Ventriculo-Peritoneal Shunt revisions in Children with Hydrocephalus at the University Teaching Hospital, Lusaka

Abstract

In sertions and revisions of ventriculo-peritoneal shunts (VPS) are common procedures done at the University Teaching Hospital (UTH) in Lusaka, Zambia. However, the actual incidence rate of revisions and the causes were not properly documented. A retrospective study of the Incidence and Causes of Ventriculo-peritoneal Shunt revisions in children with hydrocephalus at the UTH was carried out over a period of one year (September 2009 to August 2010). Its specific objectives was to determine the rate of revisions of the VPS inserted at UTH, to identify the causes of VPS revisions and the common infections present in the children undergoing these VPS revisions. Data was obtained from the medical records of patients who underwent initial VPS insertion, and subsequent revisions of these shunts during the study period, after approval from the University of Zambia Research Ethics Committee and hospital authorities.One hundred and fifty patients were recruited who required an initial VPS inserted. Of these patients, twenty-nine had shunt revisions done, with an incidence of 19.3%. Two patients had two revisions while one had three revisions done. Ninety-four (62.7%) were male and fifty-five (36.7%) were female. The age range of patients was one week to fourteen years, with 50% (75) being below 6 months. The causes of revision of VPS were surgical wound infections (28.0%), blocked or dislodged shunts, cerebrospinal fluid infections (8.0%), and outgrowing of the VPS (4.0%). Bacteriological studies confirmed Staphylococcus aureus, Enterobacter, Citrobacter and yeast cells in CSF in only four patients, while it was noted that eighty-seven patients had a positive history of either a febrile illness or convulsions. One hundred and sixteen patients (77.3%) had a negative serology for HIV, and fourteen (9.3%) had a positive reaction. The remaining twenty patients did not have an HIV test done.The rate of revision in this study is comparable to other countries in the developing world i.e.23.3% in Kenya, 20% in Libya12, and 22% in India17.