Suffering from sickle cell anemia, Chinonyerem Obianuju-Nwachukwu, originally from Port Harcourt, in Rivers State, southern Nigeria, had to learn to meticulously manage her health to avoid painful crises triggered by changing weather.
“When it’s very hot, I wear light clothing and drink water slightly above room temperature. When it’s very cold, I stay warm at home, with socks and slippers.
“Sometimes the weather is unpredictable. It can be sunny when I leave the house, and pouring rain before I even get to my destination. So when I go out, I take a sweater and an umbrella,” she explains to VaccinesWork.
With 4 to 6 million people suffering from sickle cell disease out of some 50 million worldwide, Nigeria is considered the epicenter of this disease. Between 100,000 and 150,000 children are born each year in the country with sickle cell disease, which represents 33% of the approximately 300,000 newborns diagnosed with the disease each year worldwide.
A hereditary genetic disease that persists for life, sickle cell anemia (also called sickle cell anemia) is characterized by an abnormality of hemoglobin, the main protein in red blood cells that transport oxygen to the body’s tissues.
“Diseased” red blood cells take on an abnormal sickle shape and can clump together and block blood vessels. They have a shorter lifespan than normal red blood cells, leading to chronic anemia. Diseased red blood cells can also damage the spleen – an organ that filters waste from the blood and plays an important role in the immune response – putting patients at increased risk of infections. Among the main manifestations of sickle cell disease are painful (or vaso-occlusive) crises, which result from obstruction of blood circulation and the subsequent lack of tissue oxygenation. Depending on the organ concerned, the patient may develop jaundice or suffer a stroke. Acute chest syndrome, which can be triggered by a lung infection or dehydration, is caused by blockage of one or more pulmonary arteries. It manifests itself with difficulty breathing and chest pain, sometimes accompanied by fever, and can be fatal.
« [Ceux qui se battent contre la drépanocytose] are more prone to severe forms of malaria, which is very problematic. This is why they are advised to resort to antimalarial prophylaxis. »
– Dr Oluwole Banjoko, clinical hematologist
Weather forecast or early warning system?
The unpredictability of weather conditions due to climate change complicates the management of sickle cell disease: Maureen Nwachi confides that she organizes her days according to the weather forecast.
Maureen is one of the “soldiers” fighting against sickle cell disease – a term used by many patients to combat the stigma. She is also a genetic counselor for the NGO Sickle Cell Advocacy and Care Initiative [SAMI, pou Sickle Cell Advocacy & Management Initiative] based in Lagos, of which she is one of the pillars. “I constantly check the weather forecast to plan my activities and know how to dress. I always maintain some flexibility in my schedule to be able to adapt to unexpected weather changes, and adjust my activities to minimize my exposure to extreme conditions.
“I always stay in touch with my therapist and have a whole program in place for emergency situations. The rise of vector-borne and water-borne diseases due to climate change has serious consequences for those battling sickle cell disease. »
“We are more susceptible to infections because of our weakened immune systems. Malaria, in particular, represents a significant risk because it can trigger a painful vaso-occlusive crisis. I use repellents and insecticides, I sleep under a mosquito net and I make sure I consume safe drinking water,” she explains.
“The cold is particularly difficult to deal with. With cold, blood vessels constrict while red blood cells tend to take on a sickle shape and block them. So you have to stay warm.”
– Professor Philip Olatunji, consultant in hematology
Bad for all of us, even worse for sickle cell patients
The increased vulnerability of people with sickle cell disease to malaria is fraught with a grim irony: Scientists believe that the sickle cell gene spread to parts of Africa because inheriting a copy of the defective gene (called “S”) and a normal gene (called “A”) increases resistance to malaria. But the advantage turns into a nuisance when you inherit two “S” genes.
