Cranial ultrasound in neonates and infants in rural Africa
Objective. To evaluate the usefulness of cranial ultrasound (CU) at a rural hospital in a developing country setting and to analyse how indications, results and therapeutic consequences differ from those in developed countries. Methods. All CU scans performed over a 32-month period at Haydom Lutheran Hospital, Tanzania, were retrospectively analysed. The patients’ presenting signs and symptoms were categorised into nine groups: 1. birth asphyxia; 2. congenital syndromes; 3. neural tube defects/spina bifida; 4. macrocephalus; 5. post-meningitis; 6. seizures; 7. developmental/ neuromuscular abnormalities; 8. head trauma; and 9. miscellaneous. The information derived from the scans was then analysed with regard to underlying pathology and possible influence on the child’s future management. Results. 420 scans were performed in 293 patients, of whom 34 were older than 1 year. In 155 cases no abnormal result was obtained. When results of the abnormal scans were related to their impact on patient management, the pathological findings were found to have provided useful information in groups 1 (45%), 3 (100%), 4 (87%), 6 (57%), 6 (31%) and 7 (45%). Conclusions. CU is a highly feasible technique even in resource-poor settings and provides valuable additional information in patients with neural tube defects/spina bifida, macrocephalus, post-meningitis, birth asphyxia, developmental/neuromuscular abnormalities and seizures.