Predictors of Postoperative and Neurodevelopmental Outcomes in Children with Hydrocephalus from Tribal and Low-Socioeconomic Populations

Background: Pediatric hydrocephalus is associated with considerable postoperative and neurodevelopmental morbidity, particularly among children from tribal and socioeconomically disadvantaged communities where delayed presentation and limited access to specialized care may adversely influence outcomes. This study evaluated postoperative and neurodevelopmental outcomes and their potential predictors in this vulnerable population. Material and Methods: This hospital-based prospective observational study included 25 children with hydrocephalus from predominantly tribal and low-socioeconomic backgrounds who underwent surgical management. Demographic, socioeconomic, clinical, etiological, radiological, surgical, and follow-up characteristics were recorded. Postoperative and neurodevelopmental outcomes were assessed, and factors associated with unFavourable outcomes were analyzed using SPSS. 21. statistical tests. Results: The mean age was 3.8 ± 3.2 years; 60.0% were males, 72.0% belonged to tribal communities, and 84.0% had low socioeconomic status. Delayed presentation occurred in 56.0%, developmental delay in 52.0%, and severe ventricular dilatation in 48.0%. VP shunting was performed in 100.0%. Postoperative complications occurred in 4.0%, while 4.0% had unfavourable postoperative outcomes and 44.0% had unfavourable neurodevelopmental outcomes. Delayed presentation, post-infectious/post-hemorrhagic etiology, seizures, malnutrition, severe ventricular dilatation, and distance >50 km were significantly associated with unfavourable postoperative outcomes. Unfavourable neurodevelopment was associated with baseline developmental delay (OR 11.25), structural brain abnormalities (OR 10.50), limited rehabilitation access (OR 9.78), delayed presentation (OR 8.10), seizures and postoperative complications (OR 7.20 each), and malnutrition (OR 6.42). Conclusion: Outcomes of childhood hydrocephalus in disadvantaged populations were influenced by clinical severity and healthcare-access barriers. Early referral, timely surgery, nutritional optimization, structured follow-up, and accessible neurodevelopmental rehabilitation may improve outcomes.

Keywords: Pediatric hydrocephalus; neurodevelopmental outcome; ventriculoperitoneal shunt; tribal population; socioeconomic status; postoperative outcome; developmental delay.