Epidemiology of pediatric hydrocephalus in Haiti: analysis of a surgical case series

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OBJECTIVE

Hydrocephalus is recognized as a common disabling pediatric disease afflicting infants and children disproportionately in the developing world, where access to neurosurgical care is limited and risk of perinatal infection is high. This surgical case series describes the Project Medishare Hydrocephalus Specialty Surgery (PMHSS) program experience treating hydrocephalus in Haiti between 2008 and 2015.

METHODS

The authors conducted a retrospective review of all cases involving children treated for hydrocephalus within the PMHSS program in Port-au-Prince, Haiti, from 2008 through 2015. All relevant epidemiological information of children treated were prospectively collected including relevant demographics, birth history, hydrocephalus etiology, head circumference, and operative notes. All appropriate associations and statistical tests were performed using univariate and multivariate logistic regression analyses.

RESULTS

Among the 401 children treated within PMHSS, postinfectious hydrocephalus (PIH) accounted for 39.4% (n = 158) of cases based on clinical, radiographic, and endoscopic findings. The majority of children with hydrocephalus in Haiti were male (54.8%, n = 197), born in the rainy season (59.7%, n = 233), and born in a coastal/inland location (43.3%, n = 61). The most common surgical intervention was endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) (45.7%, n = 175). Multivariate logistic regression analysis yielded coastal birth location (OR 3.76, 95% CI 1.16–12.18) as a statistically significant predictor of PIH. Increasing head circumference (adjusted OR 1.06, 95% CI 0.99–1.13) demonstrated a slight trend toward significance with the incidence of PIH.

CONCLUSIONS

This information will provide the foundation for future clinical and public health studies to better understand hydrocephalus in Haiti. The 39.4% prevalence of PIH falls within observed rates in Africa as does the apparently higher prevalence for those born during the rainy season. Although PIH was the most frequent etiology seen in almost all birth locations, the potential relationship with geography noted in this series will be the focus of further research in an effort to understand the link between climate and PIH in Haiti. The ultimate goal will be to develop an appropriate public health strategy to reduce the burden of PIH on the children of Haiti.

ABBREVIATIONS AS = aqueductal stenosis; CPC = choroid plexus cauterization; ETV = endoscopic third ventriculostomy; HBM = Hospital Bernard Mevs; MMC = myelomeningocele; PIH = postinfectious hydrocephalus; PMHSS = Project Medishare Hydrocephalus Specialty Surgery.

Article Information

Correspondence John Ragheb: Nicklaus Children’s Hospital, Miami, FL. jragheb@med.miami.edu.

INCLUDE WHEN CITING Published online February 22, 2019; DOI: 10.3171/2018.12.PEDS18568.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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    Birthplaces of patients marked on a map of Haiti. The underlying copyrighted map can be found at: https://commons.m.wikimedia.org/wiki/Atlas_of_Haiti#/media/File%3AHaiti_departements_map-fr.png; ©Rémi Kaupp, CC-BY-SA 4.0 International (https://creativecommons.org/licenses/by-sa/4.0/). Figure is available in color online only.

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