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Neurological manifestations in Nigerian children with sickle cell disease: a single-center retrospective study
Evan Adetoye1,2, Adetola Adebanwo3, Funmilola Banjo3
1Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Ogun, Nigeria. adedamolaevan@gmail.com.
Insights
Neurological issues are common in Nigerian children with sickle cell disease (SCD), leading to disability and death. Early detection and management are crucial for better outcomes in these patients.
Area of Science:
- Pediatric Neurology
- Hematology
- Public Health
Background:
- Sickle cell disease (SCD) is a major health concern in Nigeria, causing significant childhood morbidity and mortality.
- Neurological complications are a major contributor to disability and poor outcomes in pediatric SCD patients.
- Limited data exists on the prevalence and determinants of neurological manifestations in Nigerian children with SCD.
Purpose of the Study:
- To determine the burden and associated factors of neurological manifestations in children with SCD.
- To evaluate the outcomes of neurological manifestations in pediatric SCD patients.
- To inform the development of targeted interventions for SCD neurological complications in resource-limited settings.
Main Methods:
- A retrospective study of 133 children under 15 with SCD managed at Olabisi Onabanjo University Teaching Hospital.
- Data collected via structured proforma included demographics, clinical history, neurological events (seizures, stroke, paralysis, headache, visual disturbance, silent cerebral infarct), and outcomes.
- Statistical analysis included descriptive and bivariate methods to identify associations.
Main Results:
- 21.1% of children with SCD experienced neurological manifestations, most commonly seizures (12.8%), headaches (9.8%), and paralysis (9.0%).
- Neurological events were significantly associated with age, increased crisis frequency, and prior neurological history.
- These manifestations correlated with higher mortality (6% overall), prolonged hospital stays, and residual deficits in survivors.
Conclusions:
- Neurological manifestations are frequent in pediatric SCD patients and linked to adverse outcomes like disability and extended hospitalization.
- Findings highlight the critical need for enhanced early detection and tailored management strategies.
- Improving care for neurological complications is essential to reduce the burden of SCD in resource-limited settings.
Background:
Sickle cell disease (SCD) is a hereditary hemoglobinopathy that poses a significant public health problem in Nigeria, associated with significant morbidity and mortality among affected children. Neurological manifestations contribute substantially to disability and adverse outcomes, however, comprehensive data on their burden and determinants in pediatric SCD patients remain limited.
Methods:
This single-center retrospective study examined children under 15 years of age with confirmed SCD managed at Olabisi Onabanjo University Teaching Hospital (OOUTH) between March 2022 and February 2025. A structured proforma was used to extract demographic data, clinical history, neurological manifestations, associated factors, and outcomes. The neurological manifestations assessed included seizure, stroke, paralysis, headache, visual disturbance, and silent cerebral infarct. Laboratory and imaging data, where available, were used to support the diagnoses. Data were analyzed using descriptive and bivariate statistical methods.
Results:
Among the 133 children with SCD, 28 (21.1%) had documented neurological manifestations. Seizures were the most frequent (12.8%), followed by headaches (9.8%), paralysis (9.0%), and stroke (6.8%). Most neurological events occurred between 5 and 10 years of age, with a mean onset of 7.2 ± 3.8 years. Neurological manifestations were significantly associated with age at presentation (p = 0.032), higher frequency of crises (p = 0.02), and prior history of neurological manifestations (p < 0.001). No statistically significant associations were observed between neurological manifestations and sex (p = 0.232), anemia (p = 0.6), or infections (p = 0.812). Neurological manifestations were associated with increased mortality, residual deficits, and longer hospital stay. Neurological manifestations were present in half (n = 4) of all recorded deaths, with an overall mortality of 6% in the patients studied. Among survivors, approximately one-third had residual neurological deficits.
Conclusion:
Neurological manifestations in children with SCD are relatively common and are associated with adverse outcomes, including disability and prolonged hospitalization. These findings underscore the urgent need for improved early detection and context-appropriate preventive and management strategies to reduce this burden in resource-limited settings.
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