Primary Prevention of Stroke in Children With Sickle Cell Anemia in Nigeria: Protocol for a Mixed Methods Implementation Study in a Community Hospital.
Primary Prevention of Stroke in Children With Sickle Cell Anemia in Nigeria: Protocol for a Mixed Methods Implementation Study in a Community Hospital.
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DOI：
10.2196/37927
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发表时间：
2022-06-13
影响因子：
1.7
通讯作者：
King, Allison A.
中科院分区：
文献类型：
--
作者：
Bello-Manga, Halima;Haliru, Lawal;Ahmed, Kudrat Abdulkareem;Tabari, Abdulkadir Musa;Farouk, Bilkisu Usman;Bahago, Gloria Yimi;Kazaure, Aisha Shuaibu;Muhammad, Abdulrasheed Sani;Gwarzo, Samira Abubakar;Baumann, Ana A.;DeBaun, Michael R.;King, Allison A.
在尼日利亚，每年约有15万名患有镰状细胞性贫血(SCA)的儿童出生，占全世界SCA新生儿总数的一半以上。如果不进行干预，大约11%的SCA儿童将在20岁之前患上中风。一级卒中预防的循证做法包括筛查异常的经颅多普勒(TCD)测量，同时至少进行一年的定期输血治疗，然后无限期地进行羟基尿素(HU)治疗。在资源丰富的国家，这一战略有助于降低92%的中风发病率。2016年，作为尼日利亚中风预防试验能力建设目标的一部分(1R01NS094041：春季)，卡杜纳的Barau Dikko教学医院采用了TCD筛查作为标准护理。然而，该州只有70名放射科医生和3名获得TCD筛查资格的医生，只有5.49%(1101/20040)符合条件的SCA儿童得到了筛查。因此，有必要探索替代实施策略，以确保SCA儿童接受标准护理TCD筛查，以降低中风发生率。该协议描述了一项研究，该研究旨在通过将TCD筛查任务转移给护士并培训医务人员启动和监测HU用于中风预防的使用，在卡杜纳的一家社区医院创建中风预防计划。这项研究将在两个地点(教学医院和社区医院)进行，为期3年(2020年11月至2023年11月)，分3个阶段进行，采用准实验和有效性-实施研究设计。在需求评估阶段，将与卫生保健提供者和医院管理人员进行焦点小组和结构化访谈，以确定以证据为基础的中风预防实践的障碍和促进者。需求评估的结果将为干预战略和流程计划提供信息，以适应社区医院的需求。在能力建设阶段，将对社区医院的护士和医务人员进行TCD筛查和HU启动和监测方面的培训。在实施阶段，2-16岁的SCA儿童将被招募到一项非随机化的单臂前瞻性试验中，通过记录招募、保留和依从率来确定启动任务转移卒中预防计划的可行性。将使用RE-AIM(REACH、有效性、采用、实施和维护)框架的REACH和有效性部分来评估社区和教学医院之间的实施成果。这项研究的需求评估阶段于2021年2月完成。关于调查结果的手稿目前正在准备中。正在进行能力建设，为社区医院的护士和医生举办TCD培训和镰状细胞疾病和中风教育课程。预计执行试验的征聘工作将于2022年7月开始。这项研究提出了一种结构化的、理论驱动的方法，在尼日利亚卡杜纳的一家社区医院建立中风预防计划，以减少SCA儿童的中风发生率。结果将为实施科学中的最终随机临床试验提供初步数据。PRR1-10.2196/37927
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, about 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 (HU) 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, just 5.49% (1101/20,040) of eligible children with SCA were screened. Thus, 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 HU utilization for stroke prevention. This study will be conducted at 2 sites (teaching hospital and community hospital) over a period of 3 years (November 2020 to November 2023), in 3 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 HU initiation and monitoring. In the implementation phase, children with SCA aged 2-16 years will be recruited into a nonrandomized 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 (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework will be used to evaluate implementation outcomes between the community and teaching hospitals. The needs assessment phase of the study was completed in February 2021. Manuscript on findings is currently in preparation. Capacity building is ongoing with TCD training and sickle cell disease and stroke education sessions for nurses and doctors in the community hospital. Recruitment for the implementation trial is expected to commence in July 2022. 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. PRR1-10.2196/37927
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影响因子：
12.7
作者：
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通讯作者：
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