Complications of Ventriculoperitoneal Shunts in Children in Dar es Salaam

Background: From the few reports available, VP shunt surgery in sub- Saharan Africa is associated with significant complications. This study was aimed at establishing the pattern, causes and frequency of complications of VPS in Tanzania.
Methods: Sixty five of the 102 children with hydrocephalus treated with ventriculoperitoneal shunts between January 1996 and January 1999 were studied prospectively. The first follow-up was at 2 weeks postoperative when the wounds were evaluated and occipitofrontal circumference measured. Further follow-ups were at 4 weeks and at three months. Collaborating staff of the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) thereafter regularly followed up the children at home.
Results: The male to female ratio was 1.8 to 1. Forty-seven of the children (72%) were less than 12 months old but no patient was under 1 month of age at operation. The mean occipitofrontal circumference was 50.7cm. Shunt blockage was the commonest complication (32.3%) followed by infection (24.6%). The combined complication rate of shunt infection and wound infection was 46.1%. Shunt-related mortality was 13 (20.0%). There was no statistically significant correlation between the occipitofrontal circumference and type of complication or mortality. The mean age among the patients showing disconnection was 21.3 months compared to a mean age of 8.1 months for those not having this complication (P-value=0.04)
Conclusion: The complication rates were higher than those in Western series but compared well with findings from sub Saharan Africa other studies.