Barriers to Patients' Early Presentation, Diagnosis and Treatment in Childhood Hydrocephalus

Study Overview
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Brief Summary
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Patient with childhood hydrocephalus (HC) tend to present late in Low medium income countries (LMICs). This project will study the barriers leading to patients' and health system delay in patients with childhood HC. This will be done via a quantitative and qualitative study analysis. The data will be collected prospectively.

Detailed Description
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Children less than 5 years of age with HC confirmed with either magnetic resonance or computerized tomographic images will be recruited. In addition, Hospital staff members, who have been working within the Neurosurgical unit for at least 5 years will be interviewed. The patients' data that will be collected will include gender, age at presentation, socioeconomic class of parents (or guardians), religion, referral source, presenting complaint with its duration, physical findings, ventricular diameter. The Pre-presentation symptoms interval (PPI) will be defined as the number of days between the onset of symptoms and first presentation at any type of healthcare service centre (including primary healthcare centre, secondary health institutions); Presentation Interval (PI)- Number of days from symptoms to presenting at Neurosurgical centre; Pre-diagnostic interval (PDI) will be defined as the interval in days between symptoms and completion of pre-operative investigations. Patient interval (PI) will be defined as the number of days from the onset of symptoms and patient's first contact with the Neurosurgical center. Hospital interval (HI)- number of days from completion of investigations to surgical intervention. The collected data will be analyzed according to qualitative conventional content analysis. Nvivo software version 13 and Statistical Product and Service Solutions (SPSS) version 23 will be used for data analysis.

Official Title
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A Quantitative and Qualitative Analysis of the Barriers to Patients' Early Presentation, Diagnosis and Treatment in Childhood Hydrocephalus

Conditions
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Hydrocephalus in Children

Intervention / Treatment
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* Other: Hydrocephalus


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients less than 5 years of age with HC confirmed with either magnetic resonance or computerized tomographic images Patients' parents' inclusion criteria will be parents (Guardians) of children with radiologically confirmed HC with either magnetic resonance or computerized tomographic images. Hospital staff members, who have been working within the Neurosurgical unit for at least 5 years. Exclusion Criteria: All patents not investigated or operated at our centre Patients older than 5 years

Ages Eligible for Study
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Maximum Age: 5 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Hydrocephalus|Interview|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Presentation time in days | Time in days, from the onset of symptoms to the time the patient seeks medical advice. | 14 days | 
| Diagnostic delay in days | Time in days between the patient's presentation and the confirmation of the diagnosis, in days | 14 days | 
| Treatment delay in days | The duration (in days) between the diagnosis and initiation of treatment | 14 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Treatment outcome as perceived by parents/caregivers | Effectiveness of the treatment in improving patient outcomes using a questionnaire (5-point Likert scale based survey questions with higher scores meaning better outcome) | 4 weeks | 
| Parents/caregivers satisfaction | The parent's satisfaction with the quality of care received using a questionnaire (5-point Likert scale based survey questions with higher scores meaning better outcome) | 4 weeks | 
| Reason for delay in presentation, diagnosis and treatment | As described by the parents and hospital staff | 4 weeks |