Challenges of Myelomeningocele care in sub-Saharan Africa: A Nigerian centre experience

Abstract

Introduction: To study the challenges of myelomeningocele care in sub-Saharan Africa (a resource-poor setting). Reviewed the peculiarities of presentation and the management outcomes of patients with myelomeningocoele in our setting. Method: A 3-year retrospective review of all the myelomeningoceles that were managed in our centre from January 2021 to December 2023.
Results: A total of 53 patients were made up of 18 boys and 35 girls, with a male-to-female ratio of 1:2. Ages ranged from 1 hour to 16 years. Spinal levels were 1.9% cervical, 5.7% thoracic, 22.6% lumbar, and 37 (69.8%) in lumbosacral junctions. Circumferences ranged between 10.7 cm and 41 cm. All mothers knew about folic acid, but most (52, 98%) were postconceptional users. Associations include hydrocephalus (40, 75.5%), foot deformities (22.6%), and imperforate anus (1.9%). Surgeries were closure only (18.9%), flap closure (5.7%), closure with VP shunt in the same sitting (2 in 1’) in 36 (67.9%), and post-excision VP shunt in 4(7.5%). Postoperative complications (in 12 patients) were hydrocephalus (4, 33.3%), wound infection/dehiscence (5, 41.7%), and pseudomeningocele (3, 25%). Five (9.4%) patients were lost to follow-up. We had 2 mortalities (3.8%), and both were infection related.

Conclusion: Myelomeningocoele is common among females, and many presentations are late (days to years). Mothers knew about folic acid but lacked basic knowledge about its importance and appropriate usage (timing). We advocate for further public awareness of its preventive measures.