Global neurosurgery: Reflections on myelomeningocele in the Zanzibar archipelago (Tanzania).

Objective: Our main goal was to describe the general characteristics and demographic data of myelomeningocele (MMC) patients at Mnazi Mmoja Surgical NED Institute (MMSNI) in Zanzibar and to assess the clinical characteristics and medium-term result-impact of the implemented health care measures. Methods: This is a retrospective study on 41 MMC patients treated at the MMSNI in Zanzibar (Tanzania) from September 2016 to September 2018. Patient demographics, prenatal care, clinical and radiographic characteristics, surgical management and nursing care, and clinical outcomes were abstracted. Results: The mean age of the patients was 6.1 ± 4.6 days, and 53.7% were males. A total of 51.2% came from Zanzibar, 39% to Pemba, and 9.8% from mainland Tanzania. Maternal ultrasound checkups revealed hydrocephalus in 18.7% of the cases. 85.4% of the newborns were operated on. Surgical wound infection was the most frequent complication (28.6%). A significantly higher risk of complications was observed in children from Pemba Island (p = 0.046) and those born by vaginal delivery (p = 0.694), particularly infections. During follow-up, 48.57% of the patients presented with infantile hydrocephalus and in the majority of them, a ventriculoperitoneal shunt was inserted. Conclusions: Proper prenatal care with early diagnosis, together with the neurosurgical and nursing standard of care in a specialized institution, are all essential to increase the chances of successful treatment of newborns harboring MMC and is one of the main goals pursued in the MMSNI, as the only referral public health center with locally trained health personnel in Zanzibar archipelago.

Hidrocefalia infantil en el África subsahariana: impacto de los cuidados perioperatorios en el archipiélago de Zanzíbar / Infant hydrocephalus in sub-Saharan Africa: Impact of perioperative care in the Zanzibar archipelago

INTRODUCCIÓN: La hidrocefalia infantil en países de bajo y mediano ingreso, representa uno de los problemas éticos y sanitarios más conflictivos con los que se enfrenta el desarrollo de la salud a nivel internacional. Las estimaciones más optimistas señalan que 200.000 nacidos anualmente desarrollarán una hidrocefalia o nacerán con un defecto del tubo neural en África oriental, central y sur de África (ECSA). Se calcula que menos del 10% de estos niños serán operados mediante derivaciones ventriculoperitoneales y, en general, en condiciones de mala calidad o con un índice de complicaciones muy elevado. OBJETIVO: Describir las características generales, la epidemiología y los datos demográficos de la hidrocefalia infantil de los pacientes atendidos en el Instituto NED en el archipiélago de Zanzíbar y valorar los detalles clínicos y los resultados a medio plazo del impacto de los cuidados de enfermería implantados. MATERIAL Y MÉTODOS: Se trata de un estudio observacional descriptivo y analítico de carácter retrospectivo, en pacientes diagnosticados y tratados de hidrocefalia infantil, en el período comprendido entre septiembre del 2016 y septiembre del 2018. Con la implantación de una serie de protocolos perioperatorios de enfermería en dichos pacientes, se describieron y analizaron los resultados obtenidos. RESULTADOS: Un total de 96 pacientes fueron atendidos de hidrocefalia infantil. Un 51% (n = 49) de estos pacientes eran varones, con una media de edad de 9,25 meses. Todas las madres de los pacientes fueron controladas durante el embarazo, pero solamente un 8% de ellas fueron tratadas con ácido fólico durante su gestación. El 81% de los niños nacieron mediante parto vaginal o parto espontáneo no complicado. Con respecto a la etiología, el 27,1% de la hidrocefalia tratada estaba asociada a una causa infecciosa y un 35,4% a una causa desconocida. Se realizaron 67 cirugías de derivación ventriculoperitoneal y 15 ventriculostomías endoscópicas. La tasa de complicaciones fue del 23,17%. CONCLUSIONES: Los resultados de esta investigación indican que la hidrocefalia infantil en Zanzíbar tiene una etiología, una evolución y unas complicaciones similares o menores que las descritas hasta la fecha en el África oriental. El hecho de implantar una serie de protocolos perioperatorios y cuidados estandarizados de enfermería influyen positivamente en los resultados obtenidos. En la actualidad, el Mnazi Mmoja Surgical NED Institute es uno de los escasos centros en África del Este con un registro exhaustivo de la actividad asistencial y el primer centro sanitario que oferta una formación continuada al personal de enfermería

