Delays in care for hydrocephalus and spina bifida at a tertiary hospital in Somaliland

Abstract

BackgroundChildhood neurosurgical conditions such as hydrocephalus and spina bifida represent a significant burden of death and disability worldwide, particularly in low and middle-income countries. However, there are limited data on the disease prevalence and delays in care for pediatric neurosurgical conditions in very low-resource settings. This study aims to characterize the delays in access to care for pediatric neurosurgical conditions in Somaliland.MethodsWe performed a retrospective review of all children with congenital hydrocephalus and spina bifida admitted to the Edna University Hospital (EAUH) in Somaliland between 2011 and 2018. Patient demographics were analyzed with descriptive statistics and χ2test statistics. We defined delays in care for each condition based on standard care in high-income settings. Univariate and multivariate logistic regression were performed to evaluate predictors of delay in care. Statistical significance was set at p<0.05.ResultsA total of 344 children were admitted to EAUH with neurosurgical conditions from 2011 to 2018. The most common condition was congenital hydrocephalus (62%). Delays in care were found for 90% of patients and were associated with the type of diagnosis and region. The longest delay among children with spina bifida was 60 months, while the longest delay for children with congenital hydrocephalus was 36 months. Children with congenital hydrocephalus or spina bifida traveling from foreign countries had the highest waiting time to receive care, with a median delay of 8 months (IQR: 5–11 months) and 4 months (IQR: 3–7 months), respectively.ConclusionWe found significant delays in care for children with neurosurgical conditions in Somaliland. This country has an urgent need to scale up its surgical infrastructure, workforce, and referral pathways to address the needs of children with hydrocephalus and spina bifida.

The Pattern and Profile of Orofacial Clefts in Somaliland: A Review of 40 Consecutive Cleft Lip and Palate Surgical Camps

“…Initially founded as a maternity hospital by its internationally recognized humanitarian namesake, it has become the largest hospital in Somaliland. 15,16 Since 2011, a partnership between this institution, a plastic surgeon certified by the American Board of Plastic Surgery, and a sponsoring non-governmental organization (NGO) has allowed for the performance of 40 surgical camps to treat CLP in this underserved region. This study aims to report our 13-year experience in treating patients with CLP at EAUH, including the pattern and clinical profiles of patients with CLP and the disparities in health care access that characterize this setting.…”

“…Edna Adan University Hospital (EAUH) is a charitable, non-profit hospital in Hargeisa, Somaliland. Initially founded as a maternity hospital by its internationally recognized humanitarian namesake, it has become the largest hospital in Somaliland 15,16 . Since 2011, a partnership between this institution, a plastic surgeon certified by the American Board of Plastic Surgery, and a sponsoring non-governmental organization (NGO) has allowed for the performance of 40 surgical camps to treat CLP in this underserved region.…”