JMIR Publications

ABSTRACT

Background:

Background:

Sickle Cell Disease (SCD) is a genetic blood disorder affecting millions globally with life-threatening complications, where most of the patients live in Sub-Saharan Africa. Children with SCD suffer from a high risk of stroke, which is one of the most serious and life-threatening complications of this condition. Although early screening of strokes could help prevent many of these cases, access to effective stroke screening remains limited in low-resource settings. Existing traditional approaches are highly operator-dependent and often miss silent strokes, while many other technologies are costly, resource-intensive, or difficult to deploy at scale in pediatric care. These limitations highlight the urgent need for accessible, scalable, and child-appropriate stroke screening and assessment tools suitable for low-resource healthcare

Objective:

Objectives: In this systematic literature review, our aims are following (1) uncover system-level barriers affecting stroke screening accessibility for pediatric sickle cell disease patients in low-resource settings, including underserved contexts within high-income countries, (2) identify existing and emerging stroke screening and assessment technologies reported in pediatric SCD or broader stroke populations and their implementation related characteristics such as feasibility, scalability, portability, and training requirements and (3) propose a design of a user-centered mHealth-enabled framework for stroke screening that can mitigate barriers for accessibility and operationally feasible in resource-constrained healthcare settings.

Methods:

Methods:

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to organize this search process. A systematic search was conducted using an advanced query with keywords and Boolean operators in the academic databases of PubMed, IEEE Xplore, Wiley Online Library, and Google Scholar. Studies published between January 1, 2021, and October 31, 2025, were selected. Data collected from the included studies were arranged into a preformatted Excel spreadsheet to support the analysis. Eligibility criteria were restricted to peer-reviewed studies published in English involving stroke screening in pediatric sickle cell disease. Risk-of-bias (RoB) assessment was performed using various risk-of-bias analysis tools due to the heterogeneity of the included studies. Narrative synthesis is used to understand the major barriers and key aspects of stroke screening technologies' adoption in low-resource settings.

Results:

Results:

The literature search initially identified 1465 articles, of which 28 (2%) were selected for analysis using the inclusion criteria. Among 28 studies, 10/28 studies (36%) focused on stroke screening accessibility for pediatric SCD patients in either LMICs (low- and middle-income countries) or High-income countries (HIC) for low-resource settings. 18/28 studies (64%) outlined key features and the feasibility of stroke screening technologies. Barriers related to low-resource settings were organized into four major key categories (workforce and training constraints, healthcare system and infrastructure barriers, sociocultural and awareness factors, economic and logistical constraints), emphasizing difficulties in accessing early stroke screening in resource-constrained settings. Additionally, existing and emerging stroke screening technologies were classified into five groups: non-imaging, imaging, light-based optical spectroscopy, biomarker-based, and AI and ML-based mHealth, wearable approaches. Finally, a comprehensive mHealth application is proposed for an easy-to-use screening experience to overcome the challenges of stroke screening for pediatric SCD patients in low-resource settings.

Conclusions:

Conclusions:

This study contributes to identifying major barriers to stroke screening in low-resource settings and highlights key characteristics of stroke screening solutions that can be utilized in the future. It also contributes to designing a holistic mHealth solution for implementing stroke screening clinical care for pediatric SCD patients in low-resource settings. Clinical Trial: Registration: PROSPERO 2025 CRD420251172487 (https://www.crd.york.ac.uk/PROSPERO/view/CRD420251172487). Funding: Supported by KSU OVPR Grand SEED Grant Challenge Fall 2024, Kennesaw State University