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Sickle cell disease (SCD) poses a major public health challenge in sub-Saharan Africa. Nigeria, being the most populous black nation in the world, bears its greatest burden in sub-Saharan Africa. The last few decades has witnessed remarkable scientific progress in understanding of its complex patho-physiology. However, improved clinical insights have heralded development and establishment of disease modifying interventions such as chronic transfusions; hydroxyurea and bone marrow transplant. Coupled with parallel improvements in general supportive, symptomatic and preventive therapies, current evidence reveals remarkable appreciation in quality of life among affected individuals in developed nations. However, in most West African states, treatment is largely sub-optimal. Thus, this text provides a current review on SCD management, with emphasis on local patterns/peculiarities, particularly from a Nigerian perspective. Established treatment guidelines as appropriate in the West African setting are proffered, as well as recommendations for improved care of affected persons.