Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Critique our position - Sickle cell anaemia in sub-Saharan Africa (Cameroon), published by EffectiveHelp - Cameroon on August 19, 2024 on The Effective Altruism Forum.

There is a good post exploring sickle cell disease, here: [Cause Exploration Prizes] Sickle Cell Disease - EA Forum (effectivealtruism.org). This is a good starting point before reading this one.

Effective Help[1] is a small EA-inspired Cameroonian[2] organization trying to identify local cost-effective projects. We analysed data from 39 local projects and found one standing out, a small monthly cash transfer to families with a child or more suffering from sickle cell anaemia. We decided to partner with the NGO carrying out this project and raise funds for it.

We think this is a good way forward for us. Please go through our thinking below and tell us how to improve.

Questions:

1. How bad is sickle cell anaemia in Sub-Saharan Africa (Cameroon in particular) for those who suffer it?

2. Are cash transfers to families with children suffering from this problem a cost-effective form of reducing mortality and improving quality of life?

Our position: We don't think this is as cost-effective as some of the best causes globally, but we think it compares much better to other local NGOs in Cameroon and to other projects in crowdfunding sites, so we are comfortable raising more funds away from less cost-effective causes and towards this one.

The worst that can happen is that we transfer funds to a poor family, at a slightly higher cost than GiveDirectly (because of the small scale of the project, overhead is proportionally higher) and the best is that we save children from early deaths and make them win years of life with as little as 49USD a month (588 a year).

We also think the first family identified has such a brutal story, which we won't share here, that the children are significantly worse-off than the average children with sickle cell in Cameroon. We think the effect of the first donations securing the next 3 years of transfers for this family should be higher than if the project had a larger scale and covered hundreds of families systematically.

On the other hand, there is a point to be made about prioritizing families when the child is between 1 and 3 years of age and mortality peaks, and this specific family has already passed that stage.

You can check out the project on this page. Help children with sickle cell syndrome - GlobalGiving and other sickle-cell projects in GlobalGiving here: Search - GlobalGiving

How bad is sickle cell anaemia?

We have much better data from developed countries. Life expectancy with sickle cell anaemia could be 42 years for males and 48 for women, as opposed to 75 and 82.[3] Sickle cell-hemoglobin C disease is a bit better: 60 for males and 68 for females.

One of the studies we use as a reference followed 3,764 patients of different ages[4], and included investigation on 209 patients who died. 33% of those who died, died during an acute sickle crisis, and there was a high correlation between early death and some key symptoms of sickle cell anaemia: acute chest syndrome, renal failure, and seizures.

The information available tells us those living with sickle cell are very likely already to have a shorter life, even when they are accessing good treatment. This is sad and may reduce potential cost-effectiveness for our project (even in the best circumstances, patients tend to live less).

How much of the danger can be mitigated with treatment? How much worse is it without treatment?

Without treatment or with bad treatment most children die without reaching adulthood. As late as 1973, the median survival age was reported to be 14 years, and 20% of children died within two years.

So, we think regular treatment can more than triple life expectancy, over time adding 28 years to someo...