Pattern of Hydrocephalus among Children in a Tertiary Hospital in Port Harcourt, Nigeria

Abstract

Introduction: Paediatric hydrocephalus is gradually becoming an emerging public health problem in Africa including Nigeria, largely because of the challenges patients face in accessing comprehensive healthcare, with delayed hospital presentation being predominantly common. This retrospective study assessed the pattern of presentation and outcome of hydrocephalus. Method: It was a 1-year retrospective study of patients with hydrocephalus seen at the Paediatric Department of the University of Port-Harcourt Teaching Hospital from August 2020 - September 2021. Data was retrieved from the medical files of the patients; and include patients demographics, presenting complaints, examination findings, neuroimage findings, diagnosis and treatment. In addition, the antenatal histories of the mothers were obtained. Data was entered into a proforma and analysed using IBM SPSS Statistics Version 26.0, descriptive statistics was carried out. Results: The study involved 31 children aged 2 weeks to 12 years. Seventeen (54.8%) were males while 14 (45.2%) were females, giving a male to female ratio of ratio was 1.2: 1. Of the 31 patients, 22 (71.0%) had congenital hydrocephalus while 9 (29.0%) were acquired.  Eight (36.4%) of the cases with congenital hydrocephalus were identified prenatally. Aqueductal stenosis was the cause of congenital hydrocephalus in 9 (40.9%), 4 (18.2%) was due to myelomeningocele associated. Post infections accounted for 55.6% of acquired hydrocephalus. Concerning maternal antenatal history, 4 (12.9%) received preconception and periconception folic acid while others commenced after the first trimester. Twelve (38.7%) mothers used alcohol beverages or alcohol based herbal concoctions in their first trimester while 5 (9.7%) had febrile illness in their first trimester. There was delay in hospital presentation and treatment, with the mean age at presentation of 4.25 ± 2.28 months for those with congenital hydrocephalus. Only 14 (45.2%) of the patients received surgical intervention, while 17 (54.8%) patients were lost to follow up. Conclusion: Hydrocephalus is a common presentation in our setting with congenital hydrocephalus as the most common type. Aqueductal stenosis being the leading cause, followed by post meningitis sequalae. Preconception and periconception folic acid use is low, while use of herbal concoction and alcohol consumption in pregnancy is high.  Delay in hospital presentation remains a challenge in the management and a lot of patients are lost to follow up.