Primary Prevention of Stroke in Children with Sickle Cell Anaemia in Nigeria: Community vs Teaching Hospital

尼日利亚镰状细胞性贫血儿童中风的一级预防：社区与教学医院

• 批准号: 10225627
• 负责人: Halima Bello-Manga
• 金额: $ 8.51万
• 依托单位: BARAU DIKKO TEACHING HOSPITAL/ KADUNA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10225627
• 关键词: Accounting; Address; Administrator; Adopted; Affect; American Society of Hematology; Award; Birth; Blood; Blood Transfusion; Charge; Child; Clinical; Clinical Trials; Communities; Community Hospitals; Complication; Consolidated Framework for Implementation Research; Country; Coupled; Data; Detection; Disease; Dose; Drops; Education; Effectiveness; Evidence based practice; Family; Focus Groups; Funding; General Practitioners; Goals; Guidelines; Health; Health Personnel; Healthcare; Hospitals; Human Resources; Incidence; Income; Institution; Intervention; Interview; Measurement; Mentors; Methods; Morbidity - disease rate; National Institute of Neurological Disorders and Stroke; Needs Assessment; Neuraxis; Nigeria; Nurses; Outcome; Participant; Patients; Physicians; Prevention; Prevention program; Prevention strategy; Prevention trial; Primary Prevention; Process; Qualitative Methods; Randomized Clinical Trials; Randomized Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Research Personnel; Resources; Risk; Safety; Scientist; Sickle Cell Anemia; Site; State Government; Stroke; Stroke prevention; Supervision; Teaching Hospitals; Testing; Training; Transcranial Doppler Ultrasonography; United States; World Health Organization; adherence rate; base; burden of illness; certificate program; cohort; compare effectiveness; feasibility trial; hydroxyurea; implementation outcomes; implementation process; implementation science; implementation strategy; improved; informant; low and middle-income countries; mortality; pediatrician; programs; radiologist; recruit; retention rate; screening; standard care; standard of care; stroke incidence; stroke risk

ABSTRACT Stroke is a frequent complication of sickle cell anemia (SCA) that is associated with increased morbidity and mortality. Without any intervention, ~11% of children with SCA will develop stroke before their 17th 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, then hydroxyurea therapy for an indefinite period. In high-resource countries this strategy has dropped stroke incidence rates by 92%. In Nigeria, approximately 150,000 children with SCA are born annually, accounting for more than half of the total births with SCA worldwide. In comparison, there are only 1,700 affected births of children with SCA in the United States annually. Among each birth cohort, 15,000 children will have stroke annually in Nigeria. In 2016, as part of the capacity building objective of our Stroke Prevention Trial in Nigeria (SPRING,1R01NS094041) at Barau Dikko Teaching Hospital (BDTH) in Kaduna, TCD screening was adopted as standard of care. Before the trial, no TCD screening was performed at our trial site. Currently as standard of care, physicians at BDTH perform TCD screening, however, only 5.4% (1,101/20,040) of the eligible children with SCA living in Kaduna, Nigeria were reached. With just 21 radiologists and only 3 certified in TCD screening in Kaduna State, clearly, to achieve a decrease in stroke incidence among children with SCA living in Kaduna, and elsewhere, we must have a better implementation strategy to increase TCD screening. We therefore propose to initiate a stroke prevention program in a community hospital in Kaduna, Nigeria by task-shifting TCD screening and stroke detection to nurses. The aims of this proposal are to: 1) Identify barriers and facilitators that influence the adaptability of the transported intervention, including implementation process; 2) Build capacity for stroke detection and prevention in SCA in a community hospital; and 3) Conduct a feasibility trial comparing the effectiveness of a physician-based primary stroke prevention program in a teaching hospital to a task-shifted primary stroke prevention program in a community hospital.The proposed training and research will be conducted at Barau Dikko Teaching Hospital and Yusuf Dantsoho Memorial hospital in Kaduna, Nigeria and will provide preliminary data for a definitive randomized clinical trial in implementation science. A mentoring team of senior researchers in United States and Nigeria will supervise the applicant. The mentoring team has extensive research expertise in clinical trials in sickle cell disease and implementation science. The overall research objective is to develop strategies that will improve primary prevention of strokes in children with SCA.

摘要 卒中是镰状细胞性贫血（SCA）的常见并发症，与发病率增加相关 and mortality.如果不进行任何干预，约11%的SCA儿童将在17岁之前发生中风。 生日基于证据的卒中一级预防实践包括筛查异常 经颅多普勒（TCD）测量加上定期输血治疗，至少有一个 一年，然后无限期的羟基脲治疗。在资源丰富的国家， 中风发病率下降了92%在尼日利亚，大约有150，000名SCA儿童出生 每年，占全球SCA总出生人数的一半以上。相比之下，只有 在美国，每年有1,700名SCA儿童受影响。在每个出生队列中， 尼日利亚每年都有儿童中风。2016年，作为我们中风能力建设目标的一部分， 在卡杜纳的Barau Dikko教学医院（BDTH）进行的尼日利亚预防试验（SPRING，1 R 01 NS 094041）， 采用TCD筛查作为标准治疗。在试验之前，我们没有进行TCD筛查。 试验现场。目前，作为标准的护理，BDTH的医生进行TCD筛查，然而，只有5.4%的人 在尼日利亚的卡杜纳，有1，101/20，040名符合条件的SCA儿童接受了治疗。只有21个 在卡杜纳州，只有3名放射科医生和3名TCD筛查合格，显然， 在卡杜纳和其他地方的SCA儿童中，我们必须有一个更好的 加强中药筛查的实施策略。因此，我们建议启动一项预防中风的计划， 在尼日利亚的卡杜纳的一家社区医院， 护士本建议的目的是：1）确定影响适应性的障碍和促进因素， 运输干预，包括实施过程; 2）建立中风检测能力， 在社区医院预防SCA;和3）进行可行性试验，比较 在教学医院以医生为基础的原发性卒中预防计划， 社区医院的预防计划。拟议的培训和研究将在Barau进行 Dikko教学医院和Yusuf Dantsoho纪念医院在卡杜纳，尼日利亚，并将提供 执行科学中确定性随机临床试验的初步数据。一个指导团队， 美国和尼日利亚的高级研究人员将监督申请人。指导团队已经 在镰状细胞病临床试验和实施科学方面拥有广泛的研究专长。整体 研究目标是制定策略，改善儿童中风的一级预防， SCA。