Neural tube defects in Uganda: follow-up outcomes from a national referral hospital

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Children with neural tube defects (NTDs) require timely surgical intervention coupled with long-term management by multiple highly trained specialty healthcare teams. In resource-limited settings, outcomes are greatly affected by the lack of coordinated care. The purpose of this study was to characterize outcomes of spina bifida patients treated at Mulago National Referral Hospital (MNRH) through follow-up phone surveys.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>All children presenting to MNRH with NTDs between January 1, 2014, and August 31, 2015, were eligible for this study. For those with a documented telephone number, follow-up phone surveys were conducted with the children’s caregivers to assess mortality, morbidity, follow-up healthcare, and access to medical resources.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Of the 201 patients, the vast majority (n = 185, 92%) were diagnosed with myelomeningocele. The median age at presentation was 6 days, the median length of stay was 20 days, and the median time to surgery was 10 days. Half of the patients had documented surgeries, with 5% receiving multiple procedures (n = 102, 51%): 80 defect closures (40%), 32 ventriculoperitoneal shunts (15%), and 1 endoscopic third ventriculostomy (0.5%). Phone surveys were completed for 53 patients with a median time to follow-up of 1.5 years. There were no statistically significant differences in demographics between the surveyed and nonrespondent groups. The 1-year mortality rate was 34% (n = 18). At the time of survey, 91% of the survivors (n = 30) have received healthcare since their initial discharge from MNRH, with 67% (n = 22) returning to MNRH. Hydrocephalus was diagnosed in 29 patients (88%). Caregivers reported physical deficits in 39% of patients (n = 13), clubfoot in 18% (n = 6), and bowel or bladder incontinence in 12% (n = 4). The surgical complication rate was 2.5%. Glasgow Outcome Scale–Extended pediatric revision scores were correlated with upper good recovery in 58% (n = 19) of patients, lower good recovery in 30% (n = 10), and moderate disability in 12% of patients (n = 4). Only 5 patients (15%) reported access to home health resources postdischarge.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>This study is the first to characterize the outcomes of children with NTDs that were treated at Uganda’s national referral hospital. There is a great need for improved access to and coordination of care in antenatal, perioperative, and long-term settings to improve morbidity and mortality.</jats:p></jats:sec>

Demography and management outcome of neural tube defects in a Nigerian tertiary health institution

“…22 Among the overt spina bifida, most authors reported higher myelomeningocele than our findings as reported in Turkey (71%), Sokoto (84.6%) in Nigeria, Ife (86.8%) in Nigeria, and 92% in Uganda. 18,23,25,32 Despite our finding of relatively lesser meningocele, our finding is more than twice the findings of Ismail et al in Sokoto Nigeria and thrice the findings in Turkey and Ife in Nigeria. 18.23,32 Based on spina bifida sites, lumbosacral lesions were more numerous than lumbar, thoracic and cervical lesions in descending order.…”

“…[18][19][20][21][22][23][24] However, others have reported male predominance in the studies from Uganda, Sudan, India, Kenya, Ife and Kano Nigeria. 18,[25][26][27]29,30 Equal sex distribution was found in Jos and North Central Nigeria. 30,31 Spina bifida was the commonest NTD, with its subsets of lumbosacral myelomeningocele being commoner than meningocele.…”

Long-term follow-up of neurosurgical outcomes for adult patients in Uganda with traumatic brain injury

“…Because long-term follow-up in LMICs can be challenging due to a lack of established infrastructure, we utilized previously validated phone surveys to assess long-term recovery of neurocognitive function to understand the risk of subsequent TBI-related sequelae. 11,17,18…”

Neural Tube Defects and Associated Factors among Neonates Admitted to the Neonatal Intensive Care Units in Hiwot Fana Specialized University Hospital, Harar, Ethiopia

“…4,19,[30][31][32] Improved access and coordination of care in antenatal, perioperative, and rehabilitative services in long-term settings are vital to reduce morbidity and mortality. 5,15,33,34 Moreover, identifying intervention targets and offering valuable input to the systematic development of prevention strategies is a crucial component of the effort to minimize the consequences of birth defects. 35 Despite the abovementioned burden of NTDs, studies that assess the magnitude and their associated factors are limited in Ethiopia, particularly in the study setting.…”