{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T09:44:39Z","timestamp":1776246279720,"version":"3.50.1"},"reference-count":25,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Heart, Lung and Blood Institute (NHLBI) of the US National Institutes of Health","award":["U01HL156853"],"award-info":[{"award-number":["U01HL156853"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJNS"],"abstract":"<jats:p>Sickle cell disease (SCD) is a major public health concern in Tanzania where approximately 11,000 children are born with the condition annually. Newborn screening (NBS) enables early diagnosis and timely intervention. Despite the proven effectiveness of NBS in reducing early mortality from SCD, implementation in Tanzania remains limited to pilot programs at facilities such as Temeke and Amana Regional Referral Hospitals (RRHs) in the city of Dar-es-salaam. This study evaluated the implementation of NBS for the SCD Program at Temeke and Amana RRHs. An explanatory mixed-methods process evaluation was conducted between January 2022 and December 2024. Quantitative data were extracted from hospital registries and REDCap, while qualitative data were obtained from key informant interviews with 17 healthcare workers. Quantitative data were analyzed using SPSS v29.0, while qualitative transcripts were thematically analyzed using NVivo software version 15 to explore operational factors influencing implementation. A total of 10,711 newborns were screened across the two hospitals. Seventy-four (0.70%) newborns had homozygous SCD (HbS\/S), whereas 1325 (12.53%) had sickle cell trait (HbA\/S). Enrolment of infants diagnosed with SCD into comprehensive care declined substantially over time, from 65.6% in 2022 to 10.5% in 2024 at Temeke RRH, while Amana RRH recorded no enrolments beyond the first year of implementation. Qualitative findings highlighted facilitators for NBS such as maternal awareness, interdepartmental collaboration, and the availability of trained staff. However, implementation was hindered by inadequate refresher training, delayed staff incentives, supply shortages, and parental hesitancy influenced by cultural beliefs. This evaluation found a substantial decline in enrolment of newborns diagnosed with SCD into comprehensive care, driven by key operational challenges. Although early implementation benefited from trained, committed staff and interdepartmental collaboration, sustainability was limited by inadequate refresher training, delayed incentives, supply shortages, and parental hesitancy. Addressing these gaps through regular capacity building, strengthened supply chains, timely incentives, and culturally sensitive community education is critical to improving enrolment, continuity of care, and informing national scale-up of NBS for SCD in Tanzania.<\/jats:p>","DOI":"10.3390\/ijns12020024","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T08:11:18Z","timestamp":1776240678000},"page":"24","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of Implementation of Newborn Screening for Sickle Cell Disease Program in Selected Hospitals in Dar es Salaam, Tanzania"],"prefix":"10.3390","volume":"12","author":[{"given":"Tunganege","family":"Matipa","sequence":"first","affiliation":[{"name":"Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania"},{"name":"Sickle Pan African Research Consortium (SPARCO) Tanzania, Department of Haematology and Blood Transfusion, School of Diagnostic Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7951-9248","authenticated-orcid":false,"given":"Elia","family":"Nyangi","sequence":"additional","affiliation":[{"name":"Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9928-0732","authenticated-orcid":false,"given":"Agnes","family":"Jonathan","sequence":"additional","affiliation":[{"name":"Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania"},{"name":"Sickle Pan African Research Consortium (SPARCO) Tanzania, Department of Haematology and Blood Transfusion, School of Diagnostic Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mwashungi","family":"Ally","sequence":"additional","affiliation":[{"name":"Sickle Pan African Research Consortium (SPARCO) Tanzania, Department of Haematology and Blood Transfusion, School of Diagnostic Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania"},{"name":"Department of Haematology and Blood Transfusion, School of Diagnostic Medicine, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lulu","family":"Chirande","sequence":"additional","affiliation":[{"name":"Sickle