Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate professor Belinda Chimphamba Gombachika, Kamuzu University of Health Sciences, Malawi
- Second opponent: Associate professor Ruby Mahesparan, Haukeland University Hospital, Bergen
- Third member and chair of the evaluation committee: Professor Jan Frich, University of Oslo
Chair of the Defence
Professor Reidar Pedersen, University of Oslo
Principal Supervisor
Professor Heidi Fjeld, University of Oslo
Summary
This thesis aimed to identify the aetiologies of paediatric hydrocephalus across Africa, explore the perspectives of primary healthcare providers and mothers regarding the condition, and examine the care pathways that mothers and children with hydrocephalus in Blantyre, Malawi engage in. To achieve this, we conducted a systematic review and meta-analysis and two qualitative studies, performing semi-structured interviews and focus group discussions.
Our findings indicate that a considerable proportion of paediatric hydrocephalus cases had an unclear aetiology. Among the identified causes, postinfectious hydrocephalus emerged as the most prevalent, particularly in low-income countries and countries close to the equator.
Primary healthcare providers had sound theoretical knowledge of hydrocephalus. However, early detection through serial head circumference measurements was not routinely performed. Moreover, although the Malawian under-five health passport was reported to be an important tool for clinical communication, it lacks charts to track head growth which is essential to detect hydrocephalus early.
Mothers of children with hydrocephalus at Queen Elizabeth Central Hospital had diverse beliefs about the causes of the condition and faced extensive social implications in seeking care for their children. Moreover, the care pathways that mothers and children with hydrocephalus navigate are demanding and challenge timely access to care.
Both mothers and primary healthcare providers identified limited transportation as a barrier to seeking care.
In summary, our findings suggest that both the income status of a country and its geographical latitude are associated with prevalence of postinfectious hydrocephalus in Africa. Furthermore, we found that there is a need to establish guidelines to support timely identification and referrals of children suspected to have hydrocephalus in Blantyre, as well as to develop context-relevant support systems for mothers caring for affected children.
Additional information
Contact the research support staff.