“Genetically, ‘SS’ people are susceptible to malaria, unlike ‘AS’ people, who are protected from it,” confirms Dr Oluwole Banjoko, a clinical hematologist at the Lagos State University Teaching Hospital. “They are more prone to severe forms of malaria, which is very problematic. This is why those fighting sickle cell disease are advised to resort to antimalaria prophylaxis. »
Chinonyerem and Maureen’s stories join those of a representative group of Nigerian patients battling sickle cell disease, who spoke to VaccinesWork. Research in the medical and climate fields suggests that increasing frequency of extreme weather events increases risks to human health and disproportionately increases the risk of painful crises for people with sickle cell disease.
“The cold is particularly difficult to deal with,” says Professor Philip Olatunji, consultant hematologist at Olabisi Onabanjo Teaching Hospital, Ogun State. “With the cold, the blood vessels contract and the red blood cells tend to take on a sickle shape and block them. So you have to stay warm,” he explains, adding that he advises patients to refrain from strenuous tasks and drink at least three to four liters of water per day to avoid the risk of dehydration.
” Some [patients atteints de drépanocytose] may already be dehydrated due to their illness. So, if they lose more water due to cholera, they will be much more affected than the others. »
– Professor Philip Olatunji, consultant in hematology
As most parts of Nigeria begin to record rainfall, Prof. Olatunji advises sickle cell patients to be more vigilant against infectious diseases such as cholera, pay close attention to personal hygiene and be more careful what they eat and what they drink.
Nigeria is currently facing cholera outbreaks, with 1,141 suspected cases, 65 confirmed cases and 30 deaths reported in 30 states in the first half of this year.
” Some [patients atteints de drépanocytose] may already be dehydrated due to their illness. So, if they lose more water due to cholera, they will be much more affected than the others. They need to go to hospital because they may need to be rehydrated quickly,” adds Professor Olatunji.
Dr. Banjoko, a clinical hematologist, says he always tells his sickle cell patients to take hot water baths when it’s cold, go out with “a big umbrella” during the rainy season, and always carry a raincoat within reach.
“When the heat is scorching, they have to cool down. They can take hot water baths. They can be equipped with fans or air conditioning, but they must not be directly in the air currents,” he explains.
A hostile planet
Climate change has already altered temperatures significantly, confirms Professor Debo Adeyewa, professor of meteorology and climate sciences and director of the West African Climate Systems doctoral research program at the Federal University of Technology, Akure , in Ondo State.
“When it is hot in the south of Nigeria, it is even hotter in the north, especially in Sokoto State. In February and March this year, the temperature reached 33° [Celsius] in the south, which is already not normal, but it was even higher in the north. Such extreme heat, called heat stress, affects the health of individuals and can be very serious for those with sickle cell disease, due to the risk of dehydration,” explains Professor Adeyewa.
Anthony Kola-Olusanya, Professor of Sustainable Development and former Deputy Vice-Provost for Teaching, Research, Innovation and Partnerships at the Osun State University, Osogbo, adds that the Changing environmental factors (temperature, humidity and air quality) can also worsen the vaso-occlusive crises of sickle cell disease.
“The frequency and intensity of heat waves are higher in the Sahel region, particularly in Sokoto State, due to lack of vegetation. However, high temperatures can trigger the vaso-occlusive crises characteristic of sickle cell disease, responsible for intense pain and organ damage.
“At the same time, it can be extremely cold in Jos, Plateau State, known for its almost temperate climate, which is not usual in Nigeria. Extreme cold can cause vasoconstriction of blood vessels and worsen painful attacks. »
“The frequency and intensity of heat waves are higher in the Sahel region due to the lack of vegetation… [ce qui] can trigger the vaso-occlusive crises characteristic of sickle cell disease, responsible for intense pain and organ damage.
– Anthony Kola-Olusanya, Professor of Sustainable Development
“In Sokoto State, harmattan carries large amounts of dust, which can worsen the respiratory problems of sickle cell patients. They have to cover their noses to filter dust and purify the air they breathe,” adds the climate expert.
For Professor Kola-Olusanya, the combination of poor climatic conditions and sickle cell anemia constitutes a major problem, which requires better support from those who take care of them. “Those who fight against this disease must be taught to face extreme temperatures,” he concludes.
