Elsevier

World Neurosurgery

Volume 84, Issue 6, December 2015, Pages 1566-1571.e2
World Neurosurgery

Original Article
Reference Ranges for Head Circumference in Ethiopian Children 0–2 Years of Age

https://doi.org/10.1016/j.wneu.2015.08.045Get rights and content
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open access

Background

Head circumference (HC) charts are important for early detection of hydrocephalus during childhood. In low-income countries where population-based HC charts are rarely available, hydrocephalus occurs more commonly than in developed countries, and is usually not diagnosed early enough to prevent severe brain damage. This applies to Ethiopia as well. The World Health Organization (WHO) has provided standard HC charts advocated for global use, but recent studies cast doubts whether these charts are equally applicable in various populations. The aim of the study was therefore to establish reference ranges for early childhood HC in Ethiopia.

Methods

In this prospective, observational cross-sectional study, measurements of HC were collected from healthy children of different ethnicities between birth and 24 months, in health centers situated in 5 Ethiopian cities. Reference ranges for HC were estimated using the LMS method and compared with those recommended by WHO.

Results

A total of 4019 children were included. Overall, 6.7% of boys and 7.1% of girls were above the +2 standard deviation (SD) of the WHO reference ranges, whereas the corresponding figures below −2 SD were 2.8% and 2.1%. Similarly, the +2 SD lines of the Ethiopian reference curves were considerably higher than those of the WHO growth standards, whereas the median and −2 SD lines were more comparable.

Conclusions

Ethiopian HC reference ranges for children from birth to 24 months of age were found to differ significantly from those established by WHO and should correspondingly be considered as the first choice for screening for hydrocephalus in that population.

Key words

Developing country
Ethiopia
Head circumference
Hydrocephalus
Neurosurgery
Occipitofrontal circumference
Pediatrics
Screening

Abbreviations and Acronyms

HC
Head circumference
MGRS
Multicentre Growth Reference Study
SD
Standard deviation
WHO
World Health Organization

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Supplementary digital content available online.

Conflict of interest statement: Ephrem Bililigne Amare received financial support from the Norwegian Government through the Quota Scheme. The remaining authors have no conflicts to report.

Mari Idsøe and Miriam Wiksnes have contributed equally to the work presented in this paper and should both be considered second authors. Pétur B. Júlíusson, Torvid Kiserud, and Knut Wester should be considered senior authors.