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Updated: Jul 23, 2025
A Precision Medicine Tool for Measurement and Monitoring of Hemoglobin S in Sickle Cell Disease Patients Receiving Transfusion Therapy
Barriers and Facilitators to a Task-Shifted Stroke Prevention Program for Children with Sickle Cell Anemia in a
Halima Bello-Manga1, Lawal Haliru1, Kudirat Ahmed1
1Kaduna State University.
Insights
Task shifting is a viable strategy to improve stroke prevention screening for children with sickle cell anemia in under-resourced Nigerian hospitals. This approach optimizes existing healthcare staff and builds capacity for sustainable care.
Area of Science:
- Implementation science
- Global health
- Pediatric hematology
Background:
- Children with sickle cell anemia (SCA) face high stroke risk, necessitating preventative measures.
- Standard stroke prevention protocols like blood transfusions and transcranial Doppler (TCD) screening are challenging in low-resource settings like Nigeria.
- This study explored contextual factors influencing TCD screening implementation in a Nigerian community hospital.
Approach:
- Qualitative methodology using focus groups with healthcare providers and interviews with hospital administrators.
- Analysis informed by the Consolidated Framework for Implementation Research (CFIR).
- Iterative deductive (CFIR) and inductive coding of transcripts.
Key Points:
- Identified key factors within the inner setting (clinic resources, climate) and individual characteristics (beliefs).
- External context, caregiver needs, and intervention characteristics also influenced implementation.
- Task shifting emerged as a necessary strategy for TCD screening in resource-limited environments.
Conclusions:
- Task shifting offers a practical solution to enhance healthcare delivery by optimizing human resources.
- This strategy can expand the healthcare workforce and build sustainable capacity for TCD screening.
- Implementing task shifting can improve stroke prevention for children with SCA in Nigeria.
Background:
Children with sickle cell anemia (SCA) are at high risk for stroke. Protocols for stroke prevention including blood transfusions, screening for abnormal non-imaging transcranial Doppler (TCD) measurements, and hydroxyurea therapy are difficult to implement in low-resource environments like Nigeria. This study aimed to examine the contextual factors around TCD screening in a community hospital in Nigeria using qualitative interviews and focus groups.
Methods:
We conducted focus groups with health care providers and interviews with administrative leadership of the community hospital. Interview guides and analysis were informed by the Consolidated Framework for Implementation Research (CFIR) framework. Transcripts were coded and analyzed using an iterative deductive (CFIR)/Inductive (transcribed quotes) qualitative methodology.
Results:
We conducted two focus groups and five interviews with health care workers (nurses and doctors) and hospital administrators, respectively. Themes identified key elements of the inner setting (clinic characteristics, resource availability, implementation climate, and tension for change), characteristics of individuals (normative, control, and behavioral beliefs), and the implementation process (engage, implement, and adopt), as well as factors that were influenced by external context, caregiver needs, team function, and intervention characteristics. Task shifting, which is already being used, was viewed by providers and administrators as a necessary strategy to implement TCD screening in a clinic environment that is overstressed and under-resourced, a community stressed by poverty, and a nation with an underperforming health system.
Conclusion:
Task shifting provides a viable option to improve health care by making more efficient use of already available human resources while rapidly expanding the human resource pool and building capacity that is more sustainable.
Trial Registration:
NCT05434000.
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