ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Acta Biomed. 2019; 90(2): 316–320. doi: 10.23750/abm.v90i2.8485

• The authors review the present status of newborn screening in Africa and discuss the concept that adding a neonatal screening for congenital hypothyroidism (CH) to an existing sickle cell disease screening would make it easier to implement than developing an independent screening program.• Structure, funding, political will and an efficient recall system are identified as being key requirements for the development of a successful neonatal screening for CH.

This article considers important aspects around the practical approach towards the development of a successful newborn screening (NBS) program for congenital hypothyroidism (CH) in Nigeria, a resource-limited country. As we all know, NBS for CH is routinely performed in high-resource countries since the 1970’s. First, the authors discuss whether there could be a synergy between the NBS for sickle cell disease (SCD) and for CH. This was contemplated in neighbouring Ghana where NBS for SCD has been piloted for many years at Komfo Anokye Teaching Hospital (KATH) in Kumasi. The SCD program is available on the first day of life to the babies born in this tertiary care center, where the samples are analyzed. The program remains active at KATH, but a lack of funding may jeopardize sustainable continuation of the program and its extension to the rest of the country. The addition of an NBS program for CH that would build on the existing infrastructure of the NBS program for SCD has been discussed but is presently not supported by the health authorities (Dr E Ameyaw, personal communication). Second, the development of an NBS for CH needs to consider the specificities of the country and can not be based simply on the protocols used in well-resourced countries. This was addressed in the recent guidelines for development of NBS for CH in India, including the option to measure TSH on a cord blood sample and the use of local laboratories to perform TSH determination. Indeed, several issues are specific to low-resource countries, including lack of a central laboratory, difficulty to trace positive patients, large number of at home deliveries and non-existence of a reliable system to ship samples. Finally, although not mentioned by the authors, point of care (POC) testing for TSH needs to be considered. It is available for NBS for SCD and such a test is being considered for inclusion in the 2020 WHO Model List of Essential In Vitro Diagnostics. Unfortunately, a reliable test is not yet available for TSH, although large-scale testing is being considered by several companies. Such a POC test for TSH would make it possible to have an immediate diagnosis for patients irrespective from where they live or where they were born.