Background/Aims: Ventriculoperitoneal shunt complications have scarcely been reported in sub-Saharan Africa. This study aimed at determining the frequency of these complications and their associated risk factors in a Kenyan National Teaching and Referral Hospital. Methods: This cross-sectional study retrospectively covered 117 patients admitted to the Kenyatta National Hospital neurosurgical ward between January 2005 and December 2007 with ventriculoperitoneal shunt complications. The data obtained were analysed using the Statistical Package for the Social Sciences. Results: The most common complication was obstruction in 63 patients (53.8%), followed by migration in 25 (21.4%) and infection in 23 (19.7%) of the patients. Up to 49.6% of the complications occurred in patients younger than 6 months. Multiple complications were seen in 23.9% of the cases. The mean shunt duration was 18.05 months. Positive correlations existed between the presence of a shunt complication and patient age, shunt duration and the number of complications developed. These correlations were, however, neither strong nor statistically significant. Conclusion: This study reports the highest frequencies of shunt obstruction and migration ever recorded in the literature. The high rate of development of multiple shunt failures coupled with a short shunt duration calls for a closer monitoring of patients with ventriculoperitoneal shunts.

Objective: To study the aetiology, mode of presentation and outcome following treatment of brain abscesses at the Kenyatta National Hospital, Nairobi. Design: A retrospective study. Setting: Kenyatta National Hospital, Nairobi. Subjects: Sixty five patients with brain abscesses who were seen at Kenyatta National Hospital between January 1989 and December 1993. Results: Twenty patients died following surgery (30.7% mortality). Eight per cent of the patients who underwent surgery were serologically positive for the human immune deficiency virus (HIV). When these patients were excluded mortality was 25%. There were more male patients than females (ratio 2.4:1). Thirty eight per cent of the patients were children below the age of ten years. Trauma was the commonest cause of brain abscess. The aetiology was unknown in 24% of the cases. Twenty six patients who were HIV positive and had suspected brain abscesses were not included in this study because they did not undergo surgery. The commonest organisms isolated were Staphylococci, Streptococci, Klebsiella and Haemophylus influenzae. Sixty eight per cent of the patients had seizures. All the patients were diagnosed by computerised tomography (CT) scanning of the brain. Surgical treatment was by multiple burr hole aspirations and excision through craniotomy. Conclusion: Brain abscess is still a major cause of morbidity at the Kenyatta National Hospital with a high overall mortality of 30.7% during the period under study.

Objective: To study infections complicating ventriculoperitoneal (VP) shunt surgery in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi. Design: A retrospective survey. Setting: Kenyatta National Hospital, Nairobi between January 1982 and December 1991. Subjects: Three hundred and forty five patients who underwent V-P shunt placement for non-tumour hydrocephalus. Results: Three hundred and forty five patients underwent V-P shunt placement for nontumour hydrocephalus. There were 107 infection episodes involving 85 patients. The ages of these patients ranged from three months to 12 years. Most of the patients had congenital hydrocephalus. The infection rate was high (24.6%) although comparable to infection rates reported for clean surgery in the hospital. Fever, septic wounds and features of shunt malfunction were the main presenting features. Bacteriological studies confirmed Staphylococcus aureus and coagulase negative staphylococci as the two most commonly isolated micro-organisms. Conclusion: This study emphasises need to reduce infection rate in ventriculoperitoneal shunt surgery at the Kenyatta National Hospital. Definitive surgical treatment for hydrocephalus was in most cases delayed and this problem was also observed during revision of infected shunts. Late presentation was often due to ignorance and the fact that many patients went for traditional forms of treatment first before going to hospital.

OBJECTIVE:To determine the outcome of severe traumatic brain injury and to document the factors influencing mortality.

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