Health: Pediatric hydrocephalus or how the lack of essential health services marks a life | Future Planet


Although the pandemic has been in focus for the past two years, health care problems neither begin nor end with COVID-19. According to the World Bank and the World Health Organization, half the world lacks access to essential health services, with African countries being the most affected.

Without a doubt, one of the disorders that tops the list of health emergencies in low-income countries is infantile hydrocephalus. In Eastern, Central and Southern Africa alone, there are about 200,000 cases each year. A light-year figure of the 5.9 cases per 10,000 live births recorded worldwide.

The origin is in the lack of folic acid during pregnancy. Pediatric hydrocephalus is due to an excessive accumulation of cerebrospinal fluid (CSF) in the brain, either at the time of birth or immediately thereafter. This neurodevelopmental disorder is related to an abnormal size of the head, which is one of its most recognizable manifestations. But it also tends to alter certain motor, sensitive and cognitive functions, in addition to producing irritability and fatigue, among other symptoms.

Its morbidity is extremely high and affects the quality of life during childhood, which represents a highly complex socioeconomic and health challenge in the poorest areas of African countries. It should not be forgotten that the solution for pediatric hydrocephalus usually goes through surgical interventions, implantation of shunts and follow-up controls.

Hydrocephalus is often associated with possible infections during embryonic development, folic acid deficiency, and maternal malnutrition during pregnancy, common illnesses in developing countries.

What about its origin? Why is it primed with these countries? Very simple: hydrocephalus is usually associated with possible infections during embryonic development, folic acid deficiency and malnutrition of the mother during pregnancy. In addition to maternal exposure to neurotoxic agents.

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Between 2016 and 2018, a total of 96 patients with pediatric hydrocephalus were studied only in Zanzibar (a region of Tanzania), the most frequent cause being the lack of folic acid supply to the mother during pregnancy (only 8% took it ). During that same period, the incidence in western countries such as Spain did not exceed 10 cases because approximately 90% of Spanish mothers take folic acid during their pregnancy.

In light of these data, it seems understandable that low-income African countries sustain such a high incidence. After all, they do not have the care or financial resources for the medical follow-up of mothers during pregnancy.

Lack of health resources worsens the prognosis

Focusing only on the first two years of life, about 25% of those diagnosed with this condition have a poor prognosis. Sometimes due to infections during neurosurgical intervention. Others because, directly, they do not reach the operating table and remain on the road due to lack of health resources (professionals, instruments, hospitals, postoperative control).

The positive part is that 75% of those affected are operated successfully thanks to new neurosurgery techniques introduced from countries like Spain. To maintain and exceed this statistic, the training that health personnel in these countries are receiving to address child hydrocephalus by entities such as the NED Foundation is essential. This institution expands neurosurgery through training and development courses, according to the Plan Global Neurosurgery 2030 of the WHO.

Neuropsychological effects associated with infantile hydrocephalus

Although it is true that the physical symptoms of childhood hydrocephalus are beginning to be treated and resolved in these low-income countries, the assessment of the neuropsychological effects associated with this disorder in these countries is non-existent. There is a large knowledge gap in this area.

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This is largely due to the fact that studies carried out in upper-middle-income countries on the neuropsychological profile associated with pediatric hydrocephalus are scarce. And, as far as we know, they have all focused on adolescents or adults who suffered from hydrocephalus during their childhood.

Of these few studies, most point to the intellectual quotient (IQ), which is medium-low for those who suffer from hydrocephalus. But there are also projects that identify alterations in cognitive function, especially related to attention, memory, language and executive function. Others, on the contrary, affect motor function. The result is a too heterogeneous neuropsychological profile.

Why so much disparity? To begin with, because there is no consolidated and consensual protocol for neuropsychological evaluation for hydrocephalus at an early age. As a consequence, evaluations are made with different tests and at different ages, with the only common factor being hydrocephalus in childhood. Furthermore, modulating aspects of this neuropsychological profile such as age, gender, type of hydrocephalus or its severity are not taken into account.

Given this reality, it is urgent both to define a neuropsychological profile of pediatric hydrocephalus and to develop a protocol for neuropsychological evaluation applicable in countries with low income and too many health care deficiencies, this being an emerging line of research for some areas of neuroscience such as neurosurgery and neuropsychology.

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George Holan

George Holan is chief editor at Plainsmen Post and has articles published in many notable publications in the last decade.

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