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

Shukri Dahir; Cesia Cotache-Condor; Andie Grimm; Mubarak Mohamed; Henry Rice; Emily Smith; Edna Adan Ismail

doi:10.1136/wjps-2022-000472

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

World J Pediatr Surg. 2023 Jan 20;6(1):e000472. doi: 10.1136/wjps-2022-000472. eCollection 2023.

Authors

Shukri Dahir¹, Cesia Cotache-Condor², Andie Grimm², Mubarak Mohamed¹, Henry Rice^{3

4}, Emily Smith^{3

4}, Edna Adan Ismail¹

Affiliations

¹ Edna Adan University Hospital, Hargeisa, Somaliland.
² Department of Public Health, Baylor University, Waco, TX, USA.
³ Duke Global Health Institute, Duke University, Durham, NC, USA.
⁴ Department of Surgery, Duke School of Medicine, Durham, North Carolina, USA.

Abstract

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 χ² 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.

Keywords: congenital abnormalities; epidemiology; neurosurgery.