Patterns of Hydrocephalus in Rural Haiti: A Computed Tomography-Based Study.

INTRODUCTION/OBJECTIVE: Hydrocephalus is a common neurosurgical disorder that can lead to significant disability or death if not promptly identified and treated. Data on the burden of hydrocephalus in low-income countries are limited, given a lack of radiologic resources for the diagnosis of this condition. Here, we present an analysis of patterns of hydrocephalus from a large sample of computed tomography (CT) scans of the head performed at a public hospital in rural Haiti, a low-income country in the Caribbean. METHODS: We analyzed reports from 3614 CT scans of the head performed between July 2013 and January 2016 for findings that were consistent with a diagnosis of hydrocephalus (report indicating "hydrocephalus," "ventriculomegaly," or "enlargement of the ventricles"). Extracted data included demographics, study indication, radiologic findings, and reported etiology of hydrocephalus. RESULTS: In total, 119 scans had findings concerning for hydrocephalus (3.5% of all scans, 6.3% of abnormal scans; age range 0-90 years; median age 35.5 years; 49.6% male). Pediatric patients (<18 years of age) accounted for 39% of cases. In total, 113 of 119 (95%) scans had indications for possible neurosurgical intervention. Among these 113 scans, 36 (30%) scans demonstrated communicating hydrocephalus, 66 (55%) scans demonstrated noncommunicating hydrocephalus (primarily due to intraventricular hemorrhage [27 scans, 23%] or brain tumors [24, 20%]), and 11 (9%) scans were indeterminate regarding whether the hydrocephalus was communicating versus noncommunicating. CONCLUSIONS: In a large sample of CTs performed in a rural low-income setting, hydrocephalus was common, predominantly noncommunicating, and often associated with potentially operable intracranial lesions. Data of this nature can inform research, policy, and clinical collaborations that strengthen the neurosurgical capacity of low-income countries.

Head CT findings at a public hospital in rural Haiti.

BACKGROUND: Neuroimaging is often unavailable in low-income countries, creating challenges for precise diagnosis of neurologic disease in individual patients, and impeding acquisition of precise neuroepidemiologic data for program and policy development. METHODS: We analyzed reports from 3614 head CTs performed between July 2013 and January 2016 at Hôpital Universitaire de Mirebalais, a public academic hospital in rural Haiti, extracting patients' age, study indication, and radiologic findings. RESULTS: The most common indications for head CT were headache (27%), trauma (19.9%), abnormal neurological exam (12.2%), and stroke (11.3%). The most common categories of neurologic abnormalities were traumatic (31%), vascular (25.8%), and infectious (12%). Of 291 strokes, 64% were ischemic (median age at diagnosis 60.8years, SD 17.4) and 36% were hemorrhagic (median age 52.0, SD 15.5). In patients undergoing head CT for seizures or epilepsy, 17.5% had evidence of neurocysticercosis. In patients with head trauma, 42.6% had intracranial hemorrhage or fracture. Atrophy was noted on 10% of CTs (median age 57.1; SD 23.8), and was characterized as out of proportion to age in 2% (median age 34.1, SD 15.3). CONCLUSIONS: Median age of stroke patients in this rural low-income population is lower than in high-income countries and proportion of stroke due to intracerebral hemorrhage is higher. Neurocysticercosis is present in nearly one fifth of patients with seizures/epilepsy. These findings can inform policies and programs for prevention and treatment of neurologic disease in low-income settings.

A global health delivery framework approach to epilepsy care in resource-limited settings.

The Global Health Delivery (GHD) framework (Farmer, Kim, and Porter, Lancet 2013;382:1060-69) allows for the analysis of health care delivery systems along four axes: a care delivery value chain that incorporates prevention, diagnosis, and treatment of a medical condition; shared delivery infrastructure that integrates care within existing healthcare delivery systems; alignment of care delivery with local context; and generation of economic growth and social development through the health care delivery system. Here, we apply the GHD framework to epilepsy care in rural regions of low- and middle-income countries (LMIC) where there are few or no neurologists.