevalence of SCD, sickle cell trait, and haemoglobin variants among under-five children in Kakonko District and identified associated factors. Methods: A facility-based cross-sectional study was conducted from October 2025 to May 2026 among children aged 0–59 months attending three public health facilities. Systematic random sampling was used. Haemoglobin concentration was measured using a HemoCue analyzer, and sickle cell status was determined using Sickle SCAN® rapid diagnostic test, a point-of-care device for detection of haemoglobin variants. Data were analyzed using Stata version 15. Logistic regression identified associated factors. Results: A total of 552 children were enrolled in the study. The overall prevalence of sickle cell disease (HbSS) was 10.3% (n = 57), while sickle cell trait (HbAS/HbAC) accounted for 16.9% (n = 93). Specifically, HbAS was identified in 16.7% (n = 92) of participants and HbAC in 0.2% (n = 1). The majority of children (72.8%) had normal haemoglobin (HbAA). In multivariable analysis, family history of sickle cell disease, low haemoglobin concentration, and history of previous blood transfusion were independently associated with HbSS status. Conclusion: There is a high burden of SCD and sickle cell trait among under-five children in Kakonko District, indicating ongoing transmission of haemoglobinopathies.