Pre-school follow-up of a cohort of children with myelomeningocele in Cape Town, South Africa

Abstract

A cohort of South African children with myelomeningocele was followed for 5 years. Fifty-three were from metropolitan Cape Town and 65 from rural areas including the tribal region of Transkei. The mean general developmental quotient (GQ) at 5 years of age was lower than that previously reported. Black and coloured children had lower GQs than white children, but there were no significant differences between those from the urban and the rural areas. Early closure of the lesion and delivery by caesarean section were associated with higher levels of general developmental functioning. Central nervous system infections and the placement of more than one shunt for hydrocephalus resulted in lower GQs. Lesions above L2 were associated with non-ambulation. Ambulation was more likely in children in Cape Town than in rural children. Urinary incontinence occurred more frequently in rural children and among those in lower socio-economic circumstances.

Intervening factors in the walking of children presenting myelomeningocele

“…The lumbar spine was most affected, confirmed by other studies (11,12), though when considered in isolation, no predominance between upper and lower lumbar segments was found. In our study, no child presented lesion at cervical spine.…”

“…Hydrocephalus frequency (51,2%) was lower than rates reported in previous studies (9)(10)(11), and showed no significance in relation to walking prognosis in myelomeningocele children. However, functional independence in adolescents presenting myelomeningocele, evaluated by means of the Functional Independence Measure (FIM), suffered modifications according to the presence or absence of hydrocephalus, locomotion dominion, personal hygiene and transferences (9).…”

“…The nutritional status of the myelomeningocele children differed from investigations conducted in those residents in the rural area (11). In the present study, it was not possible to evaluate the interference of this factor on walking prognosis, since only five myelomeningocele patient lived in the rural area.…”

“…Decubitus ulcers are a common complication, occurring in 32% of myelomeningocele children as result from diminished or loss of sensitivity (11). Ulcers identified in 17 children (41,5%) in the present study, demand increased attention from the child, family members and professionals involved in relation to preventive care.…”

Epidemiology of neural tube defects

“…Recent population‐based data from Atlanta, Georgia (USA) indicate that survival among individuals with spina bifida is approximately 87% at 1 year, and 78% at 17 years [Wong and Paulozzi, 2001]. However, affected individuals are at risk for a range of physical and developmental disabilities [Althouse and Wald, 1980; Casari and Farrall, 1998; Buccimazza et al, 1999; Singhal and Mathew, 1999; Bowman et al, 2001], and experience excess mortality into the adult years [Hunt, 1999; Singhal and Mathew, 1999; McDonnell and McCann, 2000; Bowman et al, 2001].…”