Uganda's Mandatory Newborn Sickle Cell Disease Screening Programme: Translating a Decade of Evidence into Differentiated Implementation.

Uganda's sickle cell disease (SCD) prevalence of 1.3% and sickle cell trait (SCT) prevalence of 13.3% nationally represent a substantial public health burden, with an estimated 20,000 affected infants born annually. On 9 February 2026, Uganda's Ministry of Health launched a nationwide mandatory newborn screening programme for SCD, placing the country among the first in sub-Saharan Africa to implement universal birth screening. This policy builds on over a decade of evidence, including the Uganda Sickle Surveillance Study, and cost-effectiveness analyses showing dried blood spot (DBS) screening costs of $5.88 per child, with viable point-of-care thresholds of $3.07-$5.09. However, the initial rollout relies on rapid diagnostic tests within existing hub-and-CPHL systems and does not yet fully cover private facility births, immunization-based catch-up for missed cases, or older unscreened children. In addition, the current 4-6-week turnaround time with centralized confirmation at Central Public Health Laboratories remains an operational limitation. We propose a differentiated implementation framework to strengthen the programme. It aligns screening strategies with care entry points and age-specific test performance. Private facilities would use a microchip electrophoresis analyzer (Gazelle™) at birth due to reduced accuracy of lateral flow tests in high fetal hemoglobin. Public facilities would integrate Sickle SCAN or HemoTypeSC into immunization contacts from six weeks of age, with the 9-month contact prioritized as the most reliable screening timepoint given the progressive decline in HbF, and school-based programmes would target children aged 1-5 years who were previously missed. All pathways would connect to Uganda's 100-laboratory hub network for electrophoretic confirmation, potentially reducing turnaround time to 48-72 hours. By leveraging existing delivery, immunization, and laboratory infrastructure, this framework offers a feasible and equitable route to translate Uganda's mandatory screening policy into large-scale health impact.