Evaluation of academic performance and social integration of children operated for hydrocephalus in Cameroon.

BACKGROUND: Low intelligence quotient (IQ) and delayed psychomotor development (DPD) are formidable complications of hydrocephalus. The aim of this study was to evaluate the academic performance and social integration of children operated on for hydrocephalus in Cameroon. METHOD: The authors present a cross-sectional study with retrospective data collection from January 2010 to May 2020. All children less than 10 years of age who had undergone surgery for a ventriculo-peritoneal shunt indicated for hydrocephalus with a post-operative evolution of 7 to 10 years and who were attending school were included. Academic performance was assessed using the Wechsler Intelligence Scale for Children IV (WISC IV), and social integration was assessed using the Vineland II score. RESULTS: Of the 45 children aged 7 to 10 years who attended school and were followed-up, the sex ratio was 1.25 in favor of males. 77.8% of these children had a malformation with paralysis being the most common functional sequela (29%). 73.3% of our patients had good social integration. Fifty-three percent of patients had reduced academic performance, with non-verbal performance being the most frequent (62.2%). Long-term memory was the most impaired, with 73.3% having a very low speed of information processing. Non-verbal performance was the most affected (62.2%) particularly long-term memory. Forty percent had an IQ below 70. The statistically significant determinants of social integration were age, sex, malformative etiology, and good psychomotor development, and the statistically significant determinants of educational delay were age, malformative etiology, IQ below 70, and time to care. Academic performance was reduced in more than half of our patients, but most of them had good social integration. CONCLUSION: Early diagnosis and management improve the chances of good psychomotor development and IQ.

Long term postoperative results and quality of life after surgery for lumbar spinal stenosis in sub-sahara African countries, the case of Cameroon: A cross-sectional study.

Objectives: Lumbar spinal stenosis is a frequent and disabling disease of the elderly. However, the impact of its surgery on the long term (≥5 years) postoperative results and quality of life has not yet been evaluated in our setting. Methods: The study population consisted of 224 patients operated between 2010 and 2017 at the Yaounde Central Hospital and the Yaounde General Hospital, of whom 33 were evaluated. Long term postoperative results were defined as reoperations, indication for reoperation, time elapsed to reoperation and control-X ray findings. Quality of life (QOL) was evaluated using the Oswestry Disability Index (ODI) and Numerical Pain Rating Scale (NRS), and compared to reported preoperative values. The one-way analysis of variance and Kruskal-Wallis tests were used for associations between patient characteristics and quality of life outcomes. Results: Participants had a mean age of 57.3 years. 21% of participants were reoperated at least once, two years later on average due to reappearance of their clinical pictures. QOL significantly improved from being crippled (mean ODI 67.5%) and having severe pain (mean NRS 8) before surgery, to moderate disability (mean ODI 34.4%, p < 0.01) and moderate pain (means NRS 4, p < 0.01) five years later. Having large family support was the only factor independently associated with improved ODI and NRS (p = 0.01). Conclusion: Lumbar spinal stenosis surgery is still beneficial five years later. Large cohort studies need to be conducted in our setting.

Factors Associated with Adverse Outcomes in Cameroonian Patients with Traumatic Brain Injury: A Cross-Sectional Study.

BACKGROUND: The burden of traumatic brain injury (TBI) disproportionately affects low- and middle-income countries. In Cameroon, the estimated annual incidence rate is 572 cases per 100,000 people. This study investigated factors associated with adverse outcomes in the management of Cameroonian patients with TBI. METHODS: This cross-sectional study included all patients with TBI treated between January 1 and December 31, 2018, at 2 Cameroonian referral hospitals. Sociodemographic and clinical data were extracted from patient charts and admission registries and analyzed with SPSS v.26. Independent t tests, odds ratios, and cumulative mortality hazard rates were computed. A P-value <0.05 was considered statistically significant. Also, binomial regression analyses were calculated. RESULTS: One hundred seventy-one patients aged 38.63 ± 20.46 years old received treatment for TBI. Most patients were male (78.9%), Cameroonian (98.2%), from urban areas (75.4%), and uninsured (88.8%). The average admission length was 11.23 ± 10.71 days, during which 27.5% of patients received surgical treatment while 72.5% received non-surgical (conservative) management. From postdischarge day 12 onwards, surgically-treated patients had a greater cumulative mortality hazard rate than conservatively-treated patients. By 28 days postdischarge, 66.1% of patients had recovered completely [Glasgow Outcome Scale (GOS) = 5], 23.4% had a disability (GOS = 2-4), and 10.5% expired (GOS = 1). Complete recovery was associated with the absence of severe TBI (B = -1.42, standard error [SE] = 0.52, P = 0.006), disability was associated with increased injury-to-admission delay (B = -1.27, SE = 0.48, P = 0.009), and death was associated with severe TBI (B = 3.16, SE = 0.73, P < 0.001). CONCLUSIONS: We identified factors associated with unfavorable outcomes among Cameroonian patients with TBI. These results can inform triage and referral practices and aid policymakers in developing context-specific prehospital guidelines.

