Original ArticleTreating Pediatric Hydrocephalus at the Neurosurgery Education and Development Institute: The Reality in the Zanzibar Archipelago, Tanzania
Introduction
Pediatric hydrocephalus is a large health burden for East African countries. Because these developing countries lack the infrastructure and organization for supporting epidemiologic research, the prevalence and incidence of hydrocephalus in East Africa is largely unknown.1 Some estimate an incidence of about 6000 new cases per year2; others have reported an estimate of >14,000 infants developing hydrocephalus in the first year of life.3
Tanzania is considered the 25th poorest country in the world.4, 5 The Zanzibar Archipelago is a semiautonomous insular region of Tanzania and comprises Unguja, Pemba, and many smaller islands, with a total population of >1.6 million.6 As population growth and urbanization occur,6 poverty levels in urban Unguja are reportedly decreasing; on the other hand, rural Unguja and Pemba are increasingly poverty stricken, more so than 5 years ago.7 Pemba is one of Tanzania's poorest and most isolated areas8 and the challenge of managing pediatric hydrocephalus there is even greater than in Unguja or mainland Tanzania.
The main objective of this study is to describe the general characteristics, epidemiology, and demographics of pediatric hydrocephalus affecting patients in the Zanzibar Archipelago. We further aim to report the use of surgical procedures and complication rate and to identify factors associated with higher postsurgical complication rate.
Section snippets
Study Design and Procedure
We prospectively collected data from all pediatric patients who were diagnosed with hydrocephalus and admitted at the Neurosurgery, Education and Development (NED) Institute at Mnazi Mmoja Hospital (MMH) in Stonetown, Unguja from December 2016 to December 2017.
Study Site
MMH is the main referral hospital in the Zanzibar Archipelago and receives patients from both main islands, Unguja and Pemba, and occasionally from mainland Tanzania. It is equipped with a computed tomography (CT) scanner, use of which is
Demographics
From December 2016 to December 2017, 63 patients presented at the NED Institute with pediatric hydrocephalus. Average age at first visit was 203 days, with a range of 2 days to 4 years. Gender distribution was 49.2% female and 50.8% male. Of all patients, 57.1% (n = 36) were originally from Unguja, 36.5% (n = 23) were from Pemba; and 6.3% (n = 4) were from mainland Tanzania.
Maternal and Prenatal History
All mothers (100%) had attended antenatal clinic for routine screening during pregnancy. Of them, 44.4% had been seen by a
Discussion
Pediatric hydrocephalus is a major health problem in all East African countries (South Sudan, Kenya, Uganda, Rwanda, Burundi, and Tanzania).2 A combination of medical and socioeconomic factors, including higher birth rates, poverty, and poor infrastructure, seem to affect the state of care for pediatric hydrocephalus in this part of the world.9 Furthermore, cultural aspects, such as the societal rejection of ill children3 along with poor health education, affect the willingness of parents to
Conclusions
Our findings suggest that hydrocephalus in Zanzibar has similar causes, progression, and complication rates to previous reports from other African centers. Further studies about PIH need to be conducted, because recent findings suggest that this is a potentially preventable cause of the disease. Our impression is that etiologic diagnosis is paramount to improve management and outcome of these patients.
Acknowledgments
We are profoundly grateful to Mohammed A. Haji, A.M.O., Said Simai, M.D., and Said Idrissa Ahmada, M.D. for their support and effort in the coordination of ISC at the NED Institute and to the NED Foundation, for funding the NED Institute.
References (25)
Educate one to save a few. Educate a few to save many
World Neurosurg
(2013)Pediatric hydrocephalus in East Africa: prevalence, causes, treatments, and strategies for the future
World Neurosurg
(2010)- et al.
Impact of mobile endoscopy on neurosurgical development in East Africa
World Neurosurg
(2010) United Republic of Tanzania: 2012 Population and Housing Census
(2014)- et al.
Infant hydrocephalus in sub-Saharan Africa: the reality on the Tanzanian side of the lake
J Neurosurg Pediatr
(2017) Population and Housing Censuses 1967, 1978, 1988, 2002 and 2012
(2012)Zanzibar sees a slight decline in poverty except for Pemba. The World Bank, November 2, 2017. Press Release No. 2018/041/AFR
Zanzibar Demographic Survey 2015
(2015)- et al.
Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions
Neurosurg Focus
(2016) Zanzibar Socio-Economic Survey 2015
(2015)
Complications of ventriculoperitoneal shunts in children in Dar es Salaam
East Cent Afr J Surg
Treatment of cerebrospinal fluid shunting complications in a Nigerian neurosurgery programme. Case illustrations and review
Pediatr Neurosurg
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2020, World NeurosurgeryCitation Excerpt :Furthermore, most women stated that they did not regularly eat vegetables and there were only 9 (3%) women who were taking folic acid supplementation. This is in keeping with the findings in western Tanzania and Zanzibar, where the preconception folic acid use has been estimated at 2%−5% among mothers of infants with hydrocephalus.39,40 One limitation of our study was that we did not measure the serum folate levels of the mothers, so we cannot confirm the rate of folate deficiency in this cohort of women.
Conflict of interest statement: Andreas Leidinger, M.D. has the following financial disclosure: Neurosurgery Fellowship/Grant provided by the NED Foundation, Valencia, Spain.