Management and outcomes of myelomeningocele-associated hydrocephalus in low- and middle-income countries: a systematic review and meta-analysis protocol

Abstract

ABSTRACTIntroductionHydrocephalus and myelomeningocele (MMC) place disproportionate burdens of disease on low and middle-income countries (LMICs). MMC-associated hydrocephalus and its sequelae result in a spectrum of severely devastating clinical manifestations, for which LMICs are disproportionately unprepared in terms of human, capital, and technological resources. This study aims to review and compare the management and outcomes of infant MMC-associated hydrocephalus in LMICs and high-income countries.Methods and analysisThis systematic review and meta-analysis will follow the PRISMA 2020 guidelines. The following databases will be searched without restrictions on language, publication date, or country of origin: EMBASE, MEDLINE, The Cochrane Library, Global Index Medicus, African Journals Online, and SciELO. All peer-reviewed studies of primary data reporting management and outcomes of infant MMC-associated hydrocephalus will be included. Where high-quality homogeneous studies exist, meta-analyses will be conducted to compare the management and outcomes of MMC-associated hydrocephalus across socioeconomic and geographic regions of the world. The primary outcome will be treatment failure of the first-line hydrocephalus treatment, which we defined operationally as the performance of a second intervention for the same reason as the first. Secondary outcomes include time to failure, rates of mortality, and postoperative complications.Ethics and disseminationEthical approval was not applicable because this study does not involve human participants. Dissemination strategies will include publication in a peer-reviewed journal, oral and poster presentations at conferences, and an interactive web application to facilitate interaction with the findings and promote the discussion and sharing of findings on social media.ARTICLE SUMMARYStrengths and limitations of this studyThis review focuses on multiple treatment modes of a well-defined disease population.Six electronic databases that are commonly used across both high- and low-income countries will be searched.No restrictions on language, location, or publication date were placed during screening.Unpublished studies will not be sought.The representativeness of the sample will rely on the quality of reporting of myelomeningocoele-associated hydrocephalus in the literature.Only one operational definition of treatment failure—‘the performance of a second intervention for the same reason as the first’—will be sought.An interactive web application dashboard will be developed to facilitate the transparent interaction with our methods and findings and promote scientific discussion and scrutiny.