‘It is the child with the big head’ – Primary healthcare providers’ perceptions of paediatric hydrocephalus in Blantyre, Malawi: A qualitative study

ABSTRACT

Children in Africa are disproportionately burdened by the neurosurgical condition hydrocephalus. In Blantyre, Malawi, paediatric hydrocephalus represents the majority of surgical procedures performed in the neurosurgical department at Queen Elizabeth Central Hospital. To reduce morbidity and mortality, timely detection followed by referral from surrounding primary health centres is crucial. Aiming to explore perceptions and identify enablers and barriers to detection and referral, we conducted a qualitative study among primary healthcare providers (n = 30) from ten health centres in Blantyre district. Using a semi-structured interview-guide, we audio-recorded and transcribed the interviews before conducting a thematic analysis. One main finding is that there is a potential to improve detection through head circumference measurements, which is the recommended way to detect hydrocephalus early, yet healthcare providers did not carry this out systematically. They described the health passport provided by the Malawian Ministry of Health as an important tool for clinical communication. However, head circumference growth charts are not included. To optimise outcomes for paediatric hydrocephalus we suggest including head circumference growth charts in the health passports. To meet the need for comprehensive management of paediatric hydrocephalus, we recommend more research from the continent, focusing on bridging the gap between primary care and neurosurgery.

KEYWORDS:

• Hydrocephalus
• Malawi
• paediatrics
• global neurosurgery
• IGAP

Acknowledgements

We want to thank our study participants for their valuable time. We would not be able to share our findings without them. We also wish to thank Chrissy Chilenje (Health Management Information Systems Officer at the District Health Office, Blantyre, Malawi) for providing information about the number of health centres in Blantyre district and the catchment population for the health centres included in this study (Table 1). In addition, we are grateful to Ine Eriksen (Medical Photography and Illustration Service at the University of Oslo, Oslo, Norway) for making the map of Africa/Blantyre (Figure 2). Last, we want to thank the Department of Global Health at Oslo University Hospital, Oslo, Norway for providing practical support and housing for the first author when she is in Blantyre, Malawi.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data sets used and analysed are available from the corresponding author on reasonable request.

Authorship statement

CGA: Conceptualisation, methodology, formal analysis, writing original draft, project administration, funding acquisition. PDK: Conceptualisation, writing-review and editing, and supervision. GF: Investigation (data collection). CM: Methodology, writing-review and editing, and supervision. BAC: Writing-review and editing. HEF: Methodology, writing-review and editing, and supervision. LMT: Methodology, writing-review and editing, and supervision.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This study is part of the first author’s PhD research project, which is funded by Oslo University Hospital- Rikshospitalet, Oslo, Norway. In addition, CGA has received funding support for her PhD project from the Renée and Bredo Grimsgaard's Foundation, Norwegian Association for Spina Bifida and Hydrocephalus, Robert and Ella Wenzins Foundation, and the Norwegian Association of Neuroscience Nurses. Funding sources did not have any role in the study design, the collection, analysis, and interpretation of data, writing of the article and in the decision to submit the article for publication.