Factors influencing time of presentation among children with myelomeningocele in Zambia: a prospective study.

Abstract

Objective: Although myelomeningocele (MMC) remains a leading cause of infant disability and death in many low- and middle-income countries, data regarding access to timely neurosurgical care remain limited. The goal of this study was to characterize sociodemographic and clinical factors associated with delayed presentation for neurosurgical repair of MMC in Zambian infants.

Methods: Infants with MMC presenting to a major tertiary academic hospital in Lusaka, Zambia, for MMC repair between May 1, 2024, and October 21, 2025, were enrolled in a prospective cohort study. The primary outcome was delayed patient presentation for postnatal neurosurgical care, defined as > 72 hours from birth. Univariate and multivariate logistic regression models were fit to assess the impact of demographic and clinical factors on late presentation to this tertiary care center.

Results: One hundred eighteen infants (53% male, n = 62) were enrolled, with 22% (n = 25) born prematurely. Seventy-one percent (n = 84) had a delayed presentation to the tertiary hospital. The median age at first neurosurgical evaluation was 8.0 (IQR 3.0-22.0) days. The median maternal age was 25.0 (IQR 20.0-30.0) years, with a median parity of 2 (IQR 1-4). Most mothers (67%, n = 79) had either no formal education or completed primary school only, and of those who answered the question, the majority were married (72%, 47/65). The self-reported median monthly household income was 16.56 (IQR 4.42-26.50) US dollars. The median distance from the primary referring center to the tertiary hospital was 414.9 (IQR 206.5-577.0) km. Preterm infants (OR 3.997, p = 0.027) and those who traveled ≥ 500 km to receive care (OR 5.085, p = 0.001) were more likely to present late, while those who received ≥ 1 antenatal ultrasound after 20 weeks' gestation tended to have earlier presentation (OR 0.363, p = 0.032). No statistically significant association was found between late presentation and any of the following: maternal age at delivery, education level, marital status, parity, multiplicative increases in monthly household income, infant sex, and presence of any congenital anomalies or comorbidities (p > 0.05).

Conclusions: Longer distances to care and preterm birth were associated with delayed patient presentation, while receipt of antenatal ultrasound was associated with earlier presentation. Further investigations aimed at enhancing antenatal and postnatal care, as well as improving transportation access to neurosurgical tertiary care services, are warranted.