mHealth-Enabled Stroke Screening for Pediatric Sickle Cell Disease in Low-Resource Settings: Systematic Literature Review of Critical Barriers, Emerging Technologies, and AI-Driven Solutions.

Background: Sickle cell disease (SCD) is a genetic blood disorder affecting millions globally, with life-threatening complications, and most patients live in sub-Saharan Africa. Particularly, children with SCD have a high risk of stroke. Although early screening for stroke could help prevent many cases, access to effective stroke screening remains limited in low-resource settings (LRS). Existing traditional approaches are highly operator-dependent, costly, resource-intensive, or difficult to deploy at scale in pediatric care. These limitations highlight the urgent need for accessible, scalable, and child-appropriate stroke screening and assessment tools suitable for low-resource health care contexts. Objective: The aims of this systematic literature review are to (1) uncover system-level barriers affecting stroke screening accessibility for patients with pediatric sickle cell disease (PSCD) in LRS, including underserved contexts within high-income countries; (2) identify existing and emerging stroke screening and assessment technologies and their implementation characteristics, such as feasibility, scalability, portability, and training requirements; and (3) propose a user-centered mobile health (mHealth) framework for stroke screening that improves accessibility and feasibility in resource-constrained health care settings. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to organize the search process. A systematic search was conducted using an advanced query and defined eligibility criteria in the academic databases of PubMed, IEEE Xplore, Wiley Online Library, and Google Scholar. Studies published in English between January 1, 2021, and October 31, 2025, were selected. Collected data were arranged in a preformatted Microsoft Excel spreadsheet for analysis. Risk-of-bias assessment was performed using various risk-of-bias assessment tools because of the heterogeneity of the included studies. Narrative synthesis was used for data synthesis. Results: The literature search initially identified 1465 studies, of which 28 (2%) were selected for analysis. Among the 28 studies, 10 (36%) focused on stroke screening accessibility for patients with PSCD in either low- and middle-income countries or other income-level countries for LRS, and 18 (64%) outlined key features and the feasibility of stroke screening technologies. Identified barriers were organized into 4 major categories (workforce and training constraints, health care system and infrastructure barriers, sociocultural and awareness factors, and economic and logistical constraints), emphasizing difficulties in accessing stroke screening in LRS. Additionally, existing and emerging stroke screening technologies were classified into 5 groups: nonimaging, imaging, light-based optical spectroscopy, biomarker-based, and artificial intelligence- and machine learning-based mHealth wearable approaches. Finally, a comprehensive mHealth app is proposed for an easy-to-use screening experience to address stroke screening challenges for patients with PSCD in LRS. Conclusions: This study contributes to identifying major barriers to stroke screening in LRS and highlights key characteristics of stroke screening solutions that can be used in the future. It also contributes to the design of a holistic mHealth solution for implementing stroke screening clinical care for patients with PSCD in LRS.