title: Pediatric Hydrocephalus in Ethiopia: Treatment Failures and Infections: A Hospital-Based, Retrospective Study.
abstract: OBJECTIVE
  Treatment of pediatric hydrocephalus in sub-Saharan countries is associated with significant complication rates. The objective of this study is to analyze the management of hydrocephalus and complication rates of surgical intervention in the Ethiopian setting to improve future quality.
  
  
  METHODS
  A retrospective cohort study was conducted in a neurosurgical teaching hospital. Two cohorts separated by 2.5 years were analyzed.
  
  
  RESULTS
  A total of 128 (58.6% male and 41.4% female) children with isolated hydrocephalus, meningomyelocele (MMC)-related hydrocephalus, or MMC without hydrocephalus were included. Their age ranged from 1 day to 5 years, for a mean age of 7.2 months (median age 2 months). One hundred thirteen patients had hydrocephalus, of whom 57 (44.5.3%) had isolated hydrocephalus and 56 (43.8%) had hydrocephalus associated with MMC. Seventy-seven (74.7%) patients underwent ventriculoperitoneal (VP) shunting, whereas 24 (23.3%) underwent endoscopic third ventriculostomy (ETV). The incidence of shunt infection was 23.4%. Reoperation was needed in 54 (52.4%) patients, with the most common indication being shunt failure. ETV failed in 14 (58.3%) of the 24 patients undergoing ETV.
  
  
  CONCLUSIONS
  VP shunt insertions had unacceptably high infection rate despite the presence of a protocol for the procedure. Intraoperative guidelines should be developed further and followed strictly to reduce infections. Such measures should include restricting the number of surgeons performing the procedure. In our opinion, one should avoid insertion of a VP shunt as the primary treatment. ETV has proved to be a good alternative in other studies and the decreasing pattern of ETV failure in our study also suggest ETV as a better alternative to VP shunt.
authors.affiliation: Neurosurgery Unit, Addis Ababa University, School of Health Sciences, Addis Ababa, Ethiopia.
authors.forename: Tsegazeab
authors.initials: T
authors.lastname: Laeke
authors.affiliation: Neurosurgery Unit, Addis Ababa University, School of Health Sciences, Addis Ababa, Ethiopia.
authors.forename: Abenezer
authors.initials: A
authors.lastname: Tirsit
authors.affiliation: Neurosurgery Unit, Addis Ababa University, School of Health Sciences, Addis Ababa, Ethiopia.
authors.forename: Hagos
authors.initials: H
authors.lastname: Biluts
authors.affiliation: School of life sciences, Manipal University, Dubai, United Arab Emirates.
authors.forename: Deeptha
authors.initials: D
authors.lastname: Murali
authors.affiliation: Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway. Electronic address: kgwe@helse-bergen.no.
authors.forename: Knut
authors.initials: K
authors.lastname: Wester
mesh_terms: D002557:Cerebrospinal Fluid Shunts; D002675:Child, Preschool; D004868:Equipment Failure; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology* / Q000601:surgery*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017211:Treatment Failure
keywords: ETV; Hydrocephalus; Management; Prevalence; Shunt infection; VP shunt