Presentation and management of paediatric hydrocephalus in two academic hospitals in Gauteng Province, South Africa

Agbor, Cyril
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Background Hydrocephalus is a leading paediatric neurosurgical condition in the sub - Saharan African region. It is associated with preventable mortality and morbidity that may be related to socio-demographic, clinical and management characteristics. An audit of current outcome of hydrocephalus at selected hospitals in Gauteng may improve practice. Aim The aim of the study was to describe the clinical and radiological features of hydrocephalus and it management among children attending Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwanath Academic Hospital (CHBAH), Gauteng Province. Methodology This was a prospective analytic cross-sectional study of newly diagnosed children (aged 0-16 years) with hydrocephalus conducted at the Neurosurgical units of CHBAH and CMJAH between September 2017 to August 2018. Socio-demographic and clinical characteristics were obtained from parents or caregivers using a self-administered questionnaire. Physical examination, assessment of the radiological image of the brain and management of each participant was recorded. Data were analysed using Stata statistical software to determine the pattern and determinants of the presentation and management of the condition.Results The median age of the children was 6 (2.5 - 16) months with 79% (n= 113) of them younger than 24 months. The male to female ratio among hydrocephalic children was 1.2:1. About three-fifths (3/5) of the parents only had at most primary level education and about 68.5% were unemployed. The majority of children (85.8%) below the age of 2 years presented with enlarged head whereas, the majority of children (n=28, 83.3 %) above two years presented with features of raised ICP. Thirty seven percent (37%) previously had meningitis while 21.7% have had spinal bifida and 23% had an abnormal motor function.During the antenatal period, 7.9% of the mothers had eclampsia while 38% of them took other drugs besides haematinics (such as antiretroviral drugs). Labour was prolonged in 31.5% of cases. Among the babies delivered, 33.6% were preterm and 28.7% having low birth weight. About 16.8% had a recurrent infection, while 0.49% had traumatic brain injury during the neonatal period. The majority of the patient (32.2%) had communicating hydrocephalus and, aqueductal stenosis (21.7%) was the most prevalent cause of obstructive hydrocephalus. Majority (92.3%) of the patient have operative intervention, mostly ventriculoperitoneal shunt for cerebrospinal fluid (CSF) diversion. Discussion Paediatric hydrocephalus is a common paediatric neurosurgery condition. It occurs more frequently among children below 24 months of age. Low socioeconomic status and exposure to predisposing factors during pregnancy, labour and postnatal periods lead to hydrocephalus. More than one-third were due to infective processes such as meningitis. The ventriculoperitoneal shunt remains the most commonly used method of diverting cerebrospinal fluid, even though it is fraught with high morbidity.Conclusion Reduction in the risk of perinatal and neonatal infections could drastically reduce the risk of meningitis and hydrocephalus in our environment. Public enlightenment campaigns on the risks and management of hydrocephalus among personnel and patients attending peripheral hospitals can help to reduce morbidity and mortality from hydrocephalus as the majority of our patients were delivered at the primary healthcare centres.
A research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine in Neurosurgery to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2020