Article
Neurodevelopmental outcome in children with hydrocephalus in Malawi
Neurologische Entwicklung der Kinder mit Hydrocephalus in Malawi
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Authors
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Andrej Pala
- Universitätsklinikum Ulm, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
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James Rush
- University of Liverpool, Liverpool, Vereinigtes Königreich
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Thomas Kapapa
- Universitätsklinikum Ulm, Neurochirurgie, Ulm, Deutschland
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Christian Rainer Wirtz
- Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
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Benjamin Mayer
- Universität Ulm, Epidemiologie, Ulm, Deutschland
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Annie Micah-Bonongwe
- Queen Elizabeth Central Hospital, Neurosurgery, Blantyre, Malawi
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Melissa Gladstone
- University of Liverpool, Institute of Translational Medicine, Liverpool, Vereinigtes Königreich
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Patrick Kamalo
- Blantyre, Institute of Neurological Sciences, Institute of Neurological Sciences, Blantyre, Malawi
| Published: | June 4, 2021 |
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Outline
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Objective: Pediatric hydrocephalus are one of main factors responsible for high pediatric morbidity, mortality and functional disability in low-income countries. The overview of neurodevelopmental outcomes in these regions is very limited. The aim of this pilot investigation was to evaluate neurodevelopmental delay and poor functioning in a population of children with hydrocephalus in Malawi.
Methods: We conducted a prospective observational cohort study, at the tertiary neurosurgery clinic in Blantyre, Malawi in 2018, recruiting consecutive children with congenital and infantile hydrocephalus. We conducted demographic and health questionnaires of parents of children and have evaluated children’s functioning using the Liverpool Outcome Score and Eating and Drinking Ability Classification System. We also conducted full anthropometric assessment and directly assessed children using the Malawi Developmental Assessment Tool.
Results: We evaluated 41 children, with a mean age of 22.6 months. Functional assessment showed the majority of children 92.7% (CI 80.1- 98.5, n=38) had severe sequelae from the hydrocephalus and were found to be dependent on their parents or caregivers. Only 27 children ((27/41) 65.9%, CI 49.4 - 80.0) had full or expected control of their bowel and bladder and 6 children ((6/41)14.6%, CI 5.6 - 29.2) had recent history of seizures. Over two thirds of the children ((29/41)70.7% CI 56.8 - 84.6) were stunted and almost half of the cohort were underweight ((18/41) 43.9% (CI 28.5 - 60.3). Almost half ((20/41) 48.8% CI 32.9 - 64.9) had developmental delay on the MDAT with 17/41(41.5%, CI 26.4 - 56.6) graded as severely delayed (-
Conclusion: Our data demonstrates a high proportion of children with hydrocephalus who suffers from functional difficulties, stunted growth and developmental delay, in Malawi. There is a need for further research with larger numbers of patients to understand factors contributing to these results and potentially new strategies which could improve the treatment strategies.
