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Spina bifida in Africa: A systematic review and Meta-Analysis of Presentation, Management, and outcomes
Sean O'Leary1, Takara Newsome-Cuby2, Peace Odiase3
1Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA.
Insights
Spina bifida, a neural tube defect, causes significant pediatric mortality in Africa, with myelomeningocele being the most common type. Regional disparities in outcomes highlight the need for improved surgical care and public health initiatives like folic acid fortification.
Area of Science:
- Neuroscience
- Public Health
- Pediatric Surgery
Background:
- Neural tube defects (NTDs), particularly spina bifida, are a major cause of pediatric mortality and disability in Africa.
- Healthcare resource limitations and varied management strategies contribute to differing outcomes across African regions.
Purpose of the Study:
- To systematically review and analyze the epidemiological profile, clinical presentation, management, and outcomes of spina bifida across various African regions.
- To identify regional variations and disparities in spina bifida care and outcomes within the African continent.
Main Methods:
- A PRISMA-guided systematic review and random-effects meta-analysis of 32 studies from 10 African countries, including 4,779 patients.
- Inclusion of retrospective studies and case reports detailing spina bifida case volume, presentation, management, and outcomes.
- Estimation of pooled prevalence rates and analysis of regional variations in mortality and clinical improvement.
Main Results:
- Myelomeningocele was the most frequent subtype (61.39%), with an overall pooled mortality rate of 33.8%.
- Significant regional variations in mortality were observed, ranging from 10% in East Africa to 100% in North Africa.
- Surgical intervention was common (80.1%), but clinical improvement rates varied significantly by region (38.2% overall).
Conclusions:
- Substantial variability exists in spina bifida presentation and outcomes across Africa, with myelomeningocele posing a significant burden.
- Regional disparities necessitate standardized surgical protocols and enhanced access to neurosurgical care.
- Strengthening public health measures, including folic acid fortification and prenatal screening, is crucial for reducing NTD prevalence in Africa.
Background:
Neural tube defects (NTDs), particularly spina bifida, contribute significantly to pediatric mortality and disability in Africa. Limited healthcare resources and variation in management strategies across regions contribute to disparate outcomes. This systematic review and meta-analysis evaluate the epidemiological profile, clinical presentation, management, and outcomes of spina bifida across African regions.
Methods:
A PRISMA-guided systematic review was conducted using PubMed, Google Scholar, Cochrane, and Scopus databases. Retrospective studies and case reports reporting spina bifida case volume, presentation, management, and outcomes in African countries were included. Random-effects meta-analysis estimated pooled prevalence rates with 95% confidence intervals (CI).
Results:
A total of 32 studies from 10 African countries, encompassing 4,779 patients, met inclusion criteria. The mean age at presentation was 40.26 months (95% CI: 0---86.73). Myelomeningocele was the most common subtype (61.39%, 95% CI: (47.43---75.35). Overall pooled mortality was 33.8% (95% CI: (6.18---37.83), with significant regional variation (p < 0.01): Southern Africa 15% (95% CI: 0-38%), West Africa 39% (95% CI: 4-50%), East Africa 10% (95% CI: 7-13%), and North Africa 100% (95% CI: 99-100%). Surgical intervention was performed in 80.1% of cases (95% CI: 71.57-92.08), with ventriculoperitoneal shunting (17.61%, 95% CI: 5.48-29.75) and endoscopic third ventriculostomy (11.54%, 95% CI: 0-24.23) among the most common procedures. Clinical improvement was noted in 38.2% (95% CI: 23-71%), with significant differences between regions (p < 0.01), while 14.5% (95% CI: 7.47-24.31) showed no change or worsening.
Conclusions:
This study highlights significant variability in spina bifida presentation and outcomes across Africa. Myelomeningocele is the most common subtype, with substantial morbidity and mortality. Regional disparities underscore the need for standardized surgical protocols and increased access to neurosurgical care. Given the low rates of maternal folate supplementation, strengthening public health measures, including folic acid fortification and prenatal screening, is critical to reducing the burden of NTDs in Africa.
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