INTRODUCTION: Child hydrocephalus in low- and middle-income countries represents one of the most sensitive ethical and health problems facing international health development. The most optimistic estimates indicate that 200,000 newborns annually will develop hydrocephalus or be born with a neural tube defect in East, Central and South Africa (ECSA). It is estimated that less than 10% of these children will be operated by ventriculoperitoneal shunts, and in general in poor quality conditions or with a very high complication rate. OBJECTIVE: To describe the general characteristics, epidemiology and demographic data of childhood hydrocephalus of patients treated at the NED Institute in the Zanzibar archipelago, and assess the clinical details and medium-term results of the impact of the set-up nursing care. MATERIAL AND METHODS: This is a descriptive and analytical observational study of a retrospective nature, in patients diagnosed and treated with childhood hydrocephalus, in the period from September 2016 to September 2018. With the implementation of a series of perioperative nursing protocols in these patients, the results obtained were described and analyzed. RESULTS: A total of 96 patients were treated for childhood hydrocephalus. 51% (n = 49) of these patients were male, with a mean age of 9.25 months. All the mothers of the patients were monitored during pregnancy, but only 8% were treated with folic acid during pregnancy. 81% of children were born through vaginal delivery or uncomplicated spontaneous delivery. Regarding the etiology, 27.1% of treated hydrocephalus was associated with an infectious cause and 35.4% with an unknown cause. 67 ventriculoperitoneal shunt surgery and 15 endoscopic ventriculostomies were performed. The complication rate was 23.17%. CONCLUSIONS: The results of this research indicate that childhood hydrocephalus in Zanzibar has etiology, evolution and complications that are similar to or less than those described to date in East Africa. Implementing a series of perioperative protocols and standardized nursing care positively influences the results obtained. Currently, the Mnazi Mmoja Surgical NED Institute is one of the few centers in East Africa with an exhaustive record of healthcare activity and is the first health center that offers further training to nurses

Infant hydrocephalus in sub-Saharan Africa: Impact of perioperative care in the Zanzibar archipelago. / Hidrocefalia infantil en el África subsahariana: impacto de los cuidados perioperatorios en el archipiélago de Zanzíbar.

INTRODUCTION: Child hydrocephalus in low- and middle-income countries represents one of the most sensitive ethical and health problems facing international health development. The most optimistic estimates indicate that 200,000 newborns annually will develop hydrocephalus or be born with a neural tube defect in East, Central and South Africa (ECSA). It is estimated that less than 10% of these children will be operated by ventriculoperitoneal shunts, and in general in poor quality conditions or with a very high complication rate. OBJECTIVE: To describe the general characteristics, epidemiology and demographic data of childhood hydrocephalus of patients treated at the NED Institute in the Zanzibar archipelago, and assess the clinical details and medium-term results of the impact of the set-up nursing care. MATERIAL AND METHODS: This is a descriptive and analytical observational study of a retrospective nature, in patients diagnosed and treated with childhood hydrocephalus, in the period from September 2016 to September 2018. With the implementation of a series of perioperative nursing protocols in these patients, the results obtained were described and analyzed. RESULTS: A total of 96 patients were treated for childhood hydrocephalus. 51% (n=49) of these patients were male, with a mean age of 9.25 months. All the mothers of the patients were monitored during pregnancy, but only 8% were treated with folic acid during pregnancy. 81% of children were born through vaginal delivery or uncomplicated spontaneous delivery. Regarding the etiology, 27.1% of treated hydrocephalus was associated with an infectious cause and 35.4% with an unknown cause. 67 ventriculoperitoneal shunt surgery and 15 endoscopic ventriculostomies were performed. The complication rate was 23.17%. CONCLUSIONS: The results of this research indicate that childhood hydrocephalus in Zanzibar has etiology, evolution and complications that are similar to or less than those described to date in East Africa. Implementing a series of perioperative protocols and standardized nursing care positively influences the results obtained. Currently, the Mnazi Mmoja Surgical NED Institute is one of the few centers in East Africa with an exhaustive record of healthcare activity and is the first health center that offers further training to nurses.