A perspective in the management of myelomeningocoele in the KwaZulu-Natal Province of South Africa

Abstract

Background Myelomeningocoele (MMC) is common in the developing world. The purpose of this study was to investigate the clinical characteristics and management of myelomeningocoele and to identify factors contributing to outcomes. Methods This was a retrospective, observational study of consecutive children diagnosed with MMC managed in the Paediatric Neurosurgery Unit at Inkosi Albert Luthuli Central Hospital. Multiple logistic regression analysis identified clinical characteristics, demographics and surgical variables that were associated with outcome. Results A total of 309 children were managed during this period (M:F 1.3:1). The most common sites were lumbar, lumbo-sacral and sacral. Mean age at surgical repair was 4.7 ± 15.6 months. Two hundred and eight children had ventriculomegaly, of whom 158 had symptomatic hydrocephalus, requiring CSF diversion. Fifty-eight (21%) patients developed wound sepsis, of whom 13 (22%) developed meningitis (p = 0.001). The time to wound sepsis was 9.5 ± 3.6 days. The commonest organism isolated was Staphylococcus aureus followed by MRSA. Thirty-two patients (23%) developed shunt malfunction and three (11%) developed ETV malfunction. Twenty children (9%) demised during the admission period. Death was associated with meningitis (p < 0.0001), and meningitis itself was associated with wound sepsis (p < 0.0001). Hospital stay was 20.4 ± 16 days. Wound sepsis (p = 0.002) and meningitis (p < 0.0001), respectively, were associated with prolonged hospital stay. Conclusion There was a slight male preponderance and hydrocephalus occurred in two thirds of cases. Wound sepsis and meningitis were associated poor outcomes.

Single surgeon case series of myelomeningocele repairs in a developing world setting: Challenges and lessons

“…By comparison, Mnguni et al presented their large collective experience of 309 children treated with MMCs in a similar developing world setting. 9 Due to constrained healthcare resources average age of MMC repair in their series was 4.7 months. Given that our series was undertaken within a similar environment, with similar health constraints, our time to surgery of 13.6 days demonstrates that a concerted effort to minimise time to MMC repair can be beneficial in expediting surgery.…”

“…One study from a LMIC reported that average age of infants at time of MMC repair was 4.7 months. 9 The aim of the current series was to determine characteristics, age at repair and outcomes of neonates who had MMC, in a setting from a LMIC where there are resource constraints.…”

Nasal colonization of methicillin resistant staphylococcus aureus among slaughterhouse workers in Dar es salaam, Tanzania

“…9 The use of personal protective equipment (PPE), intensity of animal contact, gender, age, awareness, and smoking have been reported to be associated with the spread of MRSA, the among slaughterhouse workers. [10][11][12][13] There are several studies conducted to address MRSA in Tanzania. They looked at patients attending regional hospitals, 14,15 MRSA contamination and distribution in patient's care environment, 16 health care workers in tertiary and regional hospitals.…”

Management and outcomes of myelomeningocele-associated hydrocephalus in low- and middle-income countries: a systematic review and meta-analysis protocol

“…In LMICs, the incidence of MMC-associated hydrocephalus is high and can affect as many as 75% of cases (11, 12). Times to diagnoses and treatment are often delayed in these settings and, if treatment is not promptly initiated, most patients do not survive beyond infancy (4).…”