Pan African Research Consortium (SPARCO) Tanzania, Department of Haematology and Blood Transfusion, School of Diagnostic Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania"},{"name":"Department of Paediatrics and Child Health, School of Clinical Medicine, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asteria","family":"Mpoto","sequence":"additional","affiliation":[{"name":"Sickle Cell Disease Unit, Non-Communicable Diseases Section, Directorate of Curative Service, Ministry of Health, Dodoma P.O. Box 743, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3707-9985","authenticated-orcid":false,"given":"Emmanuel","family":"Balandya","sequence":"additional","affiliation":[{"name":"Sickle Pan African Research Consortium (SPARCO) Tanzania, Department of Haematology and Blood Transfusion, School of Diagnostic Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania"},{"name":"Department of Physiology, School of Biomedical Sciences, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gladys Reuben","family":"Mahiti","sequence":"additional","affiliation":[{"name":"Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Piel, F.B., Hay, S.I., Gupta, S., Weatherall, D.J., and Williams, T.N. (2013). Global burden of sickle cell anaemia in children under five, 2010\u20132050: Modelling based on demographics, excess mortality, and interventions. PLoS Med., 10.","DOI":"10.1371\/journal.pmed.1001484"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Makani, J., Cox, S.E., Soka, D., Komba, A.N., Oruo, J., Mwamtemi, H., Magesa, P., Rwezaula, S., Meda, E., and Mgaya, J. (2011). Mortality in sickle cell anemia in Africa: A prospective cohort study in Tanzania. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0014699"},{"key":"ref_3","unstructured":"(2025, January 06). Sickle-Cell Anaemia: Report by the Secretariat. Available online: https:\/\/iris.who.int\/handle\/10665\/20890."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S398","DOI":"10.1016\/j.amepre.2011.09.013","article-title":"Sickle cell disease in Africa: A neglected cause of early childhood mortality","volume":"41","author":"Grosse","year":"2011","journal-title":"Am. J. Prev. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S120","DOI":"10.1542\/peds.2007-2022UUU","article-title":"Screening Newborns for Sickle Cell Disease in Ghana","volume":"121","author":"Oduro","year":"2008","journal-title":"Pediatrics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S512","DOI":"10.1016\/j.amepre.2009.12.022","article-title":"Population estimates of sickle cell disease in the U.S","volume":"38","author":"Hassell","year":"2010","journal-title":"Am. J. Prev. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3447","DOI":"10.1182\/blood-2009-07-233700","article-title":"Improved survival of children and adolescents with sickle cell disease","volume":"115","author":"Quinn","year":"2010","journal-title":"Blood"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.puhe.2007.12.005","article-title":"Neonatal screening and clinical care programmes for sickle cell disorders in sub-Saharan Africa: Lessons from pilot studies","volume":"122","author":"Tshilolo","year":"2008","journal-title":"Public Health"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Bukini, D., Nkya, S., McCurdy, S., Mbekenga, C., Manji, K., Parker, M., and Makani, J. (2021). Perspectives on Building Sustainable Newborn Screening Programs for Sickle Cell Disease: Experience from Tanzania. Int. J. Neonatal. Screen, 7.","DOI":"10.3390\/ijns7010012"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"23","DOI":"10.11604\/pamj-oh.2024.14.23.44014","article-title":"Unpacking implementation: Drivers of nurses\u2019 utilization of the client service charter in a Tanzanian hospital","volume":"14","author":"Raphael","year":"2024","journal-title":"PAMJ-One Health"},{"key":"ref_11","first-page":"00022","article-title":"Perinatal Mortality and Associated Factors Among Deliveries in Three Municipal Hospitals of Dar Es Salaam, Tanzania","volume":"1","author":"Jonathan","year":"2014","journal-title":"J. Pediatr. Neonatal. