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：
10673681
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/10673681
关键词：
Accounting Address Administrator Adopted Affect American Society of Hematology Award Birth Blood Blood Transfusion Central Nervous System Cephalic Certification Charge Child Clinical Clinical Trials Communities Community Hospitals Complication Consolidated Framework for Implementation Research Country Coupled Data Detection Disease Dose Drops Education Effectiveness Eligibility Determination Evidence based practice Family Focus Groups Funding General Practitioners Goals Guidelines Health Health Personnel Healthcare Hospitals Human Resources Incidence Income Institution Intervention Interview Lobbying Measurement Mentors Methods Morbidity - disease rate National Institute of Neurological Disorders and Stroke Needs Assessment Nigeria Nurses Outcome Participant Patients Physicians Prevention Prevention program Prevention strategy Prevention trial Primary Prevention Process Qualitative Methods Random Allocation Randomized, Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Research Research Personnel Resource-limited setting Resources Risk Safety Scientist Sickle Cell Anemia Site State Government Stroke Stroke prevention Teaching Hospitals Testing Training Transcranial Doppler Ultrasonography United States World Health Organization adherence rate burden of illness cohort compare effectiveness feasibility trial hydroxyurea implementation evaluation implementation outcomes implementation process implementation science implementation strategy implementation/effectiveness improved informant low and middle-income countries mortality pediatrician programs radiologist randomized, clinical trials 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贫血（SCA）的常见并发症，与发病率增加有关和死亡率。没有任何干预，约有11％的SCA儿童将在17日之前出现中风生日。预防初次中风的循证实践包括筛查异常经颅多普勒（TCD）测量与常规输血疗法结合至少一个一年，然后在不确定的时期内羟基脲治疗。在高资源国家，该战略已经中风的发病率下降了92％。在尼日利亚，大约有15万名SCA儿童出生每年，在全球范围内占SCA的一半以上。相比之下，只有每年在美国有1,700人患有SCA儿童的出生。在每个出生队列中，15,000 儿童每年都会在尼日利亚中风。 2016年，作为我们中风能力建设目标的一部分尼日利亚的预防试验（春季，1R01NS094041）在卡杜纳（Kaduna）的Barau Dikko教学医院（BDTH） TCD筛查被用作护理标准。在试用之前，未在我们的试用地点。目前，作为护理标准，BDTH的医生进行TCD筛查，但是只有5.4％（1,101/20,040）居住在尼日利亚卡杜纳的合格儿童中有1,101/20,040。只有21 显然，在卡杜纳州的TCD筛查中只有3个证明者，显然可以减少中风 SCA居住在卡杜纳（Kaduna）以及其他地方的儿童的发病率，我们必须有更好的实施策略以增加TCD筛查。因此，我们建议启动预防中风通过任务转换TCD筛查和中风检测到尼日利亚卡杜纳的社区医院的计划护士。该提案的目的是：1）确定影响影响适应性的障碍和促进者运输干预，包括实施过程； 2）建立中风检测能力和在社区医院的SCA预防； 3）进行可行性试验，以比较在教学医院的基于医师的初级中风预防计划社区医院的预防计划。拟议的培训和研究将在巴劳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高级研究人员将监督申请人。指导团队有镰状细胞疾病和实施科学方面的临床试验中广泛的研究专业知识。总体研究目标是制定策略，以改善患有儿童的中风 SCA。

项目成果

期刊论文数量（6）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Strategies to increase access to basic sickle cell disease care in low- and middle-income countries.

DOI：
10.1080/17474086.2022.2063116
发表时间：
2022-04
期刊：
EXPERT REVIEW OF HEMATOLOGY
影响因子：
2.8
作者：
Dua, Meghna;Bello-Manga, Halima;Carroll, Yvonne M.;Galadanci, Aisha Amal;Ibrahim, Umma Abdulsalam;King, Allison A.;Olanrewaju, Ayobami;Estepp, Jeremie H.
通讯作者：
Estepp, Jeremie H.

Primary Prevention of Stroke in Children With Sickle Cell Anemia in Nigeria: Protocol for a Mixed Methods Implementation Study in a Community Hospital.

DOI：
10.2196/37927
发表时间：
2022-06-13
期刊：
JMIR RESEARCH PROTOCOLS
影响因子：
1.7
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.
通讯作者：
King, Allison A.

Translating research to usual care of children with sickle cell disease in Northern Nigeria: lessons learned from the SPRING Trial Team.

DOI：
10.1186/s13104-021-05885-1
发表时间：
2022-01-04
期刊：
BMC research notes
影响因子：
1.8
作者：
Bello-Manga H;Haliru L;Tabari AM;Farouk B;Suleiman A;Bahago GY;Sani AM;Bauman AA;DeBaun MR;King AA
通讯作者：
King AA

Barriers and Facilitators to a Task-Shifted Stroke Prevention Program for Children with Sickle Cell Anemia in a Community Hospital: A Qualitative Study.

社区医院镰状细胞性贫血儿童任务转移中风预防计划的障碍和促进因素：定性研究。

DOI：
10.21203/rs.3.rs-2985921/v1
发表时间：
2023
期刊：
Research square
影响因子：
0
作者：
Bello-Manga,Halima;Haliru,Lawal;Ahmed,Kudirat;Ige,Samuel;Musa,Hayatu;Muhammad-Idris,ZainabKwaru;Monday,Binshak;Sani,AbdulrashidM;Bonnet,Kemberlee;Schlundt,DavidG;Varughese,Taniya;Tabari,AbdulkadirM;DeBaun,MichaelR;Baumann,A
通讯作者：
Baumann,A

Strengthening research capacity through an intensive training program for biomedical investigators from low- and middle-income countries: the Vanderbilt Institute for Research Development and Ethics (VIRDE).