A cluster of paediatric hydrocephalus in Mohale’s Hoek district of Lesotho, 2013-2016

Rudzani Climentine Mathebula^1,2,&, Motheba Lerotholi³, Olufemi Olamide Ajumobi^4,5, Thabelo Makhupane⁶, Limpho Maile⁶, Lazarus Rugare Kuonza^1,2,7

¹School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria

²South African Field Epidemiology Training Programme, National Institute for Communicable Disease, Johannesburg, South Africa

³World Food Programme, Lesotho

⁴African Field Epidemiology Network, Nigeria Country Office, Abuja, Nigeria

⁵Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria

⁶Ministry of Health, Lesotho

⁷School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa 

^&Corresponding author

Rudzani Climentine Mathebula, South African Field Epidemiology Training Programme

ruzzanne@gmail.com

Received: 20/10/18   Accepted: 10/11/2018 Published: 13/11/18

CITATION: Rudzani Climentine Mathebula, Motheba Lerotholi, Olufemi Olamide Ajumobi, Thabelo Makhupane, Limpho Maile, Lazarus Rugare Kuonza. A cluster of paediatric hydrocephalus in Mohale’s Hoek district of Lesotho, 2013-2016. J Interv Epidemiol Public Health. 2018 Nov;1(1).

©Rudzani Climentine Mathebula et al. Journal of Interventional Epidemiology and Public Health. This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 

Abstract

Background: In 2016, an unusual increase of paediatric hydrocephalus was observed in Mohale’s Hoek (MH) district, Lesotho. This study describes the epidemiology of paediatric hydrocephalus, and review the management of case-patients in MH district. Methods: We defined a case-patient as a child ≤12 years diagnosed with hydrocephalus either radiologically (i.e. by CT or MRI scan) or clinically by a medical officer. We reviewed registries and medical records of children diagnosed or treated with hydrocephalus at national referral hospital in Maseru and in MH district. We also conducted a household survey among case-patients identified in MH. Results: A cumulative total of 75 case-patients with paediatric hydrocephalus were identified in Lesotho, giving an overall prevalence of 87/100,000 live births over the 2-years. Thirty-seven (49.3%) were diagnosed with congenital hydrocephalus, and 5 (6.7%) were acquired hydrocephalus post-meningitis. Overall, 11 case-patients were identified in MH district, giving an overall 4-years prevalence of 211/100,000 live births; case fatality of 4/11 (36.4%). The median age at the time of diagnosis was 3 weeks (range: 1 week - 12 months) and five of the 11 case-patients were diagnosed in 2015. Two (18.2%) were diagnosed with congenital hydrocephalus, 2 (18.2%) with acquired hydrocephalus post meningitis and 7 (63.6%) had hydrocephalus of unspecified origin. Five children had shunts inserted in South Africa with an average delay of about 3 months from diagnosis. All five shunts developed complications that resulted in their removal.  Conclusions: Our findings provided an insight into the burden of hydrocephalus in Lesotho and highlight sub-optimal post-surgery follow-up of children treated for hydrocephalus. We recommend that the Lesotho government implement a national surveillance system for congenital abnormalities and strengthen capacity for neurosurgical procedures at the national hospital.

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