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

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. Conclusion: 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