The Burden of Pediatric Subarachnoid Hemorrhage Healthcare Disparities in Senegal: A Retrospective Cohort Study

Abstract

Introduction Pediatric aneurysms are uncommon but potentially deadly clinical conditions with varied etiology and outcomes. In low-resource countries, numerous barriers prevent the timely diagnosis and management of pediatric aneurysmal subarachnoid hemorrhage (aSAH). Thus, this study aimed to assess the mortality of pediatric aSAH stemming from limited access to pediatric neurological surgery care in Senegal. Methods Pediatric aSAH patients admitted at the authors’ institution from 2012 and 2020 were recruited. Spearman Rho’s correlation, McNemar’s test, and Wilcoxon signed-rank test were used. Odds ratios and their 95% confidence intervals were calculated, and the population attributable fraction (PAF) was used to quantify aSAH mortality attributable to lack of surgical care. Results Twenty-four pediatric patients (12 females and 12 males) aged 12.2 (95% CI=10.0-14.3) years presented with aSAH. They had 1 median aneurysm (range [1, 2]) measuring 12.6 (6.1-19.0) mm. The median WFNS grade was 3 (range [1, 4]), and the mean Fisher grade was 4 (range [1, 4]). Fifteen patients (62.5%) had surgical treatment on day 15.0 (IQR=23.0) of hospitalization. The overall mortality rate was 20.8%, and the PAF of mortality for lack of surgical treatment during hospitalization was 0.08. Conclusion Eight percent of deaths among pediatric aSAH patients who do not receive surgical treatment are attributable to lack of access to surgical treatment. Health systems strengthening policies should be implemented to address this health inequity.