Reference Ranges for Head Circumference in Ethiopian Children 0-2 Years of Age.
BACKGROUND
Head circumference (HC) charts are important for early detection of hydrocephalus during childhood. In low-income countries where population-based HC charts are rarely available, hydrocephalus occurs more commonly than in developed countries, and is usually not diagnosed early enough to prevent severe brain damage. This applies to Ethiopia as well. The World Health Organization (WHO) has provided standard HC charts advocated for global use, but recent studies cast doubts whether these charts are equally applicable in various populations. The aim of the study was therefore to establish reference ranges for early childhood HC in Ethiopia.


METHODS
In this prospective, observational cross-sectional study, measurements of HC were collected from healthy children of different ethnicities between birth and 24 months, in health centers situated in 5 Ethiopian cities. Reference ranges for HC were estimated using the LMS method and compared with those recommended by WHO.


RESULTS
A total of 4019 children were included. Overall, 6.7% of boys and 7.1% of girls were above the +2 standard deviation (SD) of the WHO reference ranges, whereas the corresponding figures below -2 SD were 2.8% and 2.1%. Similarly, the +2 SD lines of the Ethiopian reference curves were considerably higher than those of the WHO growth standards, whereas the median and -2 SD lines were more comparable.


CONCLUSIONS
Ethiopian HC reference ranges for children from birth to 24 months of age were found to differ significantly from those established by WHO and should correspondingly be considered as the first choice for screening for hydrocephalus in that population.
Department of Pediatrics, University of Addis Ababa, Addis Ababa, Ethiopia; Centre for International Health, University of Bergen, Norway.
Ephrem Bililigne
EB
Amare
Department of Clinical Medicine K1, University of Bergen, Norway; Department of Internal Medicine, Haugesund Hospital, Haugesund, Norway.
Mari
M
Idsøe
Department of Clinical Medicine K1, University of Bergen, Norway; Division of Internal Medicine, Volda Hospital, Møre and Romsdal Hospital Trust, Volda, Norway.
Miriam
M
Wiksnes
Department of Clinical Medicine K1, University of Bergen, Norway.
Thomas
T
Moss
Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium.
Mathieu
M
Roelants
Department of Pediatrics, University of Addis Ababa, Addis Ababa, Ethiopia.
Damte
D
Shimelis
Department of Clinical Science, University of Bergen, Norway; Department of Paediatrics, Haukeland University Hospital, Bergen, Norway.
Pétur B
PB
Júlíusson
Department of Clinical Science, University of Bergen, Norway; Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway.
Torvid
T
Kiserud
Department of Clinical Medicine K1, University of Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway. Electronic address: kgwe@helse-bergen.no.
Knut
K
Wester
D002508:Cephalometry; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005260:Female; D006257:Head / Q000033:anatomy & histology* / Q000473:pathology; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening; D011446:Prospective Studies; D012016:Reference Values
Developing country; Ethiopia; Head circumference; Hydrocephalus; Neurosurgery; Occipitofrontal circumference; Pediatrics; Screening