Ventriculoperitoneal shunt surgery and shunt infections in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi

Mwang'ombe, N. J. M.; Omulo, Tom M.

doi:10.4314/eamj.v77i7.46684

Cited by 20 publications

(24 citation statements)

References 14 publications

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“…The infectious complication rate was 9.1%, which is comparable to the 9.7% rate reported in the standard-setting recent large-scale Ugandan study, and encouragingly lower than the 20%-50% range generally reported in most studies from Sub-Saharan Africa and other developing countries over the past decade. 12, 15,16,18,20,21,25 In fact, our rate of infectious complications lies just outside the 2%-9% range of infectious complications currently reported in North America. 6 The overall rate of pure mechanical failure (that is, not complicated by infection) was 11%.…”

Section: Discussionmentioning

confidence: 75%

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Outcomes of ventriculoperitoneal shunt insertion in Sub-Saharan Africa

Gathura¹,

Poenaru²,

Bransford³

et al. 2010

PED

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Object Ventriculoperitoneal (VP) shunts in Sub-Saharan Africa are traditionally associated with high complication rates and poor outcomes. The aim of this study was to review one large institutional experience with VP shunts, to evaluate the feasibility of shunt insertion procedures with acceptable long-term outcomes in Africa, and to identify factors correlated with good and/or poor outcomes. Methods A retrospective study was conducted by reviewing the charts of all children who underwent primary (93%) or subsequent VP shunt insertions at the Kijabe Hospital between November 2004 and March 2007. Epidemiological data, clinical investigations, etiology of the hydrocephalus, details of the VP shunt insertion, outcome at follow-up, and morbidity and mortality data were collected. Outcomes were graded as good, fair, or poor, according to visual, motor, and seizure criteria. Results The authors analyzed 593 VP shunt insertions in 574 patients. The sex distribution was 53% male and 47% female. The mean age at shunt insertion was 8.5 months (range 0–309 months). The commonest etiologies for hydrocephalus were spina bifida (43.4%) and postinfectious (27.7%). Follow-up was available in 76% of children, with a mean follow-up period of 8.9 months (range 2–30.5 months). The median patient age was 3.3 months. The overall shunt function rate at 2 years was 65%, and the complication rate per procedure was 20%, with infection encountered in 9.1% and shunt malfunction in 11%. Complications were significantly related to hydrocephalus etiology and to sex (p = 0.03 and p = 0.01, respectively). Overall outcomes were good in 40.2% and poor in 59.8%. Overall mortality in the group was 7.1%. Younger patients who survived had an overall good outcome (p = 0.0001). Only 10% of patients with a head circumference greater than 60 cm had a good outcome. Conclusions Despite limited resources, VP shunt procedures can be carried out in Sub-Saharan Africa with acceptable complication rates and fair long-term outcomes.

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Section: Discussionmentioning

confidence: 75%

“…By comparison, yearly volumes in the regional literature ranged from 34 to 50. 15,18,20 Predictors of Outcome Sex. Fifty-three percent of the patients were male in our study, which is consistent with a previously reported male preponderance in hydrocephalus.…”

Section: Patient Volumesmentioning

confidence: 99%

Outcomes of ventriculoperitoneal shunt insertion in Sub-Saharan Africa

Gathura¹,

Poenaru²,

Bransford³

et al. 2010

PED

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“…Staphylococcus aureus was reportedly a common organism in studies from Kenya and Nigeria. 4,5 But in Uganda, where neonatal ventriculitis is the most common cause of infant hydrocephalus, 11 we recently found evidence for a high prevalence of enteric organisms, especially Acinetobacter species, in the CSF of these infants, as well as in their home environments. 3 While clindamycin and rifampicin are effective against staphylococcal species, this is not true for gram-negative and enteric organisms.…”

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confidence: 97%

Effectiveness of the Bactiseal Universal Shunt for reducing shunt infection in a sub-Saharan African context: a retrospective cohort study in 160 Ugandan children

Lane

Mugamba

Ssenyonga

et al. 2014

PED

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Object Antibiotic-impregnated shunts have yet to find widespread use in the developing world, largely due to cost. Given potential differences in the microbial spectrum, their effectiveness in preventing shunt infection for populations in low-income countries may differ and has not been demonstrated. This study is the first to compare the efficacy of a Bactiseal shunt system with a non–antibiotic-impregnated system in a developing country. Methods The Bactiseal Universal Shunt (BUS) was placed in 80 consecutive Ugandan children who required a shunt. In this retrospective cohort study, the outcome for that group was compared with the outcome for the immediately preceding 80 consecutive children in whom a Chhabra shunt had been placed. The primary end points were shunt failure, shunt infection, and death. Shunt survival was analyzed using the Kaplan-Meier method. Significance of differences between groups was tested using the log-rank test, chi-square analysis, Fisher's exact test, and t-test. Results There was no difference between groups in regard to age, sex, or etiology of hydrocephalus. Mean follow-up for cases of nonfailure was 7.6 months (median 7.8 months, interquartile range 6.5–9.5 months). There was no significant difference between groups for any end point. The BUS group had fewer infections (4 vs 11), but the difference was not significant (p = 0.086, log-rank test). Gram-positive cocci were the most common culturable pathogens in the Chhabra group, while the only positive culture in the BUS group was a gram-negative rod. Conclusions These results provide equipoise for a randomized controlled trial in the same population and this has been initiated. It is possible that the observed trends may become significant in a larger study. The more complex task will involve determining not only the efficacy, but also the cost-effectiveness of using antibiotic-impregnated shunt components in limited-resource settings.

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“…In a retrospective review of 345 cases involving children with VP shunts at Kenyatta National Hospital, Nairobi, Mwang'ombe et al found an infection rate of 25%. 6 In Dar es Salaam, Kinasha et al reported an infection rate of 25%, an obstruction rate of 32%, and a combined complication rate of 46% in 65 children, 18% of whom were less than 6 months old. 2 Avoidance of a CSF shunt is particularly desirable in infants with extreme macrocephaly.…”

Section: Discussionmentioning

confidence: 99%

Choroid plexus coagulation in infants with extreme hydrocephalus or hydranencephaly

Shitsama

Wittayanakorn²,

Okechi³

et al. 2014

PED

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Object Severe hydrocephalus and hydranencephaly are common congenital conditions in Kenya. In patients with these conditions, ventriculoperitoneal (VP) shunts are associated with appreciable complications and endoscopic third ventriculostomies (ETVs) have limited success. Endoscopic choroid plexus coagulation (CPC) to diminish CSF production is a potential treatment option. The purpose of this study was to evaluate the effect of CPC without ETV in infants with severe hydrocephalus or hydranencephaly. Methods Medical records of infants with severe congenital hydrocephalus or hydranencephaly who underwent CPC in Kijabe Hospital from November 2010 to April 2013 were reviewed retrospectively. Thirty-three patients with complete medical records and preoperative radiographic images were identified. After CPC, the infants were followed in the Kijabe Hospital outpatient department, in mobile clinics, or by telephone. Success of the CPC was defined as resolution of preoperative symptoms, stabilization of head size, and avoidance of VP shunt placement. Results Patients were followed from 30 to 608 days (median of 120 days). Three patients were lost to follow-up. Of the 30 evaluable patients, CPC was considered to be successful in 13 (43.3%), including 8 of 20 patients with severe hydrocephalus and 5 of 10 with hydranencephaly. Failure of CPC was evident from increased head circumference in 14 (82%) of 17 patients and from CSF leakage in 3. Of the 17 failures, 13 occurred within 3 months of surgery. Six patients died: 3 whose CPC procedures were failures, 2 whose CPC was successful, and 1 postoperatively. Of the 17 in whom CPC failed, 10 subsequently underwent VP shunt insertion. Conclusions CPC stabilizes macrocephaly in approximately 40% of infants with severe congenital hydrocephalus and hydranencephaly and can be considered as an alternative to VP shunt placement.

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Ventriculoperitoneal shunt surgery and shunt infections in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi

Cited by 20 publications

References 14 publications

Outcomes of ventriculoperitoneal shunt insertion in Sub-Saharan Africa

Outcomes of ventriculoperitoneal shunt insertion in Sub-Saharan Africa

Effectiveness of the Bactiseal Universal Shunt for reducing shunt infection in a sub-Saharan African context: a retrospective cohort study in 160 Ugandan children

Choroid plexus coagulation in infants with extreme hydrocephalus or hydranencephaly

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