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

摘要 中风是镰状细胞性贫血(SCA)的一种常见并发症，与发病率增加有关 和死亡率。在没有任何干预的情况下，约11%的SCA儿童将在17岁之前发生中风 生日。一级卒中预防的循证做法包括筛查异常 至少一例患者的经颅多普勒(TCD)测量结合常规输血治疗 一年，然后无限期地进行羟基尿素治疗。在资源丰富的国家，这一战略 中风发病率下降了92%。在尼日利亚，大约有15万名患有SCA的儿童出生 每年，占全球SCA新生儿总数的一半以上。相比之下，只有 在美国，每年有1700名患有SCA的儿童受到影响。在每个出生队列中，15,000人 尼日利亚的儿童每年都会中风。2016年，作为我们中风能力建设目标的一部分 在尼日利亚的预防试验(春季，1R01NS094041)，在卡杜纳的Barau Dikko教学医院(BDTH)， 采用TCD筛查作为护理标准。在试验之前，我们没有进行TCD筛查 审判地点。目前，作为标准护理，BDTH的医生进行TCD筛查，然而，只有5.4% (1,101/20,040)居住在尼日利亚卡杜纳的符合条件的SCA儿童得到了帮助。只有21岁 在卡杜纳州，放射科医生和只有3人通过了TCD筛查，显然可以减少中风 生活在卡杜纳和其他地方的SCA儿童的发病率，我们必须有更好的 实施战略，增加TCD筛查。因此，我们建议发起一项中风预防 计划在尼日利亚卡杜纳的一家社区医院通过任务转移TCD筛查和中风检测来实现 护士。这项提案的目的是：1)找出影响 运输干预措施，包括实施过程；2)建立中风检测和 社区医院SCA中的预防；以及3)进行可行性试验，比较 以医生为基础的初级卒中预防计划在教学医院针对任务转移的初级卒中 社区医院的预防计划。拟议的培训和研究将在巴劳进行 位于尼日利亚卡杜纳的Dikko教学医院和Yusuf Dantsoho纪念医院将提供 实施科学中确定的随机临床试验的初步数据。一个指导团队 美国和尼日利亚的资深研究人员将监督申请者。指导团队已经 在镰状细胞病的临床试验和实施科学方面拥有广泛的研究专长。整体而言 研究目标是制定策略，改善中风儿童的一级预防 SCA。

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.