Global Pediatric Health (May 2018)

Stroke Prevalence in Children With Sickle Cell Disease in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

  • Lianna J. Marks MD,
  • Deogratias Munube MBChB, MMed,
  • Philip Kasirye MBChB, MS,
  • Ezekiel Mupere MBChB, MMed, MS, PhD,
  • Zhezhen Jin PhD,
  • Philip LaRussa MD,
  • Richard Idro MBChB, MMed, PhD,
  • Nancy S. Green MD

DOI
https://doi.org/10.1177/2333794X18774970
Journal volume & issue
Vol. 5

Abstract

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Objectives . The prevalence of stroke among children with sickle cell disease (SCD) in sub-Saharan Africa was systematically reviewed. Methods . Comprehensive searches of PubMed, Embase, and Web of Science were performed for articles published between 1980 and 2016 (English or French) reporting stroke prevalence. Using preselected inclusion criteria, titles and abstracts were screened and full-text articles were reviewed. Results . Ten full-text articles met selection criteria. Cross-sectional clinic-based data reported 2.9% to 16.9% stroke prevalence among children with SCD. Using available sickle gene frequencies by country, estimated pediatric mortality, and fixed- and random-effects model, the number of affected individuals is projected as 29 800 (95% confidence interval = 25 571-34 027) and 59 732 (37 004-82 460), respectively. Conclusion . Systematic review enabled the estimation of the number of children with SCD stroke in sub-Saharan Africa. High disease mortality, inaccurate diagnosis, and regional variability of risk hamper more precise estimates. Adopting standardized stroke assessments may provide more accurate determination of numbers affected to inform preventive interventions.