Epidemiology of myelomeningocoele in Africa: An experience in a Regional Neurosurgical Center in Northern Nigeria

Abstract

Abstract Background: Myelomeningocoele is a common birth defect with strong associations with folate deficiency and maternal illiteracy. The aim of this study is to describe the distribution and pattern of myelomeningocoele in a resource-poor community and determine the factors responsible for the rising incidence in Africa. Patients and Methods: Prospective cohort study of 90 patients with myelomeningocoele who were treated at the Regional Centre for Neurosurgery (RCNS), Sokoto between September 2015 and December 2016. Data were collected through a structured questionnaire and analyzed by using SPSS 21 version. Results: Ninety patients were recruited into this study with a male: female ratio of 1:1 and a mean age of 102±213 days at presentation. The majority of patients’ mothers were between 19 and 35 years of age, with 70% having no formal education; however, most of the patients’ fathers were either unskilled casual workers or subsistent farmers (56.7%). Of the 36.7% of the patients’ mothers who had antenatal care, only 35.6% of them took a folic acid supplement mostly after the first trimester. More than 90% of the mothers had persistent sources of heat irradiation during pregnancy, majorly from firewood cooking. Most of the myelomeningocoele (MMC) sacs (72.9%) were located in the lumbar and sacral regions. Wound infection was the most common complication (50.0%), whereas trans-fontanelle ultrasound scan (TFUSS) showed hydrocephalus in 45.6% of patients. Conclusion: Myelomeningocoele is a common medical problem with increased incidence in poor countries. Poverty and illiteracy play major roles in its occurrence, and challenges are faced with its prevention and management. Long-time exposure to heat from firewood cooking and multiparity were identified as significant risk factors for myelomeningocoele.