Clinical pattern, aetiology and factors affecting management outcome Of spina B.Fida cystica at the Kenyatta National Hospital (September 2011- August 2012)

Abstract

Spina bifida cystica is a congenital malformation of the neural tube. It is one of the most serious developmental disabilities in infants (1). The prevalence of spina bifida cystica varies with region and race (2). This study aims at giving an insight to the clinical pattern of spina bifida cystica in Kenya and factors affecting the outcome following management. This information will help establish important baseline data on age, sex, county of origin, clinical pattern and socio-economic status on this condition to assist in future planning. The main objective of the study is to determine the clinical pattern, aetiology and early post surgical outcome of spina bifida cystica at the Kenyatta National Hospital (KNH). It is a prospective descriptive study on children with spina bifida cystica admitted at the KNH between September 2011 and September 2012. iY-'; 1/ 1"'~ Data was collected using a questionnaire administered to the parents of the patients who met the t inclusion criteria. The data collected was then entered and analysed using Statistical Package for Social Sciences (SPSS) version 17.0 ~ Atotal of 65 patients were recruited into the study. The mean age at presentation of the patient was 9 days. There was a male preponderance with.forty (61.5%) males and twenty five (38.5%) female. In the order of family ranking thirty one (47%) were first born in their respective families. The average age of the, mother was 25.1 years with a range of 17-45 years. Most of the mothers (76.9%) of the mothe~s had a monthly-income of less than Ksh. 10,000 per month. Only three (4.6%) had a monthly income in excess of Ksh. 40,000 per month. The location of the lesions were eighteen (27.7%) lumbar, twenty (30.8%) lumbo-sacral, thirteen (20.0%) thoraco-lumbar, nine (13.8%) sacral and thciracic with five (7.7%). Of the associated malformations Forty two (64.6%) had club foot, twenty (30.8%) had hydrocephalus and seven (10.8%) had kyphosis. ate. Nine (13.8%) underwent spina bifida closure and placement ofVP shunt at the same sitting. The common immediate post-operative complications were wound dehiscence (21.5%), severe wound necrosis (l1.iYo) and surgical site infection (11.2%). Eight percent of the patients developed leakage of CErebrospinal fluid after surgery and in six percent of the patients there were clinical signs and symptoms of meningitis. The financial burden to the family, per patient, in terms of transport to-from hospital, hospital-care and outpatient follow up over a 30 day period was in excess of ksh.40, 000.