Complications and 3-month outcomes of children with hydrocephalus treated with ventriculoperitoneal shunts in Malawi

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OBJECTIVE

Hydrocephalus is the most common pediatric neurosurgical condition, with a high prevalence in low- and middle-income countries. Untreated, hydrocephalus leads to neurological disability or death. The epidemiology and outcomes of hydrocephalus treated by ventriculoperitoneal (VP) shunts in Sub-Saharan Africa are not well defined and vary by region. The aim of the present study was to examine the mortality and morbidity rates and predictors of mortality in children treated by VP shunt placement for hydrocephalus at Kamuzu Central Hospital in Lilongwe, Malawi.

METHODS

This is a prospective study of 100 consecutive children presenting with hydrocephalus who were treated with VP shunt placement from January 2015 to August 2017. Demographics, nutritional status, maternal characteristics, developmental delay, shunt complications, readmissions, and in-hospital and 3-month mortality data were collected. Multivariate logistic regression was used to identify predictors of death within 3 months of surgery.

RESULTS

Overall, 46% of participants were female, with an average age of 5.4 ± 3.7 months at the time of surgery. The majority of patients were term deliveries (87.8%) and were not malnourished (72.9%). Only 10.8% of children were diagnosed with meningitis before admission. In-hospital and 3-month mortality rates were 5.5% and 32.1%, respectively. The only significant association with mortality was maternal age, with older maternal age demonstrating decreased odds of 3-month mortality (OR 0.9, 95% CI 0.8–1.0, p = 0.045).

CONCLUSIONS

Surgical management of hydrocephalus with VP shunts portends a high mortality rate in Malawi. The association of younger maternal age with mortality is likely a proxy for social determinants, which appear to contribute as much to mortality as patient factors. VP shunting is inadequate as a sole surgical management of hydrocephalus in resource-limited settings.

ABBREVIATIONS CPC = choroid plexus cauterization; ETV = endoscopic third ventriculostomy; HIC = high-income country; KCH = Kamuzu Central Hospital; LMICs = low- and middle-income countries; ROC = receiver operating characteristic; VP = ventriculoperitoneal.

Article Information

Correspondence Trista Reid: UNC School of Medicine, University of North Carolina, Chapel Hill, NC. trista_reid@med.unc.edu.

INCLUDE WHEN CITING Published online May 10, 2019; DOI: 10.3171/2019.2.PEDS18325.

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.

Headings

Figures

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    Patient follow-up over 6 months. aPatients were lost to follow-up despite attempts to reach them by cell phone, home visit, and asking the village elder. Figure is available in color online only.

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    ROC curve for all-cause mortality by 3 months after surgery.

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