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The etiology of pediatric hydrocephalus across Asia: a systematic review and meta-analysis
Eleanor Ferris1, Jacinta Kynaston1, David Ulrich Dalle2
11Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, United Kingdom.
Insights
Pediatric hydrocephalus causes vary across Asia, influenced by geography and economic factors. Nonpostinfectious causes are more common in high-income nations, while postinfectious hydrocephalus is prevalent in lower-middle-income countries.
Area of Science:
- Neurology
- Pediatrics
- Public Health
Background:
- Pediatric hydrocephalus affects many children globally, but its causes in Asia are not well-understood.
- Understanding the distribution of hydrocephalus etiologies in Asian children is crucial for developing targeted clinical guidelines and public health interventions.
Approach:
- A systematic review and meta-analysis of observational and experimental studies was conducted.
- Searched multiple databases (EMBASE, MEDLINE, CENTRAL, Global Health, Global Index Medicus, Scopus) from inception to January 2023.
- Calculated pooled proportions for postinfectious, nonpostinfectious, and spinal dysraphism-related hydrocephalus in pediatric populations across Asian countries.
Key Points:
- Nonpostinfectious hydrocephalus was the most common etiology overall (29.0%), followed by postinfectious (10.7%) and dysraphism-related (7.6%).
- Postinfectious hydrocephalus was more prevalent in lower-middle-income countries and negatively associated with Human Development Index and urbanization.
- Regional variations were observed: postinfectious hydrocephalus in South Asia, nonpostinfectious in East Asia, and dysraphism-related in West Asia.
Conclusions:
- Geographic and economic factors significantly influence the types of pediatric hydrocephalus found in Asia.
- The high proportion of unclear hydrocephalus etiologies underscores the need for better diagnostic tools and standardized classification systems.
Objective:
Despite the high prevalence and significant implications of pediatric hydrocephalus, the etiological distribution of pediatric hydrocephalus across the diverse Asian demographic is poorly understood. This study aimed to inform clinical guidelines and public health decisions by identifying the etiological distribution of pediatric hydrocephalus across Asia.
Methods:
In this systematic review and meta-analysis, the authors searched EMBASE, MEDLINE, CENTRAL, Global Health, Global Index Medicus, and Scopus, with no language restriction, from inception to January 27, 2023. Observational or experimental studies with pediatric data on the causes of hydrocephalus in a country within Asia were included. Pooled proportions of postinfectious hydrocephalus, nonpostinfectious hydrocephalus, and hydrocephalus related to spinal dysraphism were calculated using a random-effects model. Subgroup analyses were performed on prespecified moderators. Methodological study quality was assessed using the modified Newcastle-Ottawa Score and Cochrane's risk-of-bias tool as per the registered protocol on PROSPERO.
Results:
The search yielded 5110 results, for which 79 articles were included, with data on 11,529 children from 18 Asian countries. The pooled proportion of nonpostinfectious hydrocephalus was 29.0% (95% CI 22.9-35.5); postinfectious hydrocephalus was 10.7% (95% CI 7.7-14.1); and hydrocephalus secondary to dysraphism was 7.6% (95% CI 5.1-10.5). The pooled proportion of postinfectious hydrocephalus was greatest in lower-middle-income countries (19.2% [95% CI 12.8-26.3]). There was a negative association between the proportion of postinfectious hydrocephalus and Human Development Index (-1.45 [95% CI -2.21 to -0.69]; p < 0.001); urbanization of the country (-0.008 [95% CI -0.012 to -0.004]; p < 0.001); and increasing distance from the equator (-0.016 [95% CI -0.026 to -0.006]; p = 0.002). The pooled proportion of nonpostinfectious hydrocephalus was greatest in high-income countries (36.7% [95% CI 27.6-46.3]). Certain etiologies of pediatric hydrocephalus were more common in different cultural regions, with postinfectious hydrocephalus most common in South Asia (23.2% [95% CI 15.8-31.5]); nonpostinfectious in East Asia (38.3% [95% CI 26.6-50.7]); and dysraphism in West Asia (11.9% [95% CI 6.4-18.8]).
Conclusions:
Geographic and economic characteristics are associated with the etiological distribution of pediatric hydrocephalus in Asia, with implications for prevention and management strategies. The large proportion of hydrocephalus cases in which the etiology was unclear highlights the need for both improved diagnostics as well as clear and strict universal guidelines on the etiological classification of hydrocephalus.
