Treating Pediatric Hydrocephalus at the Neurosurgery Education and Development Institute: The Reality in the Zanzibar Archipelago, Tanzania Andreas Leidinger 1,2 , Jose Piquer 2,3 , Eliana E. Kim 2 , Hadia Nahonda 2 , Mahmood M. Qureshi 4 , Paul H. Young 5 - BACKGROUND: Pediatric hydrocephalus is a health burden for East African countries, with an estimated inci- dence of 6000 new cases per year. The objective of this study is to describe the epidemiology and surgical out- comes of patients treated for pediatric hydrocephalus in the single neurosurgical center of Zanzibar. - METHODS: From December 2016 to December 2017, we prospectively collected data on all patients admitted with the diagnosis of hydrocephalus. Information was gathered regarding demographics, maternal health, preoperative im- aging, surgical procedures, and postsurgical complications. - RESULTS: We collected data on 63 patients. Average age was 203 days, and gender was 49.2% female and 50.8% male. All mothers of patients attended an antenatal clinic for routine screening during pregnancy. Folic acid pro- phylaxis was used by 9.5% of the mothers during preg- nancy. At the first visit, 46.0% of patients presented with signs of infection, 20.6% with congenital abnormalities, and 20.6% with seizures. Regarding etiology of hydro- cephalus, 22.2% of all cases were uncertain; 20.6% were associated with neural tube defects; 39.7% were post- infectious hydrocephalus; 3.2% were aqueduct stenosis; 4.8% were associated with brain tumor; and 9.6% were malformative. We performed 7 endoscopic third ven- triculostomies and placed 40 ventriculoperitoneal shunts. The complication rate at follow-up was 12.5%. - CONCLUSIONS: It seems that hydrocephalus in Zanzibar has similar causes, progression, and complication rates to previous reports from other African hospitals. Further studies of postinfectious hydrocephalus need to be con- ducted because recent findings suggest that it is a poten- tially preventable cause of the disease. INTRODUCTION P ediatric hydrocephalus is a large health burden for East African countries. Because these developing countries lack the infrastructure and organization for supporting epide- miologic research, the prevalence and incidence of hydrocephalus in East Africa is largely unknown. 1 Some estimate an incidence of about 6000 new cases per year 2 ; others have reported an estimate of >14,000 infants developing hydrocephalus in the first year of life. 3 Tanzania is considered the 25th poorest country in the world. 4,5 The Zanzibar Archipelago is a semiautonomous insular region of Tanzania and comprises Unguja, Pemba, and many smaller islands, with a total population of >1.6 million. 6 As population growth and urbanization occur, 6 poverty levels in urban Unguja are reportedly decreasing; on the other hand, rural Unguja and Pemba are increasingly poverty stricken, more so than 5 years ago. 7 Pemba is one of Tanzania’s poorest and most isolated Key words - East Africa - Pediatric hydrocephalus - Postinfectious hydrocephalus - Ventriculoperitoneal shunt - Zanzibar Abbreviations and Acronyms CSF: Cerebrospinal fluid CT : Computed tomography ETV: Endoscopic third ventriculostomy HC: Head circumference ISC: International surgical camp MM: Myelomeningocele MMH: Mnazi Mmoja Hospital NED: Neurosurgery, Education and Development PIH: Postinfectious hydrocephalus VPS: Ventriculoperitoneal shunt From the 1 Neurosurgery Education and Development (NED) Foundation, Valencia, Spain; 2 Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Stonetown, Tanzania; 3 Hospital Universitario de la Ribera, Alzira (Valencia), Spain; 4 Aga Khan University, Nairobi, Kenya; and 5 Section of Neurosurgery, Department of Surgery, St. Louis University, St. Louis, Missouri, USA To whom correspondence should be addressed: Andreas Leidinger, M.D. [E-mail: andreas_leidinger@hotmail.com] Citation: World Neurosurg. (2018). https://doi.org/10.1016/j.wneu.2018.06.050 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2018 Elsevier Inc. All rights reserved. WORLD NEUROSURGERY -: e1-e7, - 2018 www.WORLDNEUROSURGERY.org e1 Original Article