Anatomical characteristics, clinical features, and risk factors of spina bifida: A retrospective review of children at Cure Hospital, Uganda.
Keywords:
Spina Bifida, Myelomeningoceles, Lumbar, Sacral, hydrocephalus.Abstract
Background: Spina bifida, a neural tube defect, continues to pose substantial public health challenges in Uganda despite multiple preventive efforts. An estimated 1,400 children are affected annually. We conducted a retrospective cross-sectional review of hospital records for children diagnosed with spina bifida between 2020 and 2023. Methods: Using systematic sampling, we selected 414 patient records. We analysed the data using SPSS version 20. We defined severe spina bifida as a lumbosacral lesion presenting clinically with hydrocephalus. Results: Males constituted 60.4% of cases (n=250). Infants aged <1 year comprised 36.2% (n=150). Most lesions (69.0%) were located in the lumbosacral region; sacral lesions accounted for 17.4%, lumbar 8.0%, lumbothoracic 4.6%, and occipital and cervical regions 0.5% each. Regarding lesion integrity, the highest proportion of intact lesions occurred in the lumbosacral region (48.1%), followed by sacral (16.2%), lumbar (15.2%), and lumbothoracic (12.4%); ruptured lesions were also observed in the thoracic region (7.8%). Maternal febrile illness was associated with severe spina bifida (adjusted OR 2.24, 95% CI 1.34–3.74; p=0.02). Tertiary maternal education was also associated with higher odds of spina bifida (adjusted OR 2.27, 95% CI 1.43–4.57; p=0.01). Conclusion: Myelomeningocele remains the predominant form of spina bifida in Uganda, chiefly affecting the lumbosacral region.
Downloads
References
Bannink F, Larok R, Kirabira P, Bauwens L, Van Hove G. Prevention of spina bifida: folic acid intake during pregnancy in Gulu district, northern Uganda. Pan African Medical Journal. 2015;20(1).
Fletcher JM, Brei TJ. Introduction: Spina bifida—A multidisciplinary perspective. Developmental disabilities research reviews. 2010;16(1):1.
Atta CA, Fiest KM, Frolkis AD, Jette N, Pringsheim T, St Germaine-Smith C, et al. Global birth prevalence of spina bifida by folic acid fortification status: a systematic review and meta-analysis. American journal of public health. 2016;106(1):e24-e34.
Shlobin NA, Roach JT, Kancherla V, Caceres A, Ocal E, Ghotme KA, et al. The role of neurosurgeons in global public health: the case of folic acid fortification of staple foods to prevent spina bifida. Journal of Neurosurgery: Pediatrics. 2022;1(aop):1-8.
Oumer M, Taye M, Aragie H, Tazebew A. Prevalence of spina bifida among newborns in Africa: a systematic review and Meta-analysis. Scientifica. 2020;2020:1-12.
Barlow‐Mosha L, Serunjogi R, Kalibbala D, Mumpe‐Mwanja D, Williamson D, Valencia D, et al. Prevalence of neural tube defects, maternal HIV status, and antiretroviral therapy from a hospital‐based birth defect surveillance in Kampala, Uganda. Birth defects research. 2022;114(3-4):95-104.
CDC AW. Centers for disease control and prevention. 2020.
Mweshi MM, Amosun S, Ngoma M, Nkandu E. Managing children with spina bifida in sub-Saharan Africa: The Zambian experience? Medical Journal of Zambia. 2011;38(1):13-23.
Komolafe EO, Onyia CU, Ogunbameru IO, Dada OA, Owagbemi OF, Ige-Orhionkpaibima FS, et al. The pattern, peculiarities, and management challenges of spina bifida in a teaching hospital in Southwest Nigeria. Child's Nervous System. 2018;34:311-9.
Oumer M, Tazebew A, Silamsaw M. Birth prevalence of neural tube defects and associated risk factors in Africa: a systematic review and meta-analysis. BMC pediatrics. 2021;21:1-13.
Motah M, Moumi M, Ndoumbe A, Ntieafac C, Djienctheu VDP. Pattern and management of neural tube defect in Cameroon. Open Journal of Modern Neurosurgery. 2017;7(3):87-102.
Mashiloane P, Masekela R. A review of the epidemiology, post-neurosurgical closure complications and outcomes of neonates with open spina bifida. South African Journal of Child Health. 2020;14(2):77-81.
Ramachandra P KLS, A J,.Marietti, S.,& Chiang, G. Shunted hydrocephalus has a significant impact on quality of life in children with spina bifida. 2013;5(10):825-31.
Githuku JN, Azofeifa A, Valencia D, Ao T, Hamner H, Amwayi S, et al. Assessing the prevalence of spina bifida and encephalocele in a Kenyan hospital from 2005–2010: implications for a neural tube defects surveillance system. The Pan African Medical Journal. 2014;18:60.
Cook RC. Spina bifida and hydrocephalus. British Medical Journal. 2001;4(5790):796.
Frischhut B, Stockl B, Landauer F, Krismer M, Menardi G. Foot deformities in adolescents and young adults with spina bifida. JOURNAL OF PEDIATRIC ORTHOPAEDICS PART B. 2000;9(3):161-9.
Schaibley C, Torres-Izquierdo B, Meyer Z, Hosseinzadeh P. Outcomes of Ponseti Method for the Treatment of Clubfeet in Children With Spina Bifida. Journal of Pediatric Orthopaedics. 2024;44(9):539-44.
Swaroop VT, Dias L. Orthopaedic management of spina bifida—part II: foot and ankle deformities. Journal of children's orthopaedics. 2011;5(6):403-14.
Elliott SP, Villar R, Duncan B. Bacteriuria management and urological evaluation of patients with spina bifida and neurogenic bladder: a multicenter survey. The Journal of urology. 2005;173(1):217-20.
Bent MA, Ciccodicola EM, Rethlefsen SA, Wren TA. Increased Asymmetry of Trunk, Pelvis, and Hip Motion during Gait in Ambulatory Children with Spina Bifida. Symmetry. 2021;13(9):1595.
Alshalan A, Hussain MA, El-Fetoh N, Alenezi S, Alenazi A, Alanazi M, et al. Spina bifida in infants and children in Arar, Northern Saudi Arabia. The Egyptian Journal of Hospital Medicine. 2018;72(1):3497-502.
Moretti ME, Bar-Oz B, Fried S, Koren G. Maternal hyperthermia and the risk for neural tube defects in offspring: systematic review and meta-analysis. Epidemiology. 2005;16(2):216-9.1. Ntimbani J, Kelly A, Lekgwara P. Myelomeningocele-A literature review. Interdisciplinary Neurosurgery. 2020;19:100502.
Mulu GB, Atinafu BT, Tarekegn FN, Adane TD, Tadese M, Wubetu AD, et al. Factors associated with neural tube defects among newborns delivered at Debre Berhan Specialized Hospital, North Eastern Ethiopia, 2021. Case-control study. Frontiers in pediatrics. 2022;9:795637.
Byabato S, Kiryabwire J, Galukande M. Spina Bifi da Cystica; features and early postoperative outcomes an experience in Kampala. Annals of African Surgery. 2012;9.
Downloads
Published
Data Availability Statement
Data are available from the lead author (chebetfrida43@gmail.com) on reasonable request, subject to institutional approvals to ensure confidentiality and data-governance compliance.
License
Copyright (c) 2026 East African Journal of Neurological Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
