Rainfall drives hydrocephalus in East Africa

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Hydrocephalus is one of the most common brain disorders in children throughout the world. The majority of infant hydrocephalus cases in East Africa appear to be postinfectious, related to preceding neonatal infections, and are thus preventable if the microbial origins and routes of infection can be characterized. In prior microbiological work, the authors noted evidence of seasonality in postinfectious hydrocephalus (PIH) cases.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The geographical address of 696 consecutive children with PIH who were treated over 6 years was fused with satellite rainfall data for the same time period. A comprehensive time series and spatiotemporal analysis of cases and rainfall was performed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Four infection-onset peaks were found to straddle the twice-yearly rainy season peaks, demonstrating that the infections occurred at intermediate levels of rainfall.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The findings in this study reveal a previously unknown link between climate and a neurosurgical condition. Satellite-derived rainfall dynamics are an important factor in driving the infections that lead to PIH. Given prior microbial analysis, these findings point to the importance of environmental factors with respect to preventing the newborn infections that lead to PIH.</jats:p></jats:sec>

Effectiveness of the Bactiseal Universal Shunt for reducing shunt infection in a sub-Saharan African context: a retrospective cohort study in 160 Ugandan children

“…We have previously shown that the incidence of postinfectious hydrocephalus is tied to rainfall patterns in Uganda with the largest number of infections leading to postinfectious hydrocephalus occurring during periods of intermediate rainfall. 8 Furthermore, the spectrum of pathogens in the CSF of infants with postinfectious hydrocephalus also appears to change with the rain cycle. 3 Hence, although we found no significant demographic or etiological differences between the 2 groups, studying 2 cohorts that differ by epoch might introduce a time-sensitive variable in the spectrum of pathogens that would be eliminated in a randomized controlled trial.…”

Neurosurgery Education and Development program to treat hydrocephalus and to develop neurosurgery in Africa using mobile neuroendoscopic training

“…Infection is rife, and the patients are often only brought for care at an advanced stage of ventriculomegaly. 4,[17][18][19]21,22,24,25,29 In the current setting, the effectiveness of ETV was 51%, which is only slightly lower than that reported in other patient series in a similar geographic context. 22,24,25,29 A possible reason for this is that we were unable to perform choroid plexus coagulation, as suggested by Warf et al [22][23][24]27 In addition, we realize that children healthy after ETV may not return for follow-up due to travel and cost limitations.…”

Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions

“…49,64 While pediatric hydrocephalus in developed countries commonly arises from intraventricular hemorrhage of prematurity and congenital causes, in developing countries postinfectious hydrocephalus predominates, likely due to the greater incidence of neonatal sepsis. A combination of inadequate maternal-fetal care and unsanitary living environments contribute to more prevalent and severe cases of neonatal sepsis leading to postinfectious hydrocephalus, which accounts for 60% of hydrocephalus cases in Uganda 64 and 40% of cases in South Africa.…”

“…36 Another study in Uganda found that the peak incidence of postinfectious hydrocephalus was related to climate, with infection-onset peaks in the intermediate period between rainy and dry seasons. 49 Bacteriological studies to date raise concerns as to whether current antimicrobial protocols in developing nations include adequate coverage of gram-negative bacteria. Recent evidence supports this concern, as most of the gram-negative bacilli isolated from VP shunt infec-tions in Kenya were resistant to cefazolin, ciprofloxacin, and gentamycin.…”