Proper care for patients with spina bifida and hydrocephalus requires hospitals to have appropriate facilities, guidelines, and staff for pre-operative evaluation and workup, surgical treatment and post-operative care and follow-up. Only a few hospitals in Tanzania currently meet the prerequisites for good outcomes, which include proper pre-operative assessment, SMART treatment guidelines, multidisciplinary teams, intensive care capabilities, and organized outpatient follow-up plans. Ensuring patient selection, coordinated specialist care, counseling, and database management can help more hospitals successfully treat these conditions.

1. What is necessary to provide good care for
persons with SB and H?
Operative care / hospital set up
Dr H. K. Shabani MD PhD FCS
Neurosurgeon, Muhimbili Orthopedic Institute

2. Hospitals treating NTD children in Tanzania
BUGANDO
Hydom Christian Health Centre (Luth Ref Hosp)
Seliani hosp
KCMC
MOI 2005 todate. (Ω 200 patients)
Muhimbili Medical Centre ?;
CCBRT 1996-2005 (Ω 102 patients)

3. NTD Rx CENTRES
MOI hydrocephalus series
MOI receives patients from all over
the country
MKOA
40
30
20
1000 km
Frequency
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4. Why only few hospitals in Tz are involved in SB/H treatment?

5. Prerequisite for SB/H good treatment outcome at the hospital settings:
Patient selection
Proper pre operative work-up
SMART treatment guidelines and proper surgical procedure
Proper post-operative follow-up and in-patient care
Right time for discharge and organized outpatient follow up plan

6. Prerequisite for SB/H good treatment outcome at the hospital settings:
 Patient selection
Proper pre operative work-up
Late VS Early presentation
Nutritional status
SMART treatment guidelines and proper surgical procedure
Co morbidity ( pneumonia, septicemia etc)
Proper post-operative follow-up and in-patient care
Right time for discharge and organized outpatient follow up plan

7. Prerequisite for SB/H good treatment outcome at the hospital settings:
Patient selection
 Proper pre operative work-up
• Lab facility including staff
• Imaging facility – ultrasound/ CT scan
SMART treatment guidelines and proper surgical procedure
• Consent for surgery
Proper post-operative follow-up and in-patient care
• Teamwork – anesthetist, surgeon,
Right time for discharge and organized outpatient follow up plan
theatre nurse, supporting staffs etc
• Theatre facility

8. Prerequisite for SB/H good treatment outcome at the hospital settings:
Patient selection
Proper pre operative work-up
 SMART treatment guidelines and proper surgical procedure
• Updating surgical treatment guidelines in order to
Proper post-operative follow-up and in-patient care
minimize VP shunt infections, and to ensure
good outcome
Right time for discharge and organized outpatient follow up plan
• CME to ensure quality care

9.  SMART treatment guidelines and proper surgical procedure
 Repair achieved in one stage operation
Pre surgery Post surgery
8/12 old 2yr old
Occipital encephalocoele

10.  SMART treatment guidelines and proper surgical procedure
 Sometimes repair requires multistage operations
?
Cosmesis
CSF leak
Pre surgery Post surgery #1 #2 etc
Frontoethmoidal encephalocoele

11.  SMART treatment guidelines and proper surgical procedure
 Multidisciplinary approach in coordination sometimes is required
Thoracic SB and TEV child

12. Prerequisite for SB/H good treatment outcome at the hospital settings:
• Intensive care set up, treatment guidelines
Patient selection
• Committed supporting staff and collaborating care professionals
• Wound care
Proper pre•operative work-up
Nutrition
SMART treatment guidelines and proper surgical procedure
 Proper post-operative follow-up and in-patient care
Right time for discharge and organized outpatient follow up plan

13. Prerequisite for SB/H good treatment outcome at the hospital settings:
• Established engagement with collaborating team e.g.
Patient selection physiotherapy, club foot clinic, CBR worker etc
• Proper counseling ensures good follow up
Proper pre operative work-up
SMART treatment Database management to ensure Rx continuation /
• guidelines and proper surgical procedure
evaluation and dissemination
Proper post-operative follow-up and in-patient care
 Right time for discharge and organized outpatient follow up plan

14. Suggestions?