JMIR Publications

ABSTRACT

Background:

Sickle Cell Disease (SCD) is a genetic blood disorder affecting millions globally with life-threatening complications where most SCD patients live in Sub-Saharan Africa. In SCD children, strokes are one of the most frequent and life-threatening complications, and early screening of strokes could help prevent many of these cases. Standard Stroke Screening Tool (SST) covers only 8% of pediatric SCD screening in low resource settings. Existing methods like TCD are operator-dependent and miss silent strokes, while MRI and CT are costly and require contrast agents. New, accessible tools are urgently needed for spreading stroke screening and assessment in LMICs.

Objective:

In this systematic literature review, we aim to understand different barriers of low-resource and high resource setting of stroke screening accessibilities for SCD patients and show disparities among them. Additionally, we will provide different factors of existing standard and emerging technologies of stroke screening and assessments in context of LMICs. Finally, we will propose a mHealth solution for healthcare providers to use low cost, portable and operator independent machines using user-friendly and AI-based technologies.

Methods:

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to organize this literature search process. A systematic search conducted using an advanced query with keywords and boolean operator in academic databases of PubMed, IEEE Xplore, Scopus, Wiley Online Library and Google Scholar. Studies published between January 1, 2021, and December 31, 2024, were selected. Data collected from the included studies were arranged into a preformatted Excel spreadsheet to support analysis process. Thematic and Narrative synthesis is used for understanding major barriers and stroke screening technologies key aspects of adoption in LMICs.

Results:

The literature search identified 674 potentially relevant articles, of which 28 (4.15%) were selected for analysis using the inclusion criteria. Of the 28 studies, 10 (35.71%) focused on stroke screening accessibility for pediatric SCD patients in either LMIC or HIC resource settings, while 18 (64.29%) examined key features and feasibility of stroke screening technologies in low-resource environments. Barriers related to LMICs were organized into four key categories, emphasizing factors contributing to the limited adoption of early stroke screening in resource-constrained settings. Additionally, current and emerging stroke screening technologies were classified into five groups: imaging, non-imaging, blood biomarkers, SCOS, and AI-based approaches. Finally, a comprehensive mHealth application is proposed that provides an easy-to-use screening experience, addresses risk alerts, offers practical guidance, raises awareness, and facilitates remote clinical care to overcome the challenges of stroke screening for pediatric SCD patients in LMICs.

Conclusions:

This study contributes to designing a holistic mHealth solution for implementing stroke screening clinical care for pediatric SCD patients in low-resource settings. The insights from this study highlight the challenges of early stroke screening and the essential features of various technologies, offering guidance for creating a tailored, end-to-end screening system specific for low-resource environments, considering medical condition for pediatric SCD patients.