Background
: Hydrocephalus is a condition of increased volume of cerebrospinal fluid
commonly associated with impa
i
red brain function. It is more common in developing countries
and mostly frequently in children. One can expect 3000
-
6000 new cases of hydroce
phalus
annually in Ethiopia. Head circumference (HC) is commonly increased in these children and its
measurement is a simple, quick and inexpensive method of screening for hydrocephalus. Early
treatment, which is now available in Ethiopia, prevents or redu
ces the development of
malfunction. Since early treatment now has become available in Ethiopia, we were motivated to
establish such a method in the country.
Aims
of
the
study
:
The
aim
of
this
study
is
to
develop
reference
ranges
for
HC
in
Ethiopian
infant
s
and
compare
this
reference
with
the
existing
WHO
standard.
Materials
and
methods
:
This
was
a
prospective
cross
-
sectional
study
approved
by
the
ethics
review
board.
Children
age
0
-
24
months
attending
the
mother
-
and
-
child
clinic
primari
ly
for
vaccination
program
in
Addis
Ababa
and
four
other
main
cities
of
Ethiopia,
were
recruited
to
the
study
after
informed
cons
ent.
Hydrocephalus
or
having
been
treated
for
hydrocephalus
and
other
obvious
diseases
including
malnutrition
were
not
included,
nor
were
infants
without
documented
date
of
birth.
A
soft
measurement
tape
was
used
to
measure
the
circumference
in
cm
in
a
standardized
way.
In
addition
to
measuring
HC
age,
date
of
birth,
ethnicity,
medical
history
wer
e
recorded
for
all
participants.
The
LMS
method
was
u
sed
to
establish
the
reference
graphs
for
boys
and
girls.
These
graphs
were
compared
with
WHO
and
Norwegian
charts
both
by
calculating
absolute
differences
and
comparing
percentile
lines
using
95%CI.
Results
:
4025
children
(2046
boys
and
1979
girls
)
under
24
months
were
included
in
the
study.
The
established
reference
ranges
for
boys
and
girls
had
a
similar
pattern
to
those
found
in
the
WHO
and
Norwegian
studies.
The
50
th
and
97
th
percentiles
of
the
WHO
charts
were
found
to
be
significantly
below
th
e
corresponding
Ethiopian
lines.
The
3
rd
and
50
th
Norwegian
percentiles
were
significantly
above
the
corresponding
Ethiopian
lines. Conclusion
:
Ethiopian
reference
ranges
for
children
0
-
24
months
of
age
were
found
to
be
significantly
different
from
those
established
by
WHO,
suggesting
the
use
of
local
reference
for
the
screening
for
hydrocephalus.
We
speculate
that
a
trend
towards
lower
3
-
percentile
values
with
advancing
age
in
the
Ethiopian
children
may
be
due
to
nutritional
or
environmental
reasons.