Post-Infectious Hydrocephalus Among Haitian Infants Treated By Project Medishare's Specialty Surgery Program: What We Know

Background: Hydrocephalus is caused by an imbalance in the production and absorption of cerebrospinal fluid in the brain. If left untreated hydrocephalus damages the developing brain, resulting in severe neurologic disability or death. Most hydrocephalus in the developing world is caused by a prior perinatal central nervous system infection and is termed post infectious hydrocephalus (PIH). In a study done in a South African population, PIH accounted for 40% of hydrocephalus cases among infants. No study examining hydrocephalus in Haiti has previously been conducted.

Methods: Patients operated on by the Project Medishare Specialty Surgery Program were chosen based on age, onset of disease and the promise of functional recovery (March/2009-December/2014). Odds ratio (OR) and 95% confidence interval (95%CI) were calculated from logistic regression models for PIH.

Results: Of the 401 patients seen, 301 patients were given etiology. Among those, 49.5% (n=149) were diagnosed with PIH. Majority of the sample was male (54.2%), born during rainy season (63.4%), and surgical intervention endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) (46.2%). Mean age was 14.3 months (min=1day,max=266.60months;median=6.7) and mean head circumference was 54.8cm (min=35.5,max=78.7;median=55). On average patients with PIH were younger than other etiologies (11.8 vs. 16.8months) and had similar mean head circumference (54.6 vs. 55.1cm). Compared to males, females were more likely to develop PIH ([OR=1.40];95%CI:0.87-2.25) but the result was not statistically significant. There were also no significant differences for birth season (dry vs. rainy,[1.052];0.65-1.69). Out of 146 surgical interventions performed, 53% were ETV/CPC and 16% ventriculoperitoneal shunt.

Conclusions: The high rate of PIH among Haitian infants is in agreement with other developing countries as the most common cause of hydrocephalus. This demonstrates the need for public health interventions to avoid initial infection. This is the first reported study on hydrocephalus patient data in Haiti.