JMIR Publications

ABSTRACT

Background:

Background:

In Nigeria, approximately 150,000 children with sickle cell anemia (SCA) are born annually, accounting for more than half of all SCA births worldwide. Without intervention, ~11% of children with SCA will develop a stroke before their 20th birthday. Evidence-based practices for primary stroke prevention include screening for abnormal Transcranial Doppler (TCD) measurements coupled with regular blood transfusion therapy for at least one year, followed by hydroxyurea therapy indefinitely. In high-resource countries this strategy contributes to a 92% decrease in stroke incidence rates. In 2016, as part of a capacity building objective of the Stroke Prevention Trial in Nigeria (1R01NS094041-SPRING) TCD screening was adopted as standard care at Barau Dikko Teaching Hospital in Kaduna. However, with just 70 radiologists and only 3 certified in TCD screening in the state, only 5.4% (1,101/20,040) of eligible children with SCA were screened.

Objective:

There is a need to explore alternate implementation strategies to ensure children with SCA receive standard care TCD screening to decrease stroke incidence. This protocol describes a study to create a stroke prevention program in a community hospital in Kaduna through task shifting TCD screening to nurses and training medical officers to initiate and monitor hydroxyurea utilization for stroke prevention.

Methods:

This study will be conducted at two sites (teaching hospital and community hospital) over a period of 3 years (November 2020-November 2023), in three phases using both quasi-experimental and effectiveness-implementation study designs. In the needs assessment phase, focus groups and structured interviews will be conducted with health care providers and hospital administrators to identify barriers and facilitators to evidence-based stroke prevention practices. Results from the needs assessment will inform intervention strategies and a process plan to fit the needs of the community hospital. In the capacity building phase, nurses and medical officers at the community hospital will be trained on TCD screening and hydroxyurea initiation and monitoring. In the implementation phase, children with SCA age 2-16 years will be recruited into a non-randomized single arm prospective trial to determine the feasibility of initiating a task-shifted stroke prevention program by recording recruitment, retention, and adherence rates. The Reach and Effectiveness components of the RE-AIM framework will be used to evaluate implementation outcomes between the community and teaching hospitals.

Results:

Training nurses and medical officers on TCD screening and hydroxyurea utilization and monitoring in a local community hospital will increase the number of eligible children with access to evidence-based stroke prevention services, thereby decreasing stroke incidence rate among children with SCA in Kaduna, Nigeria.

Conclusions:

This study proposes a structured, theory-driven approach to create a stroke prevention program in a community hospital in Kaduna, Nigeria to decrease stroke incidence among children with SCA. Results will provide preliminary data for a definitive randomized clinical trial in implementation science. Clinical Trial: Not a randomized clinical trial