The problem of hydrocephalus in poor countries: when saving life is not enough

Pediatric hydrocephalus is described as excess cerebrospinal fluid in the lateral ventricles.

This is due to a failure in the reabsorption mechanism of said liquid that implies an exaggerated cranial perimeter, headaches, dizziness, irritability and other disabling symptoms that demand immediate surgical intervention.

In countries with high or medium income, such as those in Europe, this diagnosis and its sequelae have a low impact, since it is solved with a simple surgical intervention in which a valve or shunt is activated in the patient to drain this excess fluid. .

In these wealthier geographic areas, the most common causes are postnatal cerebral hemorrhage and comorbidity with other neurodevelopmental disorders such as spina bifida.

In both cases, there is a standardized intervention protocol that offers stability to the child patient.

Also, the incidence is low and the mortality rate from this disorder is almost non-existent.

The problem has tripled in Africa

Nothing to do with the outlook in low-income countries in Africa (Uganda, Tanzania, and Sudan stand out).

There, the data on this disorder are much more alarming, even reaching 200,000 cases of live births per year.

To be more specific, just one hospital in Uganda, a country with more than 30 million people under the age of 15, treated 500 cases of hydrocephalus and 300 cases of spina bifida per year in 2009. This number has now tripled.

The moment of diagnosis of hydrocephalus and the perception of quality of life have been related to delays in the onset of speech, social and behavioral problems.

In these areas, the main causes of hydrocephalus (congenital or acquired) are the lack of prenatal care (nutrition and intake of folic acid and ultrasound monitoring of the mother during pregnancy) and postnatal brain infections due to the lack of standardized care protocols. postoperative in these areas.

Consequently, most cases present a high potential for seriousness, including a high mortality rate before two years of age.

Significant neuropsychological deficits

Despite the paucity of experimental studies with patients residing in low-income countries, some have concluded that the neuropsychological deficits associated with this disorder are remarkable.

Most of the data shows a general index of developmental deficit compared to the control group.

In addition, it is related to other variables associated with the disorder, such as a decrease in brain volume.

Memory, attention or executive function have not been studied up to now due to several factors: heterogeneity of the methodology, lack of resources for neuropsychological evaluation, preference for other indicators more related to neurology and neurosurgery, in addition to the fact that the severity of the cases makes this type of evaluation difficult.

In contrast, the neuropsychological profile associated with pediatric hydrocephalus in patients residing in middle- and high-income countries has been further studied.

The results are not conclusive, since it is a heterogeneous profile with deficits in memory, attention and the motor sphere.

In most cases, patients maintain communication and language functions.

It is not enough to survive: studying the quality of life is important

Likewise, most of these studies include quality of life parameters as part of the neuropsychological evaluation.

To what extent does the disease interfere with daily life?

In this case, some studies have shown that during childhood the diagnosis of pediatric hydrocephalus interferes with the perception of the quality of life of patients and especially of their guardians.

Specifically, the fathers and mothers of patients with this diagnosis report that their quality of life in the school context is low due to hydrocephalus.

Timing of hydrocephalus diagnosis and perceived quality of life have also been linked to delayed speech onset, social and behavioral problems, mental retardation, and other cognitive problems.

However, when the patients themselves report this variable, they consider themselves to have levels similar to those of their peer group.

If they survive, the quality of life of these patients has an extra value.

Above all because if it is satisfactory it can make a difference in terms of their postoperative recovery, in addition to promoting cognitive improvement and a greater inclusion of this type of patient in society.

In studies located in low-income countries such as those in Africa, it is not common to assess the quality of life of these patients.

Rather, they focus on exploring the neurosurgical evolution of the disorder, including at most an assessment of cognitive development with scales that are rarely used in Europe, such as the

.

The difference is understandable if we take into account that the age of the African patient with pediatric hydrocephalus is younger than that of the European patient.

In addition to the fact that the severity of hydrocephalus in these countries places neurosurgical intervention as the highest priority for the survival of the pediatric patient.

The paradox is that, if they survive, the quality of life of these patients has an extra value.

Above all because if it is satisfactory it can make a difference in terms of their postoperative recovery, in addition to promoting cognitive improvement and a greater inclusion of this type of patient in society.

In short, a functional adaptation of the patient with hydrocephalus to his environment.

For this reason, several pioneering research groups have launched lines of research specifically aimed at exploring the neuropsychological profile of the patient with pediatric hydrocephalus residing in these low-income areas, including Neuropsychology and Acquired Brain Injury at the International University of Valencia. and the working group linked to the VIU-NED Chair of Global Neuroscience and Social Change.

Research in the field of neuropsychology and health psychology will make it possible to achieve that much-needed improvement in the patient's quality of life.

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