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Neural tube defects in Uganda: follow-up outcomes from a national referral hospital.

Publication ,  Journal Article
Xu, LW; Vaca, SD; He, JQ; Nalwanga, J; Muhumuza, C; Kiryabwire, J; Ssenyonjo, H; Mukasa, J; Muhumuza, M; Grant, G
Published in: Neurosurg Focus
October 2018

OBJECTIVE: Children with neural tube defects (NTDs) require timely surgical intervention coupled with long-term management by multiple highly trained specialty healthcare teams. In resource-limited settings, outcomes are greatly affected by the lack of coordinated care. The purpose of this study was to characterize outcomes of spina bifida patients treated at Mulago National Referral Hospital (MNRH) through follow-up phone surveys. METHODS: All children presenting to MNRH with NTDs between January 1, 2014, and August 31, 2015, were eligible for this study. For those with a documented telephone number, follow-up phone surveys were conducted with the children's caregivers to assess mortality, morbidity, follow-up healthcare, and access to medical resources. RESULTS: Of the 201 patients, the vast majority (n = 185, 92%) were diagnosed with myelomeningocele. The median age at presentation was 6 days, the median length of stay was 20 days, and the median time to surgery was 10 days. Half of the patients had documented surgeries, with 5% receiving multiple procedures (n = 102, 51%): 80 defect closures (40%), 32 ventriculoperitoneal shunts (15%), and 1 endoscopic third ventriculostomy (0.5%). Phone surveys were completed for 53 patients with a median time to follow-up of 1.5 years. There were no statistically significant differences in demographics between the surveyed and nonrespondent groups. The 1-year mortality rate was 34% (n = 18). At the time of survey, 91% of the survivors (n = 30) have received healthcare since their initial discharge from MNRH, with 67% (n = 22) returning to MNRH. Hydrocephalus was diagnosed in 29 patients (88%). Caregivers reported physical deficits in 39% of patients (n = 13), clubfoot in 18% (n = 6), and bowel or bladder incontinence in 12% (n = 4). The surgical complication rate was 2.5%. Glasgow Outcome Scale-Extended pediatric revision scores were correlated with upper good recovery in 58% (n = 19) of patients, lower good recovery in 30% (n = 10), and moderate disability in 12% of patients (n = 4). Only 5 patients (15%) reported access to home health resources postdischarge. CONCLUSIONS: This study is the first to characterize the outcomes of children with NTDs that were treated at Uganda's national referral hospital. There is a great need for improved access to and coordination of care in antenatal, perioperative, and long-term settings to improve morbidity and mortality.

Duke Scholars

Published In

Neurosurg Focus

DOI

EISSN

1092-0684

Publication Date

October 2018

Volume

45

Issue

4

Start / End Page

E9

Location

United States

Related Subject Headings

  • Uganda
  • Tertiary Care Centers
  • Referral and Consultation
  • Patient Care Management
  • Neurology & Neurosurgery
  • Neural Tube Defects
  • Meningomyelocele
  • Male
  • Length of Stay
  • Infant, Newborn
 

Citation

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MLA
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Xu, L. W., Vaca, S. D., He, J. Q., Nalwanga, J., Muhumuza, C., Kiryabwire, J., … Grant, G. (2018). Neural tube defects in Uganda: follow-up outcomes from a national referral hospital. Neurosurg Focus, 45(4), E9. https://doi.org/10.3171/2018.7.FOCUS18280
Xu, Linda W., Silvia D. Vaca, Joy Q. He, Juliet Nalwanga, Christine Muhumuza, Joel Kiryabwire, Hussein Ssenyonjo, John Mukasa, Michael Muhumuza, and Gerald Grant. “Neural tube defects in Uganda: follow-up outcomes from a national referral hospital.Neurosurg Focus 45, no. 4 (October 2018): E9. https://doi.org/10.3171/2018.7.FOCUS18280.
Xu LW, Vaca SD, He JQ, Nalwanga J, Muhumuza C, Kiryabwire J, et al. Neural tube defects in Uganda: follow-up outcomes from a national referral hospital. Neurosurg Focus. 2018 Oct;45(4):E9.
Xu, Linda W., et al. “Neural tube defects in Uganda: follow-up outcomes from a national referral hospital.Neurosurg Focus, vol. 45, no. 4, Oct. 2018, p. E9. Pubmed, doi:10.3171/2018.7.FOCUS18280.
Xu LW, Vaca SD, He JQ, Nalwanga J, Muhumuza C, Kiryabwire J, Ssenyonjo H, Mukasa J, Muhumuza M, Grant G. Neural tube defects in Uganda: follow-up outcomes from a national referral hospital. Neurosurg Focus. 2018 Oct;45(4):E9.

Published In

Neurosurg Focus

DOI

EISSN

1092-0684

Publication Date

October 2018

Volume

45

Issue

4

Start / End Page

E9

Location

United States

Related Subject Headings

  • Uganda
  • Tertiary Care Centers
  • Referral and Consultation
  • Patient Care Management
  • Neurology & Neurosurgery
  • Neural Tube Defects
  • Meningomyelocele
  • Male
  • Length of Stay
  • Infant, Newborn