Timeliness of surgical repair among infants with myelomeningocele in a tertiary care hospital in Addis Ababa, Ethiopia.

Abstract

Purpose: Ethiopia has a high prevalence of myelomeningocele (open spina bifida), a severe and often fatal birth defect affecting the spinal cord in the newborn. Timely surgery is associated with improved health outcomes and survival among those affected. Recent studies on timeliness of myelomeningocele closure surgery and factors associated with it are lacking in Ethiopia.

Methods: We conducted an observational study using data from structured electronic medical records stored at the largest surgical and treatment referral hospital for spina bifida care in Ethiopia. We used surgical information on patients with myelomeningocele from January 2020 to June 2022. Surgical timeliness was dichotomized as "timely" if the repair occurred within 3 days after birth and "delayed" after the 3rd day of birth. Prevalence of timely spina bifida surgery was assessed. Selected demographic and clinical factors associated with timeliness of the repair surgery were examined using logistic regression analysis.

Results: Of the 279 eligible patients who received myelomeningocele closure surgery during the study period, only 45 (16.1%) were timely. Family residence in Addis Ababa was significantly associated with a timely repair surgery (delayed surgery aOR = 0.25; 95% CI = 0.11, 0.57), after adjusting for the year of surgery, infant sex, presence of cerebrospinal fluid leak, and spina bifida lesion level.

Conclusion: Less than a quarter of patients with myelomeningocele received timely repair surgery in a large tertiary care referral hospital in Addis Ababa, Ethiopia. Promoting timely closure of myelomeningocele while providing equitable access to optimal surgical care for patients will improve health outcomes and prevent mortality.