ABSTRACT
INTRODUCTION Hydrocephalus is a common, underrecognized, and undertreated diagnosis among children in the developing world, where many challenges converge to impede its proper management. A dearth of centers with sufficient expertise is one obvious impediment. East and Central Africa, where I spent 6 years helping to develop a neurosurgical hospital for children (CURE Children’s Hospital of Uganda), is representative. The ratio of trained neurosurgeons to total population at this writing is around 1 to 4 million in Kenya, 1 to 7 million in Uganda, and 1 to 18 million in Tanzania. In Congo, Rwanda, and Malawi, there are none. Given that more than half the population in this region is younger than the age of 15, it goes without saying that neurosurgical problems among children, hydrocephalus being the most common, are severely underserved. Obstacles to gaining access to one of the rare centers with competence to treat hydrocephalus only compound the problem. Poverty renders travel a costly enterprise for most families, while poor infrastructure and areas of insecurity make it time-consuming and dangerous. On arrival, a family may be confronted with prohibitive costs or an ill-equipped facility. For instance, a shunt may not be available or, if so, payment up-front for its cost may be required-–a prohibitive proposition for most.
