Published in PLOS One on 2026-06-23, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Doreen Nayiga, David Mukunya, Simon Odoch, Faith Oguttu, Ian Munabi, Milton W Musaba, Charles Kimbugwe, Brian Tonny Makoko, Jonathan Babuya, Joshua Mugabi, Alain Nyalihama, Martin Chebet, Lisa Rynn, Samuel Kizito, Vincent Ssentumbwe, Sarah Kiguli, Peter Olupot Olupot
Source: PLOS One • DOI 10.1371/journal.pone.0351700
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Sickle cell anemia (SCA) is an autosomal recessive blood disorder resulting from a specific point mutation in the β-globin gene. Over half a million children are born with sickle cell anemia annually. Transcranial Doppler (TCD) velocity is an accurate predictor of the risk of stroke among children with sickle cell anemia. Unfortunately, TCD screening is not routinely done in developing countries due to limited resources. There is a need to develop a model that predicts elevated TCD velocity, utilizing routinely collected data to guide management of children with sickle cell anemia.
We conducted a cross-sectional study from 1st July 2024–30th August 2024 among children with SCA attending the Sickle Cell Clinic. We developed a risk-prediction model for elevated TCD (≥ 170 cm/s) using sociodemographic, hematological, and clinical factors.
We used the least absolute shrinkage and selection operator (LASSO) penalized regression to select the best subset of predictors of increased TCD velocity. Model performance was assessed by determining the discrimination using the area under the curve and calibration by drawing a calibration plot.
We enrolled 385 children; the mean age was 10.3 (SD 3.8) years. The prevalence of elevated TCD, defined as ≥170 cm/s was 8.3% (95% CI: 5.8, 11.5; n = 32/385). Using a lambda of 0.008, the final model had 12 predictors. The predictors included neuropathy, red blood cell count, heart rate, age, adherence to hydroxyurea, headache, hematocrit, serum lactate dehydrogenase, gender, malnutrition, blood transfusion, and neutrophils. The model predicted elevated TCD with an AUC of 84.7% (95%CI: 74.7, 90.8).
We developed and validated a model to predict elevated TCD among children living with SCA in Uganda. Further exploration is needed to assess whether this model predicts stroke.
Introduction
Sickle cell anemia (SCA) is an autosomal recessive blood disorder resulting from a specific point mutation in the β-globin gene, which results in substitution of glutamic acid to valine at position 6 of the β-globin chain [1]. Globally, more than half a million children are born with sickle cell anemia annually [2], and 80% of these are born in sub-Saharan Africa [3]. Uganda is ranked 5th among countries with the highest incidence of sickle cell anemia [4]. Children with sickle cell anemia (SCA) have a 30% life time risk of developing stroke [5,6]. This is 200-fold higher than the general pediatric population [5]. Children with sickle cell anemia in developing countries are more likely to develop complications such as stroke compared to those in developed countries [7]. This is due to limited access to TCD velocity screening services [8], drugs such as hydroxyurea, folic acid, penicillin, as well as blood transfusions [9,10]. In Uganda, the prevalence of stroke among children with SCA is 6.8% [11].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Doreen Nayiga, David Mukunya, Simon Odoch, Faith Oguttu, Ian Munabi, Milton W Musaba, Charles Kimbugwe, Brian Tonny Makoko, Jonathan Babuya, Joshua Mugabi, Alain Nyalihama, Martin Chebet, Lisa Rynn, Samuel Kizito, Vincent Ssentumbwe, Sarah Kiguli, Peter Olupot Olupot. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Burden of sickle cell anemia in Africa: A systematic review and meta-analysis
- Evidence brief: School absenteeism among children and adolescents aged 6–19 years with sickle cell disease in Uganda: A comparative cross-sectional study
- Evidence brief: Persistent proteinuria among a cohort of Nigerian children with sickle cell anaemia
