Primary Stroke Screening and Hydroxyurea Treatment for Sickle Cell Anemia in Pediatric Healthcare Settings in East and Central Africa: A Narrative Review of Capacity Gaps and Opportunities.

Abstract

Objectives: Sickle cell anemia (SCA) is associated with increased morbidity and mortality and impacts resource-limited settings with limited capacity for diagnosis and treatment. This review provides context for the magnitude of the problem, describes screening methods to prevent stroke, and factors that impact outcomes.

Methods: A narrative review was conducted. Topics included background information on SCA, its clinical characteristics, complications including primary stroke, and available treatment options. Social, economic, and political factors in East and Central Africa were described.

Results: A total of 37 publications were categorized into four themes: morbidity and mortality of SCA in sub-Saharan Africa; TCD screening for risk of primary stroke in children; treatment of children with SCA in resource-limited settings; and approaches to capacity gaps.

Conclusion: SCA represents a public health problem in sub-Saharan Africa. TCD screening with hydroxyurea treatment can improve outcomes and prevent primary stroke. Multiple barriers exist, including limited diagnostic screening, inconsistent availability of and access to hydroxyurea, and knowledge gaps. These barriers are influenced by social, economic and policy factors that can be addressed to build capacity and improve outcomes.