Prevalence and Clinical Characteristics of Acute Stroke among Children with Sickle Cell Disease Admitted to the University Teaching Hospitals-Children’s Hospital: A Retrospective Study.

Abstract

Background: Sickle cell disease (SCD) is a major public health concern, with Sub-Saharan Africa accounting for approximately 75% of the global burden. Approximately 10% of SCD patients experience symptomatic stroke within the first two decades of life. Epidemiological data on SCD-associated stroke in Zambia is limited.

Methods: This retrospective study reviewed 2022 records of children with SCD and acute stroke admitted to the University Teaching Hospitals-Children’s Hospital (UTHs-CH) in Lusaka, Zambia. It aimed to identify cases, describe their demographic and clinical characteristics and assess inpatient mortality outcomes.

Results: Among 971 children admitted with SCD, 35 (3.6%) presented with acute strokes; 17 cases had complete records. Mean age at presentation was 7 years (range: 3 to 15),77% females. The average age at SCD diagnosis was 32 months. Most patients (65%) were from Lusaka district, and 59% were self-referrals. Common stroke symptoms included: motor deficits 50%, seizures 24%, speech deficits 21% and headache 5%. Notably, 29% of patients did not receive blood transfusions, and among those transfused, 50% experienced >48-hour delays. Vaso-occlusive crises in the past year and prior strokes had occurred in 65 and 47%, respectively. Only 18% were on hydroxyurea. The inpatient mortality rate was 14%.

Conclusion: This study highlights a 3.6% prevalence of acute stroke among children with SCD at admitted to UTHs-CH and identifies gaps in acute care, particularly delays in blood transfusions. Future research should address barriers to timely intervention and optimize management protocols for SCD-associated strokes in Zambia.