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

Abstract

BackgroundHydrocephalus and myelomeningocele (MMC) place disproportionate burdens of disease on low and middle-income countries (LMICs). MMC-associated hydrocephalus and its sequelae result in a spectrum of severely devastating clinical manifestations, for which LMICs are disproportionately unprepared in terms of human, capital, and technological resources. This study aims to review and compare the management and outcomes of infant MMC-associated hydrocephalus in LMICs and high-income countries.MethodsThis study will follow the PRISMA 2020 guidelines. The following databases will be searched without restrictions on language, publication date, or country of origin: EMBASE, MEDLINE, The Cochrane Library, Global Index Medicus, African Journals Online, and ScieLO. All peer-reviewed studies of primary data reporting management and outcomes of infant MMC-associated hydrocephalus will be included. Where high-quality homogeneous studies exist, meta-analyses will be conducted to compare the management and outcomes of MMC-associated hydrocephalus across socioeconomic and geographic regions of the world. The primary outcome will be treatment failure of the first-line hydrocephalus treatment. Secondary outcomes include time to failure, rates of mortality, and postoperative complications.DiscussionThis study will generate evidence-based information on the management and outcomes of MMC-associated hydrocephalus across LMICs. Findings on our primary outcome will inform treatment decision-making; those on our secondary outcomes will synthesise the existing body of literature and help advocate for the ever-present need to improve access to safe, timely, and affordable neurosurgical care. This study will thus contribute to the global community of paediatric neurosurgery, particularly those practising in developing countries.PROSPERO registration numberCRD42021285850ARTICLE SUMMARYStrengths and limitations of this study⍰This review focuses on multiple treatment modes of a well-defined disease population.⍰Six electronic databases that are commonly used across both high- and low-income countries will be searched.⍰No restrictions on language, location, or publication date were placed during screening.⍰Unpublished studies will not be sought.⍰An interactive web application dashboard will be developed to facilitate the transparent interaction with our methods and findings and promote scientific discussion and scrutiny.