Pattern of presentation of spina bifida as seen and managed in Kenyatta National Hospital

Abstract

This was a hospital based descriptive prospective study of patients born in KNH with spina bifida and those referred with similar conditions for further evaluation and possible operation. A total of 75 patients aged 5 days to 15 years with various forms of spina bifida were recruited at Kenyatta National Hospital's Ward 4C and Neuro-surgical out patient clinic. Assessment of clinical presentations, demographic data timing of surgery and common complications was carried out. Methodology. Patients were recruited over a five month period between March 2004 and July 2004, according to the set criteria. Each patient was followed till either discharge or a minimum of 4 weeks in the clinic. Data was entered in a questionnaire and analyzed. Results From the data, 65.4 % of all patients were aged below two years with a median age of 17 months. Females accounted for 54.7% with a male to female ratio 1:1.2. Many of the patients came from Central province 56% and were first born 41.3%. Most the mothers were housewives 66.8% with poor social economics status, 52% earned less than two thousands shillings a month. Forty eight percent of the mothers had education up to primary school level and their mean age was 25.8 years. Majority of the mothers attended ANC during the third trimester 62.7%, and only 1.3% had used folic acid antenatally. Twenty percent had a history of exposure to the known teratogens. Seventy eight point seven percent of the patient had spina bifida cystica with spina bifida occulta accounting for 21.3%. Majority of the lesions were spina bifida myelomeningocele 48.7% .Of all patients, 33.3% of them were paralyzed and of these 76% had spina bifida cystica. Patients with lesion at the lumbar spine were 76%. Ultrasonography of the skull was the commonest imaging study which was performed 66.7%, followed by ultrasound of the lesion 13.3%.The commonest associated congenital malformation was hydrocephalus accounting for 54.7% .The median age at operation was 20 months. Post operatively, 16% had complications. Wound sepsis accounting for 8 % .Ventriculo peritoneal shunt placement was performed in 54.7% of the patients and of these 80.5% had them before the main operation for the spina bifida. Conclusion The commonest form of presentation of spina bifida is spina bifida myelomeningocele. Spina bifida is common in Central Kenya from mothers of poor social economic status. Use of folic acid in the periconception period and early antenatal attendance can reduce the incidence significantly. Early operation for the lesion and V.P shunting for those with hydrocephalus will enable the patients reach adulthood and lead a normal life unaware of their deficiencies