Patient Attitudes toward Neurosurgery in Low- and Middle-Income Countries: A Systematic Review.

BACKGROUND: Low- and middle-income countries (LMICs) bear the majority of the neurosurgical burden of diseases but lack the resources to meet these needs. OBJECTIVE: As we increase access to neurosurgical care in LMICs, we must understand patient attitudes toward neurosurgery. METHODS AND MATERIAL: PubMed, LILACS, and African Journals Online databases were searched systematically from inception to January 4, 2020, for studies on neurosurgical patient perceptions in LMICs. The articles found were blindly reviewed with Rayyan by two authors. The two authors resolved conflicts between themselves, and when this was not possible, a third reviewer was consulted. All the articles included were then appraised, and the results were summarized. RESULTS: Six of the 1,175 articles met the inclusion criteria. The studies were set in Brazil, Ethiopia, India, Nigeria, South Korea, and Sub-Saharan Africa. Four of the studies (50%) were phenomenological studies, and the other two were grounded theory and narrative. The studies identified patient attitudes toward neurosurgical practitioners, diseases, and interventions. Ethiopian and Nigerian patients believed cranial diseases to be otherworldly and resorted to traditional medicine or spiritual healing first, whereas Brazilian patients were more comfortable with cranial diseases and even more so if they had had a previous craniotomy. The Indian paper was a recount of a neurosurgeon's experience as a spine patient. CONCLUSIONS: There are few studies on neurosurgery patient perception in LMICs. LMIC neurosurgeons should be encouraged to study their patient beliefs concerning neurosurgical diseases and interventions, as this can explain health-seeking behaviors.

Prehospital Conditions and Outcomes After Craniotomy for Traumatic Brain Injury Performed Within 72 Hours in Central Cameroon: A Cross-Sectional Study.

BACKGROUND: Traumatic brain injury (TBI) is the most common neurosurgical condition globally. In Cameroon, there are 572 cases of TBI per 100,000 people, but <40% of Cameroonians live within 4 hours of a neurosurgical facility. We sought to understand the clinical outcomes at a neurosurgical center in Central Cameroon. METHODS: This cross-sectional study was conducted at the largest neurosurgical center of Cameroon, the Yaounde Central Hospital. Data included 100 consecutive patients undergoing an intervention 72 hours after their injury from February 1, 2015 to February 1, 2019. Patients with missing data or undergoing surgery >72 hours after injury were excluded. Analyses of covariance were performed, and a P value >0.05 was considered significant. A Kaplan-Meier survival curve was computed. RESULTS: The patients had a mean age of 31.3 ± 17.4 years, with a male predominance of 91.0%, and the principal mechanism of injury was road traffic accidents (68.0%). Only 11% arrived via ambulance, and 36.0% were admitted <3 hours after the traumatic event. The postoperative mortality was 15.0%, mean survival was 25.0 postoperative days (95% confidence interval, 23.42-26.52), and the mean Glasgow Outcome Scale score at 28 days was 3.9 ± 1.4. CONCLUSIONS: Most patients with TBI undergoing neurosurgery 72 hours after injury in Cameroon arrive at the hospital late and have a high mortality risk during the first postoperative week. Investments in prehospital care should be made to improve surgical outcomes.