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

基本信息

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
项目类别：
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

项目摘要

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.

抽象的中风是镰状细胞性贫血 (SCA) 的常见并发症，与发病率增加相关和死亡率。如果不进行任何干预，约 11% 的 SCA 儿童将在 17 岁之前患上中风生日。初级卒中预防的循证实践包括筛查异常经颅多普勒 (TCD) 测量结合至少一种定期输血治疗一年，然后进行无限期的羟基脲治疗。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 150,000 名患有 SCA 的儿童出生每年，占全球 SCA 出生总数的一半以上。相比之下，只有在美国，每年有 1,700 名患有 SCA 的新生儿受到影响。每个出生队列中，有 15,000 尼日利亚每年都会有儿童中风。 2016 年，作为我们中风能力建设目标的一部分尼日利亚卡杜纳 Barau Dikko 教学医院 (BDTH) 的预防试验 (SPRING,1R01NS094041)，采用 TCD 筛查作为护理标准。试验前，我们的实验室未进行 TCD 筛查试用网站。目前，BDTH 的医生进行 TCD 筛查作为标准护理，但只有 5.4% (1,101/20,040) 居住在尼日利亚卡杜纳的符合条件的 SCA 儿童得到了覆盖。仅用21 显然，卡杜纳州只有 3 名放射科医生获得 TCD 筛查认证，以减少中风生活在卡杜纳和其他地方的 SCA 儿童的发病率，我们必须有更好的了解加强 TCD 筛查的实施战略。因此，我们建议开展中风预防工作尼日利亚卡杜纳一家社区医院的项目通过任务转移 TCD 筛查和中风检测来护士。该提案的目的是： 1) 确定影响适应性的障碍和促进因素传输的干预措施，包括实施过程； 2) 建设中风检测和治疗的能力社区医院的 SCA 预防； 3) 进行可行性试验，比较有效性将教学医院中基于医生的初级中风预防计划转变为任务转移的初级中风社区医院的预防计划。拟议的培训和研究将在 Barau 进行尼日利亚卡杜纳的 Dikko 教学医院和 Yusuf Dantsoho 纪念医院将提供实施科学中明确的随机临床试验的初步数据。导师团队由美国和尼日利亚的高级研究人员将对申请人进行监督。辅导团队有在镰状细胞病临床试验和实施科学方面拥有丰富的研究专业知识。整体研究目标是制定策略，改善患有以下疾病的儿童中风的一级预防斯卡。