Factors associated with stroke in patients with sickle cell disease at the National Reference Centre for Sickle Cell Disease, Niamey, Niger, 2023

Introduction: Stroke is one of the most serious complications of sickle cell disease. In Niger, available data are descriptive. This study aimed to identify the factors associated with stroke in patients with sickle cell disease followed at the National Reference Centre for Sickle Cell Disease (CNRD) in Niamey. Methods: We conducted a case-control study at the CNRD from 1 May to 15 July 2023, based on the review of follow-up records. Cases were patients with sickle cell disease (SS, Sβ, SC) who had had a stroke; each case was matched with the next two patients without stroke in the follow-up list. Factors associated with stroke were identified by multiple binary logistic regression (backward stepwise procedure). Results: A total of 348 patients were included (116 cases and 232 controls). All cases had the homozygous SS form, and 74.1% were aged 15 years or younger. In the final model, stroke was associated with irregular follow-up (aOR = 4.00; 95% CI: 2.15–7.43) and a history of transfusion (aOR = 61.67; 95% CI: 23.38–162.61). Mothers without employment (aOR = 0.45; 95% CI: 0.23–0.89) and anaemia recorded in the follow-up file (aOR = 0.11; 95% CI: 0.03–0.35) were inversely associated with stroke. The Hosmer–Lemeshow test indicated an adequate fit (p = 0.449). Conclusion: Irregular follow-up, transfusion history and maternal occupation were associated with stroke in patients with sickle cell disease. The apparently protective effect of anaemia should be interpreted with caution. Strengthening regular follow-up, with active recall of patients who miss appointments, is a priority.