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

Hospitals treating NTD children in Tanzania

MOI 2005 todate. (Ω 200 patients)

Muhimbili Medical Centre ?;

CCBRT 1996-2005 (Ω 102 patients)

KCMC

Hydom Christian Health Centre (Luth Ref Hosp)

BUGANDO

Seliani hosp

MOI hydrocephalus series

MOI receives patients from all over

the country

MKOA

MKOA

znz

tanga

tabora

singida

ruvuma

rukwa

pwani

mwanza

mtw

ara

moro

mbeya

knjaro

kigoma

iringadsm

dodoma

arusha

Fre

qu

en

cy

40

30

20

10

0

NTD Rx CENTRES

1000 km

Why only few hospitals in Tz are involved in SB/H treatment?

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

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

Late VS Early presentation

Nutritional status

Co morbidity ( pneumonia, septicemia etc)

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

• Lab facility including staff

• Imaging facility – ultrasound/ CT scan

• Consent for surgery

• Teamwork – anesthetist, surgeon,

theatre nurse, supporting staffs etc

• Theatre facility

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

• Updating surgical treatment guidelines in order to

minimize VP shunt infections, and to ensure

good outcome

• CME to ensure quality care

Pre surgery

8/12 old

Post surgery

2yr old

Occipital encephalocoele

Repair achieved in one stage operation

SMART treatment guidelines and proper surgical procedure

Frontoethmoidal encephalocoele

Pre surgery Post surgery #1

?

#2 etc

Sometimes repair requires multistage operations

Cosmesis

CSF leak

SMART treatment guidelines and proper surgical procedure

SMART treatment guidelines and proper surgical procedure

Multidisciplinary approach in coordination sometimes is required

Thoracic SB and TEV child

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

• Intensive care set up, treatment guidelines

• Committed supporting staff and collaborating care professionals

• Wound care

• Nutrition

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

• Established engagement with collaborating team e.g.

physiotherapy, club foot clinic, CBR worker etc

• Proper counseling ensures good follow up

• Database management to ensure Rx continuation /

evaluation and dissemination

Suggestions?