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"h1258","DOI":"10.1136\/bmj.h1258","article-title":"Process evaluation of complex interventions: Medical Research Council guidance","volume":"350","author":"Moore","year":"2015","journal-title":"BMJ"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.nedt.2003.10.001","article-title":"Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness","volume":"24","author":"Graneheim","year":"2004","journal-title":"Nurse Educ. Today"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e195","DOI":"10.1016\/S2214-109X(15)00288-0","article-title":"Burden of sickle cell trait and disease in the Uganda Sickle Surveillance Study (US3): A cross-sectional study","volume":"4","author":"Ndeezi","year":"2016","journal-title":"Lancet Glob. Health"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Galadanci, A.A., Ibrahim, U.A., Carroll, Y., Jobbi, Y.D., Farouk, Z.L., Mukaddas, A., Hussaini, N., Musa, B.S., Klein, L.J., and DeBaun, M.R. (2024). A Novel Newborn Screening Program for Sickle Cell Disease in Nigeria. Int. J. Neonatal Screen., 10.","DOI":"10.3390\/ijns10040067"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1111\/bjh.14594","article-title":"Sickle cell disease in Africa: An overview of the integrated approach to health, research, education and advocacy in Tanzania, 2004\u20132016","volume":"177","author":"Tluway","year":"2017","journal-title":"Br. J. Haematol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1053\/j.semperi.2015.03.008","article-title":"Newborn screening for sickle cell diseases in the United States: A review of data spanning 2 decades","volume":"39","author":"Therrell","year":"2015","journal-title":"Semin. Perinatol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Masamu, U., Sangeda, R.Z., Kandonga, D., Ondengo, J., Ndobho, F., Mmbando, B., Nkya, S., Msami, K., and Makani, J. (2020). Patterns and patient factors associated with loss to follow-up in the Muhimbili sickle cell cohort, Tanzania. BMC Health Serv. Res., 20.","DOI":"10.1186\/s12913-020-05998-6"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e593","DOI":"10.1097\/MPH.0000000000001800","article-title":"Parental Notification Via Text Messaging for Infant Sickle Screening Programs: Exploration of Feasibility and Acceptability in Uganda","volume":"42","author":"Fashakin","year":"2020","journal-title":"J. Pediatr. Hematol. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"6161270","DOI":"10.1155\/2018\/6161270","article-title":"Burden of Sickle Cell Disease in Ghana: The Korle-Bu Experience","volume":"2018","author":"Asare","year":"2018","journal-title":"Adv. Hematol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e534","DOI":"10.1016\/S2352-3026(20)30143-5","article-title":"Implementing newborn screening for sickle cell disease as part of immunisation programmes in Nigeria: A feasibility study","volume":"7","author":"Nnodu","year":"2020","journal-title":"Lancet Haematol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/s12687-020-00463-7","article-title":"Empowering newborn screening programs in African countries through establishment of an international collaborative effort","volume":"11","author":"Therrell","year":"2020","journal-title":"J. Community Genet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"10","DOI":"10.37432\/jieph.2024.7.1.10","article-title":"Laboratory diagnostics performance in Uganda: A survey of test availability and constraints","volume":"7","author":"Namuhani","year":"2024","journal-title":"J. Interv. Epidemiol. Public Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2225","DOI":"10.4102\/ajlm.v12i1.2225","article-title":"Bridging the gaps in newborn screening programmes: Challenges and opportunities to detect haemoglobinopathies in Africa","volume":"12","author":"Twum","year":"2023","journal-title":"Afr. J. Lab. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1177\/17470161221076974","article-title":"Experiences and practices of key research team members in obtaining informed consent for pharmacogenetic research among people living with HIV: A qualitative study","volume":"18","author":"Sylvia","year":"2022","journal-title":"Res. Ethics"}],"container-title":["International Journal of Neonatal Screening"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2409-515X\/12\/2\/24\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T08:44:21Z","timestamp":1776242661000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2409-515X\/12\/2\/24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,15]]},"references-count":25,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["ijns12020024"],"URL":"https:\/\/doi.org\/10.3390\/ijns12020024","relation":{},"ISSN":["2409-515X"],"issn-type":[{"value":"2409-515X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,15]]}}}