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Outcome of Ventriculoperitoneal Shunt insertion at Myungsung Christian Medical Centre in Ethiopia
Biluts, H. & Admasu, A.K.
Abstract
Background:
We investigated the feasibility of shunt insertion
procedures with acceptable
short-term outcomes in Ethiopia, and to identify factors associated with good and bad
outcomes.
Methods:
This is a hospital based prospective cohort study of outcome of
ventriculoperitoneal shunt insertion at Myungsung Christian Medical center (MCM), Addis
Ababa, Ethiopia in the period between January 2011
and December 2012. Medical records
were reviewed in a structured questionnaire prepared for this purpose. Epidemiological
data, head circumference, clinical investigations,
etiology of the hydrocephalus, details of
the ventriculoperitoneal(VP) shunt insertion, outcome by the end of 6 months, morbidity
and mortality data were collected. Outcomes were graded as good, fair, or poor, according
to head circumference, anterior fontanels status, visual, motor, and seizure criteria.
Difference in proportions was examined using Chi-square test.
Results:
The Authors review141 VP shunt insertions in 114 patients≤ 12 years of ageatMCM,
61(53.5%) were male and 46(46.5%) female. The median age was 3 months (range 0.3-144); the mean head circumference at presentation was 50.4 ± 10.1cm (range, 34-106). The
commonest causes of hydrocephalus were spina bifida
(42.3%) and post infectious
(20.2%). Early complications following surgery were
seen in 65(58.0%) patients. The
commonest complication was mechanical failure in 54
(48.2%) patients, under shunting
constituted 83.3% of the mechanical shunt failure,
shunt infection being 7%. Follow-up was
available in 75.4% of children, with a mean follow-up period of 6.8 ± 7.2 months (range 1-36). In-hospital mortality was 1.8%. The overall shunt function rate at last visit was 88.3%,
head circumference ≥ 50 cm had significant early complication compared to those with ≤ 50 cm. Age and Sex were not significantly correlated to the occurrence of complications and
outcomes.
Conclusion:
Spina bifida was main etiological cause of hydrocephalus. Our study has
documented good outcomes at 12 months follow-up period for VP shunt insertion with
acceptable early complication rates. However, child
ren with a head circumference greater
than 50 cm had significant early complication (p=0.028). Given the availability of fully
subsidized VP shunts in a country with enormous number of hydrocephalic children, shunts
will continue to play a pivotal role in the management of hydrocephalus in Ethiopia.
Keywords
Ethiopia; hydrocephalus; outcome; Ventriculoperitoneal shunt
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