Thousands of Nigerian children born with hydrocephalus, commonly known as “water on the brain,” are at risk of preventable complications and lifelong disabilities because many are diagnosed late, cannot afford treatment or have limited access to specialist neurosurgical care, a new nationwide study has revealed.
The study, published in Neurosurgical Review, found that despite major advances in the treatment of childhood hydrocephalus globally, Nigerian children continue to face serious barriers to timely and effective care, including high medical costs, shortages of neurosurgeons, inadequate healthcare infrastructure, and poor long-term follow-up.
The researchers, including Chidera Stanley Anthony, Nwamaka Chidera Bob-Ume, Ikponmwosa Jude Ogieuhi, and Victor Oluwatomiwa Ajekiigbe, analysed 10 hospital-based studies involving 1,127 children treated at tertiary hospitals across several geopolitical zones in Nigeria.
They identified delayed presentation, financial hardship, inadequate healthcare facilities, and unequal access to specialist neurosurgical services as major obstacles to successful treatment.
According to the review, congenital hydrocephalus, a condition in which excess cerebrospinal fluid builds up in a baby’s brain before or shortly after birth, was the most common form among infants and young children. It was frequently associated with birth defects, while infections were a more common cause among older children.
Many affected children were not brought to the hospital until they were between one and 12 months old, the researchers found. Such delays can reduce the chances of early treatment and increase the risk of permanent neurological damage.
The study found that ventriculoperitoneal (VP) shunting remains the most widely performed surgical treatment for hydrocephalus in Nigeria.
Endoscopic third ventriculostomy (ETV), a more advanced procedure, is available mainly in a limited number of specialist centres because of inadequate equipment, funding constraints, and a shortage of trained neurosurgeons.
One major concern highlighted by the researchers was the rate of complications following surgery. Shunt infections occurred in between 11 and 28 per cent of patients across the studies reviewed.
Such infections can lead to repeated operations, longer hospital stays, and additional financial pressure on already struggling families.
Beyond the medical challenges, the review highlighted the heavy economic burden placed on parents and caregivers.
Most families continue to pay out of pocket for diagnosis, surgery, and follow-up care, while inadequate health insurance coverage further limits access to treatment.
The researchers also identified limited access to CT and MRI scans, poor referral systems, and sociocultural beliefs that can delay hospital visits as major barriers to timely treatment, warning that many of these obstacles are preventable.
The researchers called on governments at all levels to decentralise neurosurgical services, expand health insurance coverage, invest in specialist training and modern diagnostic facilities, and introduce nationwide awareness campaigns to help parents recognise the early signs of hydrocephalus and seek medical attention promptly.
Without urgent reforms, they warned, many Nigerian children with hydrocephalus will continue to suffer avoidable complications and lifelong disabilities from a condition that can often be successfully treated when detected early.
