Delays in care for hydrocephalus and spina bifida at a tertiary hospital in Somaliland

Background Childhood neurosurgical conditions such as hydrocephalus and spina bifida represent a significant burden of death and disability worldwide,particularly in low and middle-income countries.However,there are limited data on the disease prevalence and delays in care for pediatric neurosurgical conditions in very low-resource settings.This study aims to characterize the delays in access to care for pediatric neurosurgical conditions in Somaliland.Methods We performed a retrospective review of all children with congenital hydrocephalus and spina bifida admitted to the Edna University Hospital(EAUH)in Somaliland between 2011 and 2018.Patient demographics were analyzed with descriptive statistics and χ^(2) test statistics.We defined delays in care for each condition based on standard care in high-income settings.Univariate and multivariate logistic regression were performed to evaluate predictors of delay in care.Statistical significance was set at p<0.05.Results A total of 344 children were admitted to EAUH with neurosurgical conditions from 2011 to 2018.The most common condition was congenital hydrocephalus(62%).Delays in care were found for 90%of patients and were associated with the type of diagnosis and region.The longest delay among children with spina bifida was 60 months,while the longest delay for children with congenital hydrocephalus was 36 months.Children with congenital hydrocephalus or spina bifida traveling from foreign countries had the highest waiting time to receive care,with a median delay of 8 months(IQR:5–11 months)and 4 months(IQR:3–7 months),respectively.Conclusion We found significant delays in care for children with neurosurgical conditions in Somaliland.This country has an urgent need to scale up its surgical infrastructure,workforce,and referral pathways to address the needs of children with hydrocephalus and spina bifida.

Prevalence and outcomes of pediatric surgical conditions at Connaught Hospital in Freetown:a retrospective study

Background Sub-Saharan Africa experiences a disproportionate amount of pediatric surgical disease,with 80%of children lacking access to timely,affordable,and safe surgical care.This study aims to characterize the burden of disease and outcomes of pediatric surgical conditions at Connaught Hospital,the main pediatric referral hospital in Sierra Leone.Methods This retrospective and hospital-based study included children up to 15 years old who were operated on between 2015 and June 2016 at Connaught Hospital in Freetown,Sierra Leone.Descriptive and inferential statistics were used to characterize the distribution of disease and compare all variables against age category and mortality.Findings A total of 215 patients were included in this study of which 72.5%(n=132)were male and 27.5%(n=50)were female.Most of the patients were diagnosed with congenital anomalies(60.9%;n=131).However,infection was the leading diagnosis(60.5%;n=23)among patients aged 5–10 years(n=38).Inguinal hernia was the leading condition(65.0%;n=85)among patients presenting with a congenital anomaly.The condition with the highest mortality was infections(17.0%;n=8),followed by other conditions(9.1%;n=2)and congenital anomalies(3.1%;n=4).Based on the results of this study,over 7000 children with inguinal hernias remain untreated annually in Freetown,Sierra Leone.Conclusion This study quantifies the burden of surgical disease among children,a foundational step toward the prioritization of pediatric surgical care in national health agendas,the development of evidence-based interventions,and the strategic allocation of resources in Sierra Leone.