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Factors affecting survival of infants with myelomeningocele in southeastern Uganda
Benjamin C Warf1, Ernest J Wright, Abhaya V Kulkarni
1Department of Neurosurgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts 02115, USA. benjamin.warf@childrens.harvard.edu
Insights
Five-year survival for infants with myelomeningocele (MM) and hydrocephalus in Uganda was 63%. Community-based rehabilitation programs significantly improved survival rates for these children.
Area of Science:
- Pediatric Surgery
- Neuroscience
- Public Health
Background:
- Myelomeningocele (MM) and hydrocephalus significantly impact infant survival in low-resource settings.
- Data on long-term outcomes for infants treated for these conditions in Uganda is limited.
Purpose of the Study:
- To determine the 5-year survival rate for infants treated for myelomeningocele (MM) and hydrocephalus in Uganda.
- To identify factors influencing mortality in this patient population.
Main Methods:
- A cohort of 140 infants undergoing MM repair before 6 months of age in Uganda was studied.
- Kaplan-Meier survival analysis was used, assessing factors like hydrocephalus presence and treatment.
- Data was collected via hospital records and interviews, with a median follow-up of 86 months.
Main Results:
- 63% of infants survived beyond 5 years, with an under-5 mortality rate of 37%.
- Mortality was not significantly associated with age at closure, lesion level, or hydrocephalus status.
- Survival rates were notably lower in areas without community-based rehabilitation programs (p=0.001).
Conclusions:
- Community-based support is crucial for improving the survival of children with MM and hydrocephalus in Africa.
- Surgical intervention alone is insufficient; integrated community support is essential for long-term outcomes.
Object:
The survival of infants treated for myelomeningocele (MM) and hydrocephalus in Uganda is unknown. This study investigated 5-year survival and the factors that influenced death in these patients.
Methods:
All 140 children from 16 contiguous districts in southeastern Uganda presenting to CURE Children's Hospital of Uganda for repair of MM prior to 6 months of age between December 2000 and December 2004 comprised the study cohort. Nine patients died within 1 month (6.4% operative mortality) and were excluded from further analysis. Sixty-seven (51%) required treatment for hydrocephalus. Survival status could not be determined for 3 patients (2%). Circumstances of death were ascertained by hospital record or interview. The Kaplan-Meier method was used for survival analysis. Association between survival and district of origin, age at MM closure, MM lesion level, presence of hydrocephalus, and method of hydrocephalus treatment were investigated.
Results:
The median follow-up was 86 months. Seventy-three children (56%) were alive at the time of the study, and 81 (63%) had survived more than 5 years. The under-5 mortality rate was 37% (2.5 times greater than the general population). Only 4 deaths appeared directly related to hydrocephalus or MM. There was no significant association between survival and age at MM closure, MM lesion level, presence of hydrocephalus, or its method of treatment. Mortality was lower, approaching that for their unaffected peers, in districts with community-based rehabilitation programs (p = 0.001).
Conclusions:
Community-based support following surgical interventions for MM and hydrocephalus appears essential to the continued survival of these children in Africa.
