Stroke in Children with Sickle Cell Disease: Prevalence, Pattern of Presentation and Outcomes in Jos, Nigeria

Stroke in Children with Sickle Cell Disease

Abstract

Background: Stroke is a severe complication in children with sickle cell disease (SCD), leading to persistent disabilities and a markedly reduced quality of life. Most research on paediatric stroke in Nigerian children with SCD originates from low-altitude southern regions, leaving gaps regarding higher-altitude areas like Jos, Plateau State. This is important, as cerebral blood flow velocity has been shown to be influenced by altitude. We investigated the prevalence, presentation, and outcomes of stroke in children with SCD in Jos.

Methods: A descriptive, retrospective study was conducted at Jos University Teaching Hospital from January 2018 to December 2022 using data from the paediatric haematology registry and hospital records. Records of children under 18 years were thoroughly reviewed for demographic details, stroke history, presentation, and outcomes. Stroke was diagnosed per WHO criteria, and analyses were performed using SPSS version 23.0.

Results: Of 778 eligible children with SCD, 42 experienced stroke, yielding a prevalence of 5.4%. The mean age at first stroke was 7.7 ± 3.4 years, with 57.1% occurring in the 5–9-year group. Males comprised 57.1% of cases, and 57.1% belonged to the middle socioeconomic class. Clinically, all children exhibited limb weakness; hemiplegia was seen in 92.9% and aphasia in 42.9%. Concerningly, only 26.2% presented within 24 hours of symptom onset, and 40.5% had recurrent strokes.

Conclusion: This study reveals a significant burden of paediatric stroke in Nigerian children with SCD. High recurrence rates, consistently delayed presentations, and limited imaging highlight the urgent need for early transcranial Doppler screening, improved preventive measures, and better healthcare access to reduce the stroke burden.