Infant hydrocephalus in sub-Saharan Africa: the reality on the Tanzanian side of the lake

Maria M. Santos, Derick K. Rubagumya, Imani Dominic, Amos Brighton, Soledad Colombe, Philip O'Donnell, Micaella R. Zubkov, Roger Härtl

Research output: Contribution to journalArticlepeer-review


OBJECTIVE Infant hydrocephalus is estimated to affect more than 100,000 new infants each year in sub-Saharan Africa (SSA). Bugando Medical Centre (BMC), a government-funded and patient cost-shared referral center, serves over 13 million people in the Lake and Western regions of Tanzania. The goals of this study were to characterize the infant population affected by hydrocephalus who presented to BMC and were treated with a ventriculoperitoneal shunt (VPS) to determine the rate of early complications associated with this surgical procedure and to assess its potential risk factors. METHODS Data were prospectively collected from all patients less than 1 year of age who, over a period of 7 months, were diagnosed with hydrocephalus and admitted to BMC for insertion of a primary VPS. Demographic data, maternal history, preoperative studies, surgical procedure, and surgical complications developing by the time of the first follow-up visit were analyzed. Risk factors associated with the surgical complications were determined. RESULTS During the 7-month study period, 125 infants eligible for the study were included in the analysis. Overall, 75 months of age, and 56 98 and 2556, and other patients had postinfectious (22.4 or myelomeningocele-associated (16 hydrocephalus. Patients' mean head circumference on admission was 51.4 ± 6.3 cm. Their median age at shunt surgery was 137 days, and 22.4 at least one surgical complication was found in 33.6up assessment (median follow-up time of 70 days); shunt infection was the most common complication. The postoperative mortality rate was 9related etiology, larger head circumference, and postoperative hospital stays of greater duration. CONCLUSIONS In a region of the continent where most infant hydrocephalus cases had an uncertain etiology, most patients presented to the hospital in a late stage, with no prenatal diagnosis and with large head circumferences. Standard preoperative investigations were not uniformly performed, and the surgical complications, led by VPS infection, were disturbingly high. Younger patient age, previous endoscopic procedure, surgeon involved, and cranial location of the VPS had no statistical relation to the surgical complications. This study shows that the positive results previously reported by SSA mission hospitals, subspecialized in pediatric neurosurgery, are still not generalizable to every hospital in East Africa. To improve maternal and neonatal care in the Lake region of Tanzania, the development of a fluxogram to determine hydrocephalus etiology, a strict perioperative protocol for VPS insertion, and an increase in the number of endoscopic procedures are recommended to BMC.
Original languageEnglish
JournalJournal of Neurosurgery. Pediatrics
Issue number5
Pages (from-to)423-431
Number of pages9
Publication statusPublished - 1-Nov-2017


  • BKKH = Bethany Kids at Kijabe Hospital
  • BMC = Bugando Medical Centre
  • CPC = choroid plexus cauterization
  • CSF = cerebrospinal fluid
  • Dietary Supplements
  • ETV = endoscopic third ventriculostomy
  • Female
  • Folic Acid
  • Follow-Up Studies
  • HIV = human immunodeficiency virus
  • Humans
  • Hydrocephalus
  • Infant
  • infant hydrocephalus
  • Newborn
  • IQR = interquartile range
  • Male
  • MMC = myelomeningocele
  • Neuroendoscopy
  • Postoperative Complications
  • Prospective Studies
  • SSA = sub-Saharan Africa
  • sub-Saharan Africa
  • Tanzania
  • Ultrasonography
  • Prenatal
  • ventriculoperitoneal shunt
  • Ventriculoperitoneal Shunt
  • VPS = ventriculoperitoneal shunt


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