Identifying strokes in Nigerian children with sickle cell disease as part of clinical trials: training curriculum for healthcare professionals in low-income settings
IntroductionNigeria has the highest proportion of children with sickle cell anemia (SCA) globally; without transcranial Doppler screening and ongoing treatment (regular blood transfusions or hydroxyurea therapy), 10% will have a stroke in childhood. In low-resource settings, training to recognize an...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Stroke |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fstro.2024.1444718/full |
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| author | Djamila L. Ghafuri Halima Bello-Manga Fenella J. Kirkham Mariana Ciobanu Edwin Trevathan Edwin Trevathan Mark Rodeghier Michael R. DeBaun Michael R. DeBaun Lori C. Jordan |
| author_facet | Djamila L. Ghafuri Halima Bello-Manga Fenella J. Kirkham Mariana Ciobanu Edwin Trevathan Edwin Trevathan Mark Rodeghier Michael R. DeBaun Michael R. DeBaun Lori C. Jordan |
| author_sort | Djamila L. Ghafuri |
| collection | DOAJ |
| description | IntroductionNigeria has the highest proportion of children with sickle cell anemia (SCA) globally; without transcranial Doppler screening and ongoing treatment (regular blood transfusions or hydroxyurea therapy), 10% will have a stroke in childhood. In low-resource settings, training to recognize and prevent strokes in children with SCA is vital. A sustainable Sickle Cell Disease Stroke Prevention Teams program was established, as part of clinical trials, to address the need for stroke care in northern Nigeria. We describe our health professional stroke training curriculum and specific application to detect strokes in clinical trials in low-resource settings.MethodsChildren aged 5–12 and 2–16 years with SCA in northern Nigeria were enrolled in the SPRING and SPRINT primary and secondary stroke prevention trials, respectively. The primary outcome measure in both trials was a clinical stroke based on the World Health Organization definition. Non-neurologist physicians were trained in-person and via video lectures regarding stroke recognition, performing neurological examinations using the adapted Pediatric NIH Stroke Scale, and acute stroke care. Central stroke adjudicators, two pediatric neurologists, reviewed the case report forms and recorded videos of the neurological examinations.ResultsSix physicians completed the curriculum at three sites and were certified to detect strokes. Of 20 children with suspected stroke, 8 and 11 children had acute initial or acute recurrent strokes confirmed in the SPRING (N = 220) and SPRINT (N = 101) trials, respectively. The concordance rate between local stroke diagnoses and the central stroke adjudication process was 95% (19 of 20). One child presented with non-specific symptoms and hypertonia and was mislabeled locally as an acute stroke.DiscussionA curriculum to train healthcare providers in pediatric acute stroke recognition and care in a low-resource setting is feasible and sustainable. We successfully identified strategies for task shifting from a single pediatric neurologist in the region to multiple non-neurologist physicians. |
| format | Article |
| id | doaj-art-f5a8cbe0261e463dac84355a41847303 |
| institution | Kabale University |
| issn | 2813-3056 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Stroke |
| spelling | doaj-art-f5a8cbe0261e463dac84355a418473032025-01-06T04:13:06ZengFrontiers Media S.A.Frontiers in Stroke2813-30562025-01-01310.3389/fstro.2024.14447181444718Identifying strokes in Nigerian children with sickle cell disease as part of clinical trials: training curriculum for healthcare professionals in low-income settingsDjamila L. Ghafuri0Halima Bello-Manga1Fenella J. Kirkham2Mariana Ciobanu3Edwin Trevathan4Edwin Trevathan5Mark Rodeghier6Michael R. DeBaun7Michael R. DeBaun8Lori C. Jordan9Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, United StatesDepartment of Hematology and Blood Transfusion, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, NigeriaDevelopmental Neurosciences, University College London Great Ormond Street Institute of Child Health, London, United KingdomDepartment of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, United StatesDepartment of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, United StatesVanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United StatesRodeghier Consultants, Chicago, IL, United StatesVanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United StatesDepartment of Pediatrics, Vanderbilt-Meharry Sickle Cell Center for Excellence, Nashville, TN, United StatesDepartment of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, United StatesIntroductionNigeria has the highest proportion of children with sickle cell anemia (SCA) globally; without transcranial Doppler screening and ongoing treatment (regular blood transfusions or hydroxyurea therapy), 10% will have a stroke in childhood. In low-resource settings, training to recognize and prevent strokes in children with SCA is vital. A sustainable Sickle Cell Disease Stroke Prevention Teams program was established, as part of clinical trials, to address the need for stroke care in northern Nigeria. We describe our health professional stroke training curriculum and specific application to detect strokes in clinical trials in low-resource settings.MethodsChildren aged 5–12 and 2–16 years with SCA in northern Nigeria were enrolled in the SPRING and SPRINT primary and secondary stroke prevention trials, respectively. The primary outcome measure in both trials was a clinical stroke based on the World Health Organization definition. Non-neurologist physicians were trained in-person and via video lectures regarding stroke recognition, performing neurological examinations using the adapted Pediatric NIH Stroke Scale, and acute stroke care. Central stroke adjudicators, two pediatric neurologists, reviewed the case report forms and recorded videos of the neurological examinations.ResultsSix physicians completed the curriculum at three sites and were certified to detect strokes. Of 20 children with suspected stroke, 8 and 11 children had acute initial or acute recurrent strokes confirmed in the SPRING (N = 220) and SPRINT (N = 101) trials, respectively. The concordance rate between local stroke diagnoses and the central stroke adjudication process was 95% (19 of 20). One child presented with non-specific symptoms and hypertonia and was mislabeled locally as an acute stroke.DiscussionA curriculum to train healthcare providers in pediatric acute stroke recognition and care in a low-resource setting is feasible and sustainable. We successfully identified strategies for task shifting from a single pediatric neurologist in the region to multiple non-neurologist physicians.https://www.frontiersin.org/articles/10.3389/fstro.2024.1444718/fullstroke preventionchildrensickle cell anemialow-resource settingNigeriasub-Saharan Africa |
| spellingShingle | Djamila L. Ghafuri Halima Bello-Manga Fenella J. Kirkham Mariana Ciobanu Edwin Trevathan Edwin Trevathan Mark Rodeghier Michael R. DeBaun Michael R. DeBaun Lori C. Jordan Identifying strokes in Nigerian children with sickle cell disease as part of clinical trials: training curriculum for healthcare professionals in low-income settings Frontiers in Stroke stroke prevention children sickle cell anemia low-resource setting Nigeria sub-Saharan Africa |
| title | Identifying strokes in Nigerian children with sickle cell disease as part of clinical trials: training curriculum for healthcare professionals in low-income settings |
| title_full | Identifying strokes in Nigerian children with sickle cell disease as part of clinical trials: training curriculum for healthcare professionals in low-income settings |
| title_fullStr | Identifying strokes in Nigerian children with sickle cell disease as part of clinical trials: training curriculum for healthcare professionals in low-income settings |
| title_full_unstemmed | Identifying strokes in Nigerian children with sickle cell disease as part of clinical trials: training curriculum for healthcare professionals in low-income settings |
| title_short | Identifying strokes in Nigerian children with sickle cell disease as part of clinical trials: training curriculum for healthcare professionals in low-income settings |
| title_sort | identifying strokes in nigerian children with sickle cell disease as part of clinical trials training curriculum for healthcare professionals in low income settings |
| topic | stroke prevention children sickle cell anemia low-resource setting Nigeria sub-Saharan Africa |
| url | https://www.frontiersin.org/articles/10.3389/fstro.2024.1444718/full |
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