Burden of pediatric hydrocephalus in a Latin American upper-middle-income country: a nationwide ecological study in Colombia.

Objective: Pediatric hydrocephalus is a common complex condition, in which late diagnosis can cause irreversible sequelae. The prevalence worldwide is estimated to be approximately 88/100,000, but the literature suggests it is higher in developing countries, with predominantly postinfectious etiologies. The incidence has been found to be inversely associated with a country's income level. South America is among the regions considered most affected by this disease, but very few recent prevalence studies exist. This is the first prevalence study of pediatric hydrocephalus in Colombia, an upper-middle-income country. This study aimed to estimate the prevalence of pediatric hydrocephalus (ages 0 to 17 years) in Colombia between 2017 and 2022 and to determine its national distribution.

Methods: A search of the Colombian System of Integrated Information of Social Protection was performed, using International Classification of Diseases, 10th Revision codes to extract the Individual Registries for Provision of Health Services. These data were compared to those in the population registries of the National Administrative Department of Statistics. Prevalence for each code was calculated, and distribution according to age group, sex, and department was made. Yearly and overall prevalence rates were graphed on nationwide maps throughout the study period years.

Results: The authors found a nationwide prevalence of 57.2/100,000, with an underreporting rate for all cases of 31.3%. The adjusted prevalence for underreporting was 83.0 cases per 100,000. A total of 55% of cases were in male patients. The reported causes of hydrocephalus were as follows: 24.9% of cases were due to postinfectious etiologies, 9.9% were attributed to CNS malformations, 0.3% were posttraumatic, and 0.3% were neoplastic. In most cases, etiology was not reported. The maps created show a heterogeneous prevalence distribution through the years. The adjusted prevalence rate map shows a prevalence distribution with higher rates in lower-income regions.

Conclusions: In this study, the estimated prevalence of pediatric hydrocephalus in Colombia was lower than the prevalence estimated worldwide, and even lower than that estimated for high-income areas. This is explained partially by a significant rate of underreporting; however, even accounting for the underreporting, the prevalence remains considerably lower than that estimated for developing regions like South America. This may suggest a trend of decreasing prevalence in developing countries whose economies have grown in recent years. These findings can guide public policy for adequate surveillance and prevention of pediatric hydrocephalus in Colombia and highlight the importance of further updated research in the region.