Published in PLOS One on 2026-05-29, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Juliane Peninah Nattimba, Sabrina Bakeera-Kitaka, Joseph Rujumba, Ruth Namazzi, Ivan Segawa, Kizza Lubega, Alphonse Taban, Edison Mworozi, Phillip Kasirye, Deogratias Munube, Grace Ndeezi, Sarah Kiguli, Thereza Piloya, Aloysius Gonzaga Mubuuke
Source: PLOS One • DOI 10.1371/journal.pone.0350308
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Sickle cell disease (SCD) contributes substantially to school absenteeism due to recurrent pain, infections, and frequent hospital visits that interrupt learning and long-term academic progress. In Uganda, where the SCD burden is high, the extent and drivers of absenteeism are not well documented, limiting the development of supportive school health strategies. This study assessed the prevalence and associated factors of absenteeism among children and adolescents with SCD to inform education and health policy.
A comparative cross-sectional study was conducted at Mulago National Referral Hospital’s Sickle Cell Clinic in Kampala, Uganda, from 18 July to 03 November 2024. Children aged 6–19 years with SCD and their siblings or peers were consecutively enrolled. Chronic absenteeism: missing ≥10% of expected school days in the previous term (~89 days), was the primary outcome. Sociodemographic, school-related, and clinical data were collected through structured interviews and medical record review. Chi-square and Wilcoxon rank-sum tests were used to compare participant characteristics, while logistic regression identified factors associated with chronic absenteeism, generating odds ratios (ORs) and 95% confidence intervals (CIs).
A total of 358 participants were enrolled (179 with SCD and 179 peers). Children with SCD missed a median of 5 school days per term (interquartile range [IQR]: 2–10), compared with 0 days (IQR: 0–3) among peers (p < 0.001). Chronic absenteeism affected 33% of children with SCD versus 6% of peers (OR 7.3, 95% CI: 3.7–14.4). In multivariable analysis, class repetition (adjusted OR [aOR] 2.5, 95% CI: 1.1–5.9) and hospital admissions (aOR 3.6, 95% CI: 1.9–6.8) were significantly associated with absenteeism.
Learners with SCD experienced significantly high rates of absenteeism compared to their peers, with one-third chronically absent. Frequent hospital admissions and prior class repetition were strongly associated, highlighting the need for integrated health-education strategies to enhance attendance and academic outcomes.
Introduction
Sickle Cell Disease (SCD) is a group of inherited blood disorders that impair oxygen transport, resulting in chronic anemia, recurrent pain crises, and fatigue, factors that disrupt daily activities such as school attendance and learning [1]. One of the most measurable consequences of this burden is school absenteeism, which disrupts learning and can contribute to long-term educational disadvantage [2]. School performance correlated positively with hemoglobin concentration (r = 0.26, p < 0.001), suggesting lower hemoglobin levels are associated with poorer academic outcomes among children with SCD [3]. These findings illustrate how the physiological burden of SCD can directly translate into educational disparities, making school absenteeism an important marker of the disease’s wider social impact.
Globally, 300,000–400,000 babies are born with SCD each year, with sub-Saharan Africa (SSA) accounting for over 75% of this burden [4,5]. In Uganda alone, approximately 15,000 children are born with SCD annually, with a national prevalence of 13.3% and a sickle cell anemia prevalence of 0.8% [6,7]. Historically, 50–80% of affected children in SSA died before the age of five [5]. Survivors often experience recurrent pain episodes, infections, end-organ damage, and delayed growth and development, all of which limit educational achievement and perpetuate cycles of poverty [5]. Although interventions such as neonatal screening, hydroxyurea therapy, prophylactic treatments, and health education have improved survival [7,8], these have not adequately addressed the long-term educational and socio-economic challenges faced by children with SCD [7].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Juliane Peninah Nattimba, Sabrina Bakeera-Kitaka, Joseph Rujumba, Ruth Namazzi, Ivan Segawa, Kizza Lubega, Alphonse Taban, Edison Mworozi, Phillip Kasirye, Deogratias Munube, Grace Ndeezi, Sarah Kiguli, Thereza Piloya, Aloysius Gonzaga Mubuuke. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Newborn screening for sickle cell disease in Caluquembe, southwestern Angola, 2024–2025
- Evidence brief: “Heartbreak and Frustration’’ experiences of healthcare providers caring for pregnant women with sickle cell disease in Uganda
- Evidence brief: Perceptions and experiences of Hospital-Acquired Diarrhea among children aged 0–59 months with Severe Acute Malnutrition at Mwanamugimu Nutrition Unit, Mulago, Uganda: A qualitative study
