Endoscopic neurosurgery was introduced at the turn of the twentieth century to diagnose and treat hydrocephalus, a potentially life-threatening condition listed among the dominant pathologies of the central nervous system (CNS) in developing countries. A conservative estimate suggests an annual incidence of more than 14,000 cases of infants developing hydrocephalus within their first year of life in East, Central, and Southern Africa (ECSA), which has a combined population of more than 250 million. This number shows the enormous burden of the condition in developing countries, compared with developed nations prevalence of 0.9 to 1.2 cases per 1000.
Prenatal health care continues to be poor in many developing countries, and reports have suggested that in Central Africa the most common causes of hydrocephalus are neural tube defects and congenital aqueductal stenosis. In Zambia, meningitis and other CNS infections account for almost 75% of hydrocephalus cases. Clinical series from East Africa have shown that meningitis and/or ventriculitis is the most common cause of hydrocephalus in East Africa, accounting for almost 60% of the cases. The high prevalence of hydrocephalus in developing countries could be related to untreated or poorly treated neonatal meningitis and nutritional deficiencies during pregnancy and infancy.
Although universal access to health care and treatments considered basic in developed countries has yet to be achieved, general improvements in nutrition and health care have resulted in a reduction of the under-5 child mortality rate (U5MR). In recent years, urban, middle-class African families have seen improvements in female education, better infant nutrition and hygiene, and, therefore, a lower U5MR than the regional average. Nonetheless, health care in the less developed regions is a challenge, and specialties requiring highly trained professionals and sufficient access to expensive equipment and supplies is severely lacking in developing countries. The figures, in this regard, speak for themselves. A survey sponsored by the World Health Organization in 1998 revealed the existence of only 79 neurosurgeons in sub-Saharan Africa, a ratio of 1 to 3,600,000 inhabitants, while the world ratio is 1 to 230,000 inhabitants.
Children born with hydrocephalus in developed societies are likely to receive surgery in the immediate perinatal period. However, management of hydrocephalus in developing countries is challenging; parents or caregivers often do not seek medical attention for at least 7 months after onset of clinical symptoms. Less than 5% of children with hydrocephalus in developing countries receive surgery each year, usually consisting of placement of a ventriculoperitoneal shunt (VPS). In Kenya, one of the more progressive nations, less than 25% of affected children will undergo VPS surgery.
