{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:04:26Z","timestamp":1789643066919,"version":"4.0.0"},"reference-count":38,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"unspecified","delay-in-days":78,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009053","name":"Wellcome Trust DBT India Alliance","doi-asserted-by":"publisher","award":["IA\/CRC\/20\/1\/600007"],"award-info":[{"award-number":["IA\/CRC\/20\/1\/600007"]}],"id":[{"id":"10.13039\/501100009053","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,8,14]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Sickle cell disease (SCD) remains a major public health challenge in India, disproportionately affecting tribal populations. In 2023, the Government of India launched the National Sickle Cell Anaemia Elimination Mission (NSCAEM) to strengthen screening, diagnosis and long-term care. However, evidence on the readiness of health facilities to implement SCD-specific services under NSCAEM is limited, particularly in tribal and resource-constrained settings. This protocol outlines a systematic assessment of health-system readiness for NSCAEM implementation in a predominantly tribal district of Karnataka.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This study will adopt a cross-sectional, facility-based, mixed-methods design in Chamarajanagar District, Karnataka, conducted between September 2024 and March 2027. All public health facilities involved in SCD screening, diagnosis, referral or management, across primary, secondary and tertiary levels, will be included. Quantitative data will be collected using an adapted WHO Service Availability and Readiness Assessment toolkit, incorporating indicators for SCD diagnostics, medicines, emergency care, counselling and referral systems. The adapted toolkit was developed through expert consultation and piloted at four facilities. Readiness will be assessed using tracer indicators and summarised through domain-specific scores and a composite Service Readiness Index, with a planned sensitivity analysis comparing equal-weighted and expert-weighted domain scores. Qualitative data will be collected through approximately 15\u201320\u2009key informant interviews and a stakeholder validation workshop to contextualise quantitative findings and explore implementation challenges. Descriptive and comparative analyses will be undertaken, with triangulation of quantitative and qualitative results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval for this study has been obtained from the Institutional Ethics Committee of JSS Academy of Higher Education and Research, Mysuru, Karnataka (Reference: JSS\/MC\/PG\/217\/2024-25). Findings will be disseminated through policy briefs to district and state health authorities, stakeholder workshops, community forums and peer-reviewed open-access publications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2026-005317","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T10:50:30Z","timestamp":1789642230000},"page":"e005317","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Health service readiness for implementing the National Sickle Cell Anaemia Elimination Mission in Chamarajanagar District, Karnataka, India: a cross-sectional mixed-methods protocol"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1159-969X","authenticated-orcid":false,"given":"Anandhu K","family":"Ramesan","sequence":"first","affiliation":[{"name":"Anatomy, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Seshadri","sequence":"additional","affiliation":[{"name":"Center of Adivasi Health, Institute of Public Health Bengaluru, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manashri","family":"Bhuyar","sequence":"additional","affiliation":[{"name":"Anatomy, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India"},{"name":"Institute of Public Health Bengaluru, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4928-1718","authenticated-orcid":false,"given":"Deepa","family":"Bhat","sequence":"additional","affiliation":[{"name":"Anatomy, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"2026091703501937000_4.3.e005317.1","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000035237","article-title":"Understanding Sickle cell disease: Causes, symptoms, and treatment options","volume":"102","author":"Elendu","year":"2023","journal-title":"Medicine (Baltimore)"},{"key":"2026091703501937000_4.3.e005317.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2015.11.005"},{"key":"2026091703501937000_4.3.e005317.3","doi-asserted-by":"crossref","DOI":"10.1155\/2022\/3885979","article-title":"Sickle Cell Disease in Children and Adolescents: A Review of the Historical, Clinical, and Public Health Perspective of Sub-Saharan Africa and Beyond","volume":"2022","author":"Egesa","year":"2022","journal-title":"Int J Pediatr"},{"key":"2026091703501937000_4.3.e005317.4","doi-asserted-by":"crossref","first-page":"e585","DOI":"10.1016\/S2352-3026(23)00118-7","article-title":"Global, regional, and national prevalence and mortality burden of sickle cell disease, 2000-2021: a systematic analysis from the Global Burden of Disease Study 2021","volume":"10","year":"2023","journal-title":"Lancet Haematol"},{"key":"2026091703501937000_4.3.e005317.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0002120","article-title":"Is Sickle Cell Anemia a Neglected Tropical Disease?","volume":"7","author":"Ware","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"key":"2026091703501937000_4.3.e005317.6","doi-asserted-by":"publisher","DOI":"10.4103\/0971-5916.159492"},{"key":"2026091703501937000_4.3.e005317.7","doi-asserted-by":"crossref","first-page":"101678","DOI":"10.1016\/j.cegh.2024.101678","article-title":"Prevalence of Sickle cell disease, Sickle cell trait and HBS-beta-thalassemia in India: A systematic review and Meta-analysis","volume":"28","author":"Rao","year":"2024","journal-title":"Clin Epidemiol Glob Health"},{"key":"2026091703501937000_4.3.e005317.8","doi-asserted-by":"crossref","unstructured":"Epidemiology BRS . 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