Spina Bifida in Africa: A Systematic Review and Meta-analysis of Presentation, Management, and Outcomes
Document Type
Article
Publication Title
Journal of Clinical Neuroscience
Abstract
Background
Neural tube defects (NTDs), particularly spina bifida, contribute significantly to pediatric mortality and disability in Africa. Limited healthcare resources and variation in management strategies across regions contribute to disparate outcomes. This systematic review and meta-analysis evaluate the epidemiological profile, clinical presentation, management, and outcomes of spina bifida across African regions.
Methods
A PRISMA-guided systematic review was conducted using PubMed, Google Scholar, Cochrane, and Scopus databases. Retrospective studies and case reports reporting spina bifida case volume, presentation, management, and outcomes in African countries were included. Random-effects meta-analysis estimated pooled prevalence rates with 95% confidence intervals (CI).
Results
A total of 32 studies from 10 African countries, encompassing 4,779 patients, met inclusion criteria. The mean age at presentation was 40.26 months (95% CI: 0–––86.73). Myelomeningocele was the most common subtype (61.39%, 95% CI: (47.43–––75.35). Overall pooled mortality was 33.8% (95% CI: (6.18–––37.83), with significant regional variation (p < 0.01): Southern Africa 15% (95% CI: 0–38%), West Africa 39% (95% CI: 4–50%), East Africa 10% (95% CI: 7–13%), and North Africa 100% (95% CI: 99–100%). Surgical intervention was performed in 80.1% of cases (95% CI: 71.57–92.08), with ventriculoperitoneal shunting (17.61%, 95% CI: 5.48–29.75) and endoscopic third ventriculostomy (11.54%, 95% CI: 0–24.23) among the most common procedures. Clinical improvement was noted in 38.2% (95% CI: 23–71%), with significant differences between regions (p < 0.01), while 14.5% (95% CI: 7.47–24.31) showed no change or worsening.
Conclusions
This study highlights significant variability in spina bifida presentation and outcomes across Africa. Myelomeningocele is the most common subtype, with substantial morbidity and mortality. Regional disparities underscore the need for standardized surgical protocols and increased access to neurosurgical care. Given the low rates of maternal folate supplementation, strengthening public health measures, including folic acid fortification and prenatal screening, is critical to reducing the burden of NTDs in Africa.
DOI
10.1016/j.jocn.2026.111986
Publication Date
6-2026
Keywords
Spina bifida, Myelomeningocele, Neural tube defects, Pediatrics, Folic acid fortification, Global neurosurgery
ISSN
1532-2653
Recommended Citation
O'Leary S, Newsome-Cuby TR, Odiase P, Patel S, Khalil ME, Pulido S, Gowda P, Yevudza E, Okikioluwa O, Sivakumar M, Darko K, Ilyas Y, Barrie U, Totimeh T. Spina Bifida in Africa: A Systematic Review and Meta-analysis of Presentation, Management, and Outcomes. Journal of Clinical Neuroscience. 2026; 148. doi: 10.1016/j.jocn.2026.111986.
