Management of neural tube defects in a Sub-Saharan African country: the situation in Yaounde, Cameroon.
BACKGROUND
Neural tube defect is a serious disabling but preventable congenital malformation with an incidence of 1.99 per 1000 births in Yaounde [A.K. Njamnshi, V. d e P. Djientcheu, A. Lekoubou, M. Guemse, M.T. Obama, R. Mbu, S. Takongmo, I. Kago. Neural tube defects are rare among black Americans but not in Sub-Saharan black Africans: The case of Yaounde-Cameroon. Journal of the Neurological Sciences 2008; 270: 13-17]. The management requires highly qualified personnel and a significant social cost. The aim of this study was to evaluate the management of neural tube defect in a resource-limited developing Sub-Saharan nation like Cameroon.


METHODS
We reviewed all patients with neural tube defects admitted in the neonatology unit of the Mother and Child Center (Chantal Biya Foundation Yaounde) between January 1st 2000 and December 31st 2006.


RESULTS
Sixty-nine (69) patients were enrolled. There was a male predominance (69.57%) in the sample. Myelomeningomecele represented 68.11% of cases, followed by encephalocele (27.54%) and meningocele (4.35%). Antenatal ultrasound examinations were done in 27 cases (32.8%). The prenatal diagnosis was made only in 8 cases. No medical abortion was performed in any of these cases. Medical abortion is illegal in Cameroon (except in certain specific situations) as well as other Sub-Saharan African countries. Hydrocephalus was diagnosed in 40.02% of cases. As most of the patients (62.32%) could not afford modern treatment, only 26.09% of them were operated at birth. The rest sought traditional and other forms of treatment, due to poverty or cultural beliefs. Eight patients (11.59%) died before surgery. Surgery consisted of local closure alone (40%) or local closure associated to CSF shunting (60%). The complications were wound dehiscence (13.69%), shunt infection (1.37%), meningitis (1.37%) and iatrogenic pulmonary oedema (1.37%).


CONCLUSIONS
Neural tube defects are the most frequent and disabling malformations in neonates in the Sub-Saharan African paediatric environment. Prenatal management and outcome at birth are limited by poverty and cultural beliefs. Prevention is possible and may be better than palliative care in developing countries.
de Paul Djientcheu
Vincent
V
Neurosurgery Department, Central Hospital Yaounde, Cameroon.
Njamnshi
Alfred Kongnyu
AK
Wonkam
Ambroise
A
Njiki
Julie
J
Guemse
Mohamadou
M
Mbu
Robinson
R
Obama
Marie Thérèse
MT
Takongmo
Samuel
S
Kago
Innocent
I
Tetanye
Ekoe
E
Tietche
Felix
F
D002163:Cameroon / Q000453:epidemiology; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009436:Neural Tube Defects / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies