Is VP Shunt Infection Still a Threat? Clinical Burden and Outcomes of Paediatric Ventriculoperitoneal Shunts in Tanzania

Is VP Shunt Infection Still a Threat? 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Clinical Burden and Outcomes of Paediatric Ventriculoperitoneal Shunts in Tanzania Dennis Machaku, Happiness Rabiel, Kondo Chilonga This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7075425/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND The mainstay treatment for patients with hydrocephalus is surgical, with VPS placement being a routine practice in hospitals with limited resources and workforce. However, VP shunt-related infections continue to exert a significant clinical and economic burden, particularly in low-resource settings such as Tanzania; where infection control infrastructure may be limited. Despite advances in surgical technique and perioperative care, the persistence of these infections raises critical concerns regarding outcomes and system preparedness. METHODS A cohort study was carried out at a tertiary hospital from 2020 to 2023. It included 263 patients who underwent initial VPS surgeries. Postoperatively, the patients had routine follow-up care for three months, at which time their characteristics in relation to post-operative VP shunt infections were evaluated. SPSS version 26 was utilized for analyzing the data that had been gathered. RESULTS A total of 263 pediatric patients underwent VP shunt procedures at a tertiary hospital in northern Tanzania. Most were aged ≤ 5 years (56.3%), with increased head size (74.9%) and fever (42.2%) as common symptoms. VP shunt infections occurred in 23.2% of cases, with children aged ≤ 5 years (OR = 1.87, p = 0.043) and those with ASA score III (AOR = 5.34, 95% CI: 2.02–14.1, p = 0.001) being at higher risk. Shunt revisions were performed in 35.7% of patients, and 35.0% experienced prolonged hospital stays. Staphylococcus aureus (22.2%) was the most frequent isolate. These findings underscore the ongoing burden of shunt infections and highlight the importance of early risk identification and improved perioperative care in pediatric neurosurgery. CONCLUSION Yes, VPS infections remain a significant threat in pediatric patients in northern Tanzania, with infection rates reaching 27% in children five years and younger. These infections contribute to serious clinical and resource challenges. Children with poorer preoperative health were over five times more likely to develop infections, emphasizing the vulnerability of this group. These findings highlight the urgent need to improve infection prevention and perioperative care to reduce complications and improve outcomes in this resource-limited setting. Hydrocephalus Ventriculoperitoneal shunt Kocher’s point Figures Figure 1 Introduction Hydrocephalus is a critical pediatric neurosurgical condition that, if untreated, can lead to severe morbidity or mortality. It arises from abnormal cerebrospinal fluid (CSF) accumulation due to impaired circulation or absorption. Clinical manifestations vary by age, from macrocephaly in infants to headaches and developmental delays in older children. Ventriculoperitoneal (VP) shunting remains the primary treatment, especially in resource-limited settings where alternative therapies are often unavailable ( 1 , 2 ).The primary objective of VP shunting is to divert excess CSF and alleviate elevated intracranial pressure (ICP). In pediatric neurosurgery, the proximal catheter is typically inserted at anatomical landmarks such as Kocher’s point (frontal), Keen’s point (parietal), or the occipital region (Frazier or Dandy’s point), with the distal catheter positioned in the peritoneal cavity. This standardized approach has been widely adopted due to its effectiveness and adaptability across varying clinical environments ( 1 , 3 – 7 ). This study focuses on VP shunts placed at Kocher’s point in pediatric patients, noting that 25–30% of shunt-related complications occur within the first-year post-surgery. This highlights the need for careful monitoring and technique refinement to improve outcomes in children with hydrocephalus ( 8 ). A multi-state study in the U.S. found that 22% of ventriculoperitoneal (VP) shunt complications occur within the first-year post-surgery, often requiring revision. VP shunt infections are among the most severe and costly complications, frequently leading to prolonged hospitalization, multiple surgeries, and long-term neurological care. Most occur early postoperatively but can arise at any time, contributing to high morbidity, shunt failure, increased healthcare use, mortality, and lasting cognitive and developmental issues in children ( 9 , 10 ). Similarly, numerous studies have identified shunt infections as a major contributor to the need for revisions, playing a significant role in both patient morbidity and mortality ( 11 – 13 ). In children, these issues are particularly concerning due to their developing anatomy and higher susceptibility to infection. Furthermore, each shunt placement carries its own risks, often leading to repeated surgical interventions over time ( 14 – 17 ). In Tanzanian context, a study conducted in Northern Tanzania found a high VP shunt revision rate of 34.2%, with infections responsible for 50% of these cases—among the highest reported globally. The high infection burden is linked to factors such as limited resources, longer surgery durations, and involvement of less experienced surgeons ( 18 ). Compared to lower infection rates in high-income countries (4–20%), the findings highlight high prevalence of infections, well above global averages. This not only confirms the ongoing nature of this challenge but also reveals its severe impact on surgical outcomes, hospital resources, and patient survival. These complications are exacerbated by systemic constraints such as limited access to sterile surgical environments, inadequate perioperative protocols, and insufficient training. Thus, this study aims to critically examine the scope and consequences of VP shunt infections in the pediatric population, affirming their continued relevance as a major public health and neurosurgical concern in Tanzania. Materials and methods This combined retrospective and prospective study, conducted at Kilimanjaro Christian Medical Center, a tertiary hospital in Northern Tanzania from 2020 to 2023. The study provides critical insight into the burden of VP shunt infections by examining early postoperative outcomes in pediatric patients with hydrocephalus. The study documented key clinical indicators of infection, including surgical site complications and blood and CSF culture results, while also evaluating important outcomes such as VP shunt revisions and extended hospital stays within a three-month follow-up. Through the assessment of factors like surgical duration, preoperative ASA classification, and patient demographics, the research offers insights into potential risk factors associated with postoperative VP shunt infections. Statistical analysis The data were subjected to a descriptive statistical analysis using SPSS version 26. The chi-square test, with statistical significance set at p < 0.05, was employed to determine the association between variables. Results In this study involved 263 pediatric patients that underwent VP shunt revisions, the median age was 1 year (SD 0.496), with the majority (56.3%) being five years old or younger, reflecting the higher prevalence of hydrocephalus and its surgical management in early childhood. The gender distribution was nearly balanced, with males comprising 51.3% and females 48.7%, indicating no significant sex predilection in the population studied. Geographically, most patients originated from the Kilimanjaro (44.5%) and Arusha (36.5%) regions, consistent with the hospital’s catchment area, while fewer patients came from Manyara (13.7%) and other regions (5.3%). These demographic characteristics provide important context for interpreting the clinical outcomes and complications observed in this cohort, underscoring the early age at intervention and wide regional representation within northern Tanzania. [Table 1] Table 1: The social demographic characteristics of the patients. N = 263 (%) Characteristics N % Age Median age Standard deviation ≤ 5 years 6 – 17 years 1 year 0.496 148 115 56.3 43.7 Sex Males Females 135 128 51.3 48.7 Region Kilimanjaro Arusha Manyara Other 117 96 36 14 44.5 36.5 13.7 5.3 Among the 263 pediatric patients, the most common symptom was increased head size (197, 74.9%), followed by fever (111, 42.2%), vomiting (108, 41.1%), and bulging fontanelles (103, 39.2%). Neurological signs were also frequent, including delayed milestones (95, 36.1%), convulsions (90, 34.2%), and neurological deficits (74, 28.1%). Other symptoms included poor feeding (84, 31.9%), headaches (73, 27.8%), excessive crying (63, 24.0%), sunset eyes (43, 16.3%), and anisocoria (37, 14.1%). Communicating hydrocephalus was diagnosed in 162 (61.6%) patients, while 125 (47.5%) had obstructive hydrocephalus. Most surgeries lasted over 45 minutes (158, 60.1%), and preoperative ASA scores showed that 154 (58.6%) were ASA II, 63 (23.9%) ASA III, and 46 (17.5%) ASA I. These findings reflect late presentation, varied disease severity, and procedural risk factors that may contribute to complications like shunt infection [Table 2]. Table 2: The patients’ clinical characteristics; N = 263 (%) Variable N % Signs and symptoms Fever 111 42.2 Bulging fontanelles 103 39.2 Increased head size 197 74.9 Sunset eyes 43 16.3 Convulsions 90 34.2 Anisocoria 37 14.1 Excessive crying 63 24.0 Neurological deficits 74 28.1 Vomiting 108 41.1 Poor feeding 84 31.9 Delayed milestones 95 36.1 Headaches 73 27.8 Type of hydrocephalus Communicating 162 61.6 Obstructive 125 47.5 Surgery duration ≤ 45 minutes 122 46.4 > 45 minutes 158 60.1 Preoperative ASA score ASA 1 46 17.5 ASA 2 154 58.6 ASA 3 63 23.9 Postoperative Ventriculoperitoneal shunt infections Among the variables analyzed, age and preoperative ASA score showed statistically significant associations with VP shunt infections. Children aged 5 years and below had a higher infection rate of 40 (27.0%) compared to 19 (16.5%) in the 6–17-year age group (OR = 1.87, p = 0.043), indicating that younger children are at greater risk. Preoperative health status, measured by ASA score, also showed a strong relationship with infection rates: patients classified as ASA III had the highest infection rate of 42 (67.7%), compared to 30 (19.5%) in ASA II and 9 (19.6%) in ASA I patients (OR = 2.71, p = 0.021), suggesting that children with significant systemic illness are more susceptible to postoperative complications. Other variables, including sex, region of origin, type of hydrocephalus, and surgery duration, did not reach statistical significance. Although females showed a slightly higher infection rate (34, 26.6%) than males (25, 18.5%), the difference was not statistically significant ( p = 0.118). Likewise, patients from regions outside Kilimanjaro, Arusha, and Manyara appeared to have a higher infection rate (35.7%), but the association was not significant ( p = 0.490). The infection rates were also comparable between communicating (33, 20.4%) and obstructive hydrocephalus (30, 24.0%) types ( p = 0.310). While longer surgeries (> 45 minutes) had a higher infection rate (38, 24.1%) compared to shorter ones (21, 17.2%), this trend was not statistically significant ( p = 0.441). Overall, age and ASA score emerged as the most predictive factors for VP shunt infection in this cohort [Table 3]. Table 3: Social and clinical characteristics in relation to postoperative VPS infections; N = 263(%) Variable VP Shunt infections OR P value Present Absent Age 1.87 0.043 ≤ 5 years 40(27.0) 108(73.0%) 6 – 17 years 19(16.5) 96(83.5) Sex 0.63 0.118 Males 25(18.5) 110(81.5) Females 34(26.6) 94(73.4) Region 2.39 0.490 Kilimanjaro 24(20.5) 93(79.5) Arusha 20(20.8) 76(79.2) Manyara 10(27.8) 26(72.2) Other 5(35.7) 9(64.3) Type of hydrocephalus 1.14 0.310 Communicating 33(20.4) 129(79.6) Obstructive 30(24.0) 95(76.0) Surgery duration 1.26 0.441 ≤ 45 minutes 21(17.2) 101(82.8) > 45 minutes 120(75.9) 38(24.1) Preoperative ASA score 2.71 0.021 ASA 1 9(19.6) 37(80.4) ASA 2 30(19.5) 124(80.5) ASA 3 42(67.7) 20(32.3) Where; OR – Odds ratio, with a P value of 0.05, 95%CI Microbial characteristics of patients presented with postoperative VP shunt infection Out of the 263 pediatric patients in this study, blood cultures were collected from 162 cases of VP shunt infection. The most frequently isolated organism was Staphylococcus aureus (36, 22.2%), followed by coagulase-negative Staphylococci (30, 18.5%), both commonly linked to skin flora and surgical site contamination. Among Gram-negative pathogens, Klebsiella pneumoniae (24, 14.8%), Pseudomonas aeruginosa (20, 12.3%), and Escherichia coli (13, 8.0%) were notable, reflecting potential nosocomial and gastrointestinal sources. Other less common organisms were identified in 9 cases (5.6%), while 30 cultures (18.5%) showed no microbial growth. These findings support the burden of VP shunt infections in pediatric populations, particularly in resource-limited settings. The mix of Gram-positive and Gram-negative isolates highlights the need for comprehensive infection control and targeted antimicrobial strategies [Figure 1]. The association of VP shunt infections with study participants The bivariate analysis, children aged ≤5 years had significantly higher odds of developing VP shunt infections compared to those aged 6–17 years (COR = 1.87; 95% CI: 1.02–3.41; p = 0.043). However, this association was not statistically significant after adjustment in the multivariate model (AOR = 1.43; 95% CI: 0.71–2.70; p = 0.261), suggesting that age may be a contributing factor but not an independent predictor. Similarly, female patients had higher odds of infection (AOR = 1.43; 95% CI: 0.56–2.70), though this was also not statistically significant (p = 0.163). Of all factors analyzed, only a preoperative ASA score of 3 remained a strong independent predictor of VP shunt infection, with a significantly elevated adjusted odds ratio (AOR = 5.34; 95% CI: 2.02–14.1; p = 0.001), indicating that patients in poorer preoperative health were at markedly increased risk. Variables such as region of origin, type of hydrocephalus, and surgery duration showed no statistically significant associations with shunt infection in the adjusted model. This highlights that while demographic and procedural factors are relevant, baseline health status remains a key determinant of postoperative infection risk in this resource-limited setting [Table 5] . Table 5: Bivariate and Multivariate Logistic Regression Analysis of Factors Associated with VP Shunt Infections among Pediatric Patients at KCMC (n = 263) Variable COR (95%, CI) P value AOR (95%, CI) P value Age ≤ 5 years 1.87 (1.02 – 3.41) 0.043 1.43 (0.71 – 2.70) 0.261 6 – 17 years Ref Ref Sex Males Ref Ref Females 1.62 (0.89 – 2.49) 0.118 1.43 (0.56 – 2.70) 0.163 Region Kilimanjaro Ref Ref Arusha 1.12 (0.52 – 2.01) 0.955 0.96 (0.47 – 1.99) 0.913 Manyara 1.51 (0.64 – 3.58) 0.332 1.32 (0.52 – 3.34) 0.553 Other 2.29 (0.29 – 7.56) 0.176 2.01 (0.58 – 6.93) 0.271 Type of hydrocephalus Communicating Ref Ref Obstructive 1.22 (0.83 – 1.78) 0.310 1.15 (0.76 – 1.73) 0.508 Surgery duration ≤ 45 minutes Ref Ref > 45 minutes 1.26 (0.70 – 2.27) 0.441 1.19 (0.64 – 2.19) 0.579 Preoperative ASA score ASA 1 Ref Ref ASA 2 0.99 (0.43 – 2.27) 0.983 1.02 (0.43 – 2.40) 0.069 ASA 3 6.27 (2.59 – 15.2) < 0.00 5.34 (2.02 – 14.1) 0.001 Postoperative outcomes for VP shunt placements Among the 263 pediatric patients, 94 (35.7%) required VP shunt revision, highlighting a high complication rate commonly linked to postoperative infections or mechanical failure. This underscores the clinical burden of shunt-related morbidity in resource-limited settings like Northern Tanzania. Additionally, 92 patients (35.0%) experienced prolonged hospital stays of more than 14 days, suggesting extended recovery due to complications or the need for close monitoring. Although the mortality rate was relatively low at 4 (1.5%), it reflects the potentially severe outcomes associated with VP shunt infections in this population [Table 4]. Table 4: Postoperative outcomes for VP shunt placements; N = 263 (%) Variable N % VP shunt revision 94 35.7 Lengthy hospital stays 92 35.0 Death 4 1.5 Discussion This study highlights the burden of VP shunt infections in pediatric patients, examining not only the frequency of shunt revisions but also the underlying factors and resulting clinical outcomes. While much of the existing literature emphasizes the management of hydrocephalus in children, fewer studies have delved deeply into the infection-related complications that lead to shunt revision. By focusing specifically on postoperative VP shunt infections in a pediatric population, this research contributes critical insight into the patterns, predictors, and consequences of shunt-related morbidity in resource-limited settings ( 14 , 19 ). The pediatric patient cohort in this study was reflective of the broader population in northern Tanzania, with demographic distributions across age, sex, and geographic region aligning closely with findings from earlier research. Likewise, the clinical burden and outcomes observed in relation to VP shunt infections, such as revision rates and prolonged hospital stays, were consistent with trends reported in similar low-resource pediatric neurosurgical settings ( 6 , 20 ). A VP shunt revision rate of 35.7% in this cohort mirrors the high complication rates observed in similar sub-Saharan African settings. A Kenyan study reported a 32% revision rate among 1,840 procedures, while a South African series estimated failure rates between 30–50% ( 2 , 12 , 21 ). Our findings confirm that in resource-constrained environments, shunt-related complications—including infection—remain a critical challenge. Infection rates in our study were higher than those reported in Ethiopia (16.2%) and Nigeria (7–14%), and notably exceed earlier Kenyan results of 9–24% ( 7 , 22 – 24 ). This supports our hypothesis and core research question; “Is VP shunt infection still a threat in Tanzania?”, by demonstrating that infection remains a leading predictor of shunt revision, prolonged hospitalization, and even mortality, particularly in younger and systemically ill children. Furthermore, our regression analysis identified age ≤ 5 years and preoperative ASA score of 3 as key predictors of infection, though only ASA score remained significant after adjustment (AOR = 5.34; p = 0.001). International literature also highlights younger age and poor preoperative health as risk factors for VP shunt failure ( 25 , 26 ). Together, these findings suggest that systemic vulnerability, not just procedural or demographic factors—drives infection risk in low-resource settings. Clinical outcomes support this: 35.0% of children had hospital stays longer than 14 days, and mortality reached 1.5%. These are comparable to similar cohorts in sub-Saharan Africa, where mortality ranges between 1–7% ( 2 , 23 ). This study thus contributes robust local data to a regional understanding of VP shunt infection burden—highlighting its persistence as a public health concern in Tanzania. Interestingly, a study conducted in Iran ( 17 ) highlights the multifactorial nature of shunt failure, particularly in resource-limited settings where surgical expertise may vary. Our findings reinforce that once a VP shunt system becomes infected and requires revision, the likelihood of subsequent complications increases, potentially leading to multiple re-revisions. This underscores the need for future research to examine technical and procedural contributors to infection risk, especially in pediatric populations. Expanding such studies across diverse clinical environments and enhancing collaboration between neurosurgical teams could support better standardization of practices and ultimately improve shunt survival and patient outcomes. Study limitations This study was conducted in a single tertiary care center in northern Tanzania, which may limit the generalizability of the findings to other regions with differing healthcare infrastructure and surgical practices. The observational nature of the study also limits causal inferences, and some potentially influential variables, such as surgeon experience, intraoperative sterility protocols, and long-term follow-up beyond three months, were not captured. Conclusion This study demonstrates that ventriculoperitoneal shunt (VPS) infections remain a significant clinical burden in pediatric hydrocephalus management in northern Tanzania, particularly among children under five and those with poor preoperative health status. With a shunt infection rate exceeding 20%, coupled with high rates of revision surgery (35.7%) and prolonged hospital stays (35.0%), the data underscore the ongoing threat posed by postoperative infections. The predominance of both Gram-positive and Gram-negative pathogens highlights the need for robust perioperative infection control strategies. These findings affirm that VPS infections are not only a medical but also a systemic and infrastructural challenge in resource-limited settings, reinforcing the urgent need for improved surgical protocols, early diagnosis, and long-term care pathways to reduce morbidity and improve outcomes in this vulnerable population. Declarations Ethical approval and consent to participate Ethical clearance was obtained from KCMC University, and the General Surgery department, KCMC Hospital, and permission to conduct the study was granted by Clinical Research and Ethics Committee (CREC). Informed consent was not applicable since this was a retrospective study. Consent for publication Not applicable. Clinical trial number not applicable. Competing interests The authors declare no competing interests. Author Contribution H.R. and K.C. are the main supervisors of the research and conceptualized and revised the manuscript. 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Ventriculoperitoneal shunt complications needing shunt revision in children: A review of 5 years of experience with 48 revisions. African J Paediatr Surg. 2012;9(1):32–9. Heij H. The fate of ventriculo-peritonea1 shunts and outcome of revision surgery. East Cent African J Surg. 1998;5(2):2–4. Kinasha A, Kahamba J, Semali I. Complications of ventriculoperitoneal shunts in children in Dar es Salaam. East Cent African J Surg. 2005;10(2):55–9. Kelly A. Evaluating the Incidence and Risk factors for ventriculo-peritoneal shunt sepsis. Neurosci Neurol Surg. 2018;2(4):01–4. Hasanain AA, Abdullah A, Alsawy MFM, Soliman MAR, Ghaleb AA, Elwy R, et al. Incidence of and Causes for Ventriculoperitoneal Shunt Failure in Children Younger Than 2 Years: A Systematic Review. J Neurol Surgery, Part A Cent Eur Neurosurg. 2019;80(1):26–33. Gonzalez DO, Mahida JB, Asti L, Ambeba EJ, Kenney B, Governale L, et al. Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision. Pediatr Neurosurg. 2016;52(1):6–12. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7075425","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500700165,"identity":"a97fa679-a5d0-4cdd-8b09-6d12538222ae","order_by":0,"name":"Dennis Machaku","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYDCCA2DEwMDewMAg8QHIYGMnVgsPkJScAdLCTIQWBpgWaR4Qi5AWvuO9Bw/+3GGTx8Pe+/C2za9t8nzMDIwfPubg1iJ55lzCYd4zacU8PMeNrXP7bhu2MTMwS87chluLwY0cg8OMbYcT90uksUnn9txmBGphY+bFp+X+G4ODP9v+J/aAtFj23LYnrOUGj8EB3rYDEC0MP24nEtQieQboMN4zyYk9PMeYLXsbbie3MTM24/UL3/Ezxh9/7rBL7GFvY7zx489t2/ntzQc/fMSjBQwYG2CMNhQuMVoY/hBWPApGwSgYBSMPAABxwlUz/iDcngAAAABJRU5ErkJggg==","orcid":"","institution":"Catholic University of Health and Allied Sciences","correspondingAuthor":true,"prefix":"","firstName":"Dennis","middleName":"","lastName":"Machaku","suffix":""},{"id":500700166,"identity":"327a5d91-e749-43a2-8a7a-c3ec4de04b38","order_by":1,"name":"Happiness Rabiel","email":"","orcid":"","institution":"Kilimanjaro Christian Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Happiness","middleName":"","lastName":"Rabiel","suffix":""},{"id":500700167,"identity":"888f9f52-cf5a-4c6b-95d1-e4a1ac5f84ce","order_by":2,"name":"Kondo Chilonga","email":"","orcid":"","institution":"Kilimanjaro Christian Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Kondo","middleName":"","lastName":"Chilonga","suffix":""}],"badges":[],"createdAt":"2025-07-08 13:38:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7075425/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7075425/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89384984,"identity":"79d33393-8d68-4196-a237-b21c5f5cc7af","added_by":"auto","created_at":"2025-08-19 12:27:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":64242,"visible":true,"origin":"","legend":"\u003cp\u003eMicrobial isolates from 162 cases of VP shunt infection.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7075425/v1/f885f3402fb4b855f8f35c9a.png"},{"id":94062111,"identity":"89ddef2b-4eac-40a1-aa8b-a9004dcf2cb4","added_by":"auto","created_at":"2025-10-22 07:01:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":903359,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7075425/v1/89d196a1-b0df-4e8c-86f8-e243504ca945.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eIs VP Shunt Infection Still a Threat? Clinical Burden and Outcomes of Paediatric Ventriculoperitoneal Shunts in Tanzania\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHydrocephalus is a critical pediatric neurosurgical condition that, if untreated, can lead to severe morbidity or mortality. It arises from abnormal cerebrospinal fluid (CSF) accumulation due to impaired circulation or absorption. Clinical manifestations vary by age, from macrocephaly in infants to headaches and developmental delays in older children. Ventriculoperitoneal (VP) shunting remains the primary treatment, especially in resource-limited settings where alternative therapies are often unavailable (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).The primary objective of VP shunting is to divert excess CSF and alleviate elevated intracranial pressure (ICP). In pediatric neurosurgery, the proximal catheter is typically inserted at anatomical landmarks such as Kocher\u0026rsquo;s point (frontal), Keen\u0026rsquo;s point (parietal), or the occipital region (Frazier or Dandy\u0026rsquo;s point), with the distal catheter positioned in the peritoneal cavity. This standardized approach has been widely adopted due to its effectiveness and adaptability across varying clinical environments (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This study focuses on VP shunts placed at Kocher\u0026rsquo;s point in pediatric patients, noting that 25\u0026ndash;30% of shunt-related complications occur within the first-year post-surgery. This highlights the need for careful monitoring and technique refinement to improve outcomes in children with hydrocephalus (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). A multi-state study in the U.S. found that 22% of ventriculoperitoneal (VP) shunt complications occur within the first-year post-surgery, often requiring revision. VP shunt infections are among the most severe and costly complications, frequently leading to prolonged hospitalization, multiple surgeries, and long-term neurological care. Most occur early postoperatively but can arise at any time, contributing to high morbidity, shunt failure, increased healthcare use, mortality, and lasting cognitive and developmental issues in children (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSimilarly, numerous studies have identified shunt infections as a major contributor to the need for revisions, playing a significant role in both patient morbidity and mortality (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In children, these issues are particularly concerning due to their developing anatomy and higher susceptibility to infection. Furthermore, each shunt placement carries its own risks, often leading to repeated surgical interventions over time (\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In Tanzanian context, a study conducted in Northern Tanzania found a high VP shunt revision rate of 34.2%, with infections responsible for 50% of these cases\u0026mdash;among the highest reported globally. The high infection burden is linked to factors such as limited resources, longer surgery durations, and involvement of less experienced surgeons (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Compared to lower infection rates in high-income countries (4\u0026ndash;20%), the findings highlight high prevalence of infections, well above global averages. This not only confirms the ongoing nature of this challenge but also reveals its severe impact on surgical outcomes, hospital resources, and patient survival. These complications are exacerbated by systemic constraints such as limited access to sterile surgical environments, inadequate perioperative protocols, and insufficient training. Thus, this study aims to critically examine the scope and consequences of VP shunt infections in the pediatric population, affirming their continued relevance as a major public health and neurosurgical concern in Tanzania.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThis combined retrospective and prospective study, conducted at Kilimanjaro Christian Medical Center, a tertiary hospital in Northern Tanzania from 2020 to 2023. The study provides critical insight into the burden of VP shunt infections by examining early postoperative outcomes in pediatric patients with hydrocephalus. The study documented key clinical indicators of infection, including surgical site complications and blood and CSF culture results, while also evaluating important outcomes such as VP shunt revisions and extended hospital stays within a three-month follow-up. Through the assessment of factors like surgical duration, preoperative ASA classification, and patient demographics, the research offers insights into potential risk factors associated with postoperative VP shunt infections.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe data were subjected to a descriptive statistical analysis using SPSS version 26. The chi-square test, with statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, was employed to determine the association between variables.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn this study involved 263 pediatric patients that underwent VP shunt revisions, the median age was 1 year (SD 0.496), with the majority (56.3%) being five years old or younger, reflecting the higher prevalence of hydrocephalus and its surgical management in early childhood. The gender distribution was nearly balanced, with males comprising 51.3% and females 48.7%, indicating no significant sex predilection in the population studied. Geographically, most patients originated from the Kilimanjaro (44.5%) and Arusha (36.5%) regions, consistent with the hospital\u0026rsquo;s catchment area, while fewer patients came from Manyara (13.7%) and other regions (5.3%). These demographic characteristics provide important context for interpreting the clinical outcomes and complications observed in this cohort, underscoring the early age at intervention and wide regional representation within northern Tanzania.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e[Table 1]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1:\u0026nbsp;The social demographic characteristics of the patients. N = 263 (%)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMedian age\u003c/p\u003e\n \u003cp\u003eStandard deviation\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026le; 5 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;6 \u0026ndash; 17 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 year\u003c/p\u003e\n \u003cp\u003e0.496\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56.3\u003c/p\u003e\n \u003cp\u003e43.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e51.3\u003c/p\u003e\n \u003cp\u003e48.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eKilimanjaro\u003c/p\u003e\n \u003cp\u003eArusha\u003c/p\u003e\n \u003cp\u003eManyara\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e44.5\u003c/p\u003e\n \u003cp\u003e36.5\u003c/p\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAmong the 263 pediatric patients, the most common symptom was increased head size (197, 74.9%), followed by fever (111, 42.2%), vomiting (108, 41.1%), and bulging fontanelles (103, 39.2%). Neurological signs were also frequent, including delayed milestones (95, 36.1%), convulsions (90, 34.2%), and neurological deficits (74, 28.1%). Other symptoms included poor feeding (84, 31.9%), headaches (73, 27.8%), excessive crying (63, 24.0%), sunset eyes (43, 16.3%), and anisocoria (37, 14.1%). Communicating hydrocephalus was diagnosed in 162 (61.6%) patients, while 125 (47.5%) had obstructive hydrocephalus. Most surgeries lasted over 45 minutes (158, 60.1%), and preoperative ASA scores showed that 154 (58.6%) were ASA II, 63 (23.9%) ASA III, and 46 (17.5%) ASA I. These findings reflect late presentation, varied disease severity, and procedural risk factors that may contribute to complications like shunt infection \u003cstrong\u003e[Table 2].\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2:\u0026nbsp;The patients\u0026rsquo; clinical characteristics; N = 263 (%)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSigns and symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e111\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e42.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eBulging fontanelles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e103\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e39.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eIncreased head size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e197\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e74.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eSunset eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e43\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eConvulsions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e90\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e34.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eAnisocoria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e37\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eExcessive crying\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e63\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eNeurological deficits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e74\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eVomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e108\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e41.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003ePoor feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e84\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e31.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eDelayed milestones\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e95\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e36.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eHeadaches\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e73\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e27.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of hydrocephalus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eCommunicating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e61.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eObstructive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e47.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026le; 45 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e46.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026gt; 45 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e60.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative ASA score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eASA 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e17.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eASA 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e58.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eASA 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eVentriculoperitoneal shunt infections\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the variables analyzed, age and preoperative ASA score showed statistically significant associations with VP shunt infections. Children aged 5 years and below had a higher infection rate of 40 (27.0%) compared to 19 (16.5%) in the 6\u0026ndash;17-year age group (OR = 1.87, \u003cem\u003ep\u003c/em\u003e = 0.043), indicating that younger children are at greater risk. Preoperative health status, measured by ASA score, also showed a strong relationship with infection rates: patients classified as ASA III had the highest infection rate of 42 (67.7%), compared to 30 (19.5%) in ASA II and 9 (19.6%) in ASA I patients (OR = 2.71, \u003cem\u003ep\u003c/em\u003e = 0.021), suggesting that children with significant systemic illness are more susceptible to postoperative complications.\u003c/p\u003e\n\u003cp\u003eOther variables, including sex, region of origin, type of hydrocephalus, and surgery duration, did not reach statistical significance. Although females showed a slightly higher infection rate (34, 26.6%) than males (25, 18.5%), the difference was not statistically significant (\u003cem\u003ep\u003c/em\u003e = 0.118). Likewise, patients from regions outside Kilimanjaro, Arusha, and Manyara appeared to have a higher infection rate (35.7%), but the association was not significant (\u003cem\u003ep\u003c/em\u003e = 0.490). The infection rates were also comparable between communicating (33, 20.4%) and obstructive hydrocephalus (30, 24.0%) types (\u003cem\u003ep\u003c/em\u003e = 0.310). While longer surgeries (\u0026gt; 45 minutes) had a higher infection rate (38, 24.1%) compared to shorter ones (21, 17.2%), this trend was not statistically significant (\u003cem\u003ep\u003c/em\u003e = 0.441). Overall, age and ASA score emerged as the most predictive factors for VP shunt infection in this cohort \u003cstrong\u003e[Table 3].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3:\u0026nbsp;Social and clinical characteristics in relation to postoperative VPS infections; N = 263(%)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003eVP Shunt infections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026le; 5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e40(27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e108(73.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e6 \u0026ndash; 17 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e19(16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e96(83.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e25(18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e110(81.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e34(26.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e94(73.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e2.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0.490\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eKilimanjaro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e24(20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e93(79.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eArusha\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e20(20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e76(79.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eManyara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e10(27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e26(72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e5(35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9(64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 290px;\"\u003e\n \u003cp\u003eType of hydrocephalus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eCommunicating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e33(20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e129(79.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eObstructive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e30(24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e95(76.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026le; 45 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e21(17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e101(82.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026gt; 45 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e120(75.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e38(24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 290px;\"\u003e\n \u003cp\u003ePreoperative ASA score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e2.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eASA 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e9(19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e37(80.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eASA 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e30(19.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e124(80.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eASA 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e42(67.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e20(32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eWhere; OR \u0026ndash; Odds ratio, with a P value of 0.05, 95%CI\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMicrobial characteristics of patients presented with postoperative VP shunt infection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 263 pediatric patients in this study, blood cultures were collected from 162 cases of VP shunt infection. The most frequently isolated organism was \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (36, 22.2%), followed by coagulase-negative \u003cem\u003eStaphylococci\u003c/em\u003e (30, 18.5%), both commonly linked to skin flora and surgical site contamination. Among Gram-negative pathogens, \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e (24, 14.8%), \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (20, 12.3%), and \u003cem\u003eEscherichia coli\u003c/em\u003e (13, 8.0%) were notable, reflecting potential nosocomial and gastrointestinal sources. Other less common organisms were identified in 9 cases (5.6%), while 30 cultures (18.5%) showed no microbial growth.\u003c/p\u003e\n\u003cp\u003eThese findings support the burden of VP shunt infections in pediatric populations, particularly in resource-limited settings. The mix of Gram-positive and Gram-negative isolates highlights the need for comprehensive infection control and targeted antimicrobial strategies \u003cstrong\u003e[Figure 1].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe association of VP shunt infections with study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe bivariate analysis, children aged \u0026le;5 years had significantly higher odds of developing VP shunt infections compared to those aged 6\u0026ndash;17 years (COR = 1.87; 95% CI: 1.02\u0026ndash;3.41; p = 0.043). However, this association was not statistically significant after adjustment in the multivariate model (AOR = 1.43; 95% CI: 0.71\u0026ndash;2.70; p = 0.261), suggesting that age may be a contributing factor but not an independent predictor. Similarly, female patients had higher odds of infection (AOR = 1.43; 95% CI: 0.56\u0026ndash;2.70), though this was also not statistically significant (p = 0.163).\u003c/p\u003e\n\u003cp\u003eOf all factors analyzed, only a preoperative ASA score of 3 remained a strong independent predictor of VP shunt infection, with a significantly elevated adjusted odds ratio (AOR = 5.34; 95% CI: 2.02\u0026ndash;14.1; p = 0.001), indicating that patients in poorer preoperative health were at markedly increased risk. Variables such as region of origin, type of hydrocephalus, and surgery duration showed no statistically significant associations with shunt infection in the adjusted model. This highlights that while demographic and procedural factors are relevant, baseline health status remains a key determinant of postoperative infection risk in this resource-limited setting\u0026nbsp;\u003cstrong\u003e[Table 5]\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u003c/strong\u003e Bivariate and Multivariate Logistic Regression Analysis of Factors Associated with VP Shunt Infections among Pediatric Patients at KCMC (n = 263)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOR (95%, CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR (95%, CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026le; 5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e1.87 (1.02 \u0026ndash; 3.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1.43 (0.71 \u0026ndash; 2.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.261\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e6 \u0026ndash; 17 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e1.62 (0.89 \u0026ndash; 2.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1.43 (0.56 \u0026ndash; 2.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eKilimanjaro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eArusha\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e1.12 (0.52 \u0026ndash; 2.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.955\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e0.96 (0.47 \u0026ndash; 1.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.913\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eManyara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e1.51 (0.64 \u0026ndash; 3.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.32 (0.52 \u0026ndash; 3.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.553\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e2.29 (0.29 \u0026ndash; 7.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2.01 (0.58 \u0026ndash; 6.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.271\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of hydrocephalus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eCommunicating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eObstructive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e1.22 (0.83 \u0026ndash; 1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1.15 (0.76 \u0026ndash; 1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.508\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026le; 45 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026gt; 45 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e1.26 (0.70 \u0026ndash; 2.27)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1.19 (0.64 \u0026ndash; 2.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative ASA score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eASA 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eASA 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e0.99 (0.43 \u0026ndash; 2.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1.02 (0.43 \u0026ndash; 2.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eASA 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e6.27 (2.59 \u0026ndash; 15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt; 0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e5.34 (2.02 \u0026ndash; 14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative outcomes for VP shunt placements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 263 pediatric patients, 94 (35.7%) required VP shunt revision, highlighting a high complication rate commonly linked to postoperative infections or mechanical failure. This underscores the clinical burden of shunt-related morbidity in resource-limited settings like Northern Tanzania.\u003c/p\u003e\n\u003cp\u003eAdditionally, 92 patients (35.0%) experienced prolonged hospital stays of more than 14 days, suggesting extended recovery due to complications or the need for close monitoring. Although the mortality rate was relatively low at 4 (1.5%), it reflects the potentially severe outcomes associated with VP shunt infections in this population \u003cstrong\u003e[Table 4].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Postoperative outcomes for VP shunt placements; N = 263 (%)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eVP shunt revision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e35.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eLengthy hospital stays\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e35.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights the burden of VP shunt infections in pediatric patients, examining not only the frequency of shunt revisions but also the underlying factors and resulting clinical outcomes. While much of the existing literature emphasizes the management of hydrocephalus in children, fewer studies have delved deeply into the infection-related complications that lead to shunt revision. By focusing specifically on postoperative VP shunt infections in a pediatric population, this research contributes critical insight into the patterns, predictors, and consequences of shunt-related morbidity in resource-limited settings (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The pediatric patient cohort in this study was reflective of the broader population in northern Tanzania, with demographic distributions across age, sex, and geographic region aligning closely with findings from earlier research. Likewise, the clinical burden and outcomes observed in relation to VP shunt infections, such as revision rates and prolonged hospital stays, were consistent with trends reported in similar low-resource pediatric neurosurgical settings (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA VP shunt revision rate of 35.7% in this cohort mirrors the high complication rates observed in similar sub-Saharan African settings. A Kenyan study reported a 32% revision rate among 1,840 procedures, while a South African series estimated failure rates between 30\u0026ndash;50% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Our findings confirm that in resource-constrained environments, shunt-related complications\u0026mdash;including infection\u0026mdash;remain a critical challenge. Infection rates in our study were higher than those reported in Ethiopia (16.2%) and Nigeria (7\u0026ndash;14%), and notably exceed earlier Kenyan results of 9\u0026ndash;24% (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This supports our hypothesis and core research question; \u0026ldquo;Is VP shunt infection still a threat in Tanzania?\u0026rdquo;, by demonstrating that infection remains a leading predictor of shunt revision, prolonged hospitalization, and even mortality, particularly in younger and systemically ill children.\u003c/p\u003e\u003cp\u003eFurthermore, our regression analysis identified age\u0026thinsp;\u0026le;\u0026thinsp;5 years and preoperative ASA score of 3 as key predictors of infection, though only ASA score remained significant after adjustment (AOR\u0026thinsp;=\u0026thinsp;5.34; p\u0026thinsp;=\u0026thinsp;0.001). International literature also highlights younger age and poor preoperative health as risk factors for VP shunt failure (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Together, these findings suggest that systemic vulnerability, not just procedural or demographic factors\u0026mdash;drives infection risk in low-resource settings.\u003c/p\u003e\u003cp\u003eClinical outcomes support this: 35.0% of children had hospital stays longer than 14 days, and mortality reached 1.5%. These are comparable to similar cohorts in sub-Saharan Africa, where mortality ranges between 1\u0026ndash;7% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This study thus contributes robust local data to a regional understanding of VP shunt infection burden\u0026mdash;highlighting its persistence as a public health concern in Tanzania. Interestingly, a study conducted in Iran (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) highlights the multifactorial nature of shunt failure, particularly in resource-limited settings where surgical expertise may vary. Our findings reinforce that once a VP shunt system becomes infected and requires revision, the likelihood of subsequent complications increases, potentially leading to multiple re-revisions. This underscores the need for future research to examine technical and procedural contributors to infection risk, especially in pediatric populations. Expanding such studies across diverse clinical environments and enhancing collaboration between neurosurgical teams could support better standardization of practices and ultimately improve shunt survival and patient outcomes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study was conducted in a single tertiary care center in northern Tanzania, which may limit the generalizability of the findings to other regions with differing healthcare infrastructure and surgical practices. The observational nature of the study also limits causal inferences, and some potentially influential variables, such as surgeon experience, intraoperative sterility protocols, and long-term follow-up beyond three months, were not captured.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that ventriculoperitoneal shunt (VPS) infections remain a significant clinical burden in pediatric hydrocephalus management in northern Tanzania, particularly among children under five and those with poor preoperative health status. With a shunt infection rate exceeding 20%, coupled with high rates of revision surgery (35.7%) and prolonged hospital stays (35.0%), the data underscore the ongoing threat posed by postoperative infections. The predominance of both Gram-positive and Gram-negative pathogens highlights the need for robust perioperative infection control strategies. These findings affirm that VPS infections are not only a medical but also a systemic and infrastructural challenge in resource-limited settings, reinforcing the urgent need for improved surgical protocols, early diagnosis, and long-term care pathways to reduce morbidity and improve outcomes in this vulnerable population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from KCMC University, and the General Surgery department, KCMC Hospital, and permission to conduct the study was granted by Clinical Research and Ethics Committee (CREC). Informed consent was not applