Barriers to Spina Bifida Care in Benin: A Single-Center Hospital-Based Cross-Sectional Study

Abstract

 Introduction

Spina bifida (SB) is one of the common birth defects of the spinal cord and leads to permanent disability for newborns and young children. The management of this condition has faced barriers in the Republic of Benin. We aimed to assess the current prevalence of SB, management, in Benin, as well as the availability of pediatric neurosurgery in Benin.

Methods

SB patients admitted at the authors’ institution between January 2018 and August 2021 were included. Demographics, access to care, and therapeutic data were extracted from patient records. 

Results

Forty patients aged 99 days (95% CI:5.9-192.1) were included. Most were male (24, 60%), 23 (57.5%) experienced a delay in diagnosis after birth ranged from 5 days - 7months and 28 (70%) could not afford neuroimaging. Most lesions were lumbosacral (n=23, 57.5%). Five patients had comorbidities, the most prevalent of which was club foot (4, 10%). Twenty-two patients (55%) had surgery repair, and the admission-to-surgery delay ranged from 2 days - 2 years. Sixteen patients (40%) required a ventriculoperitoneal shunt, and they were more likely to experience delays (OR=11.67, 95% CI:2.14-63.64, p=0.02). Three patients died (7.5%), and one developed meningitis (2.5%).

Conclusion

SB care in Benin remains suboptimal due to the lack of access to care, and cultural barriers like the belief in a curse of the gods, or infidelity of the woman.

The delay between care and the diagnosis is long because of the unavailability of time and cost of neuro-imaging, cost of the device, and consumables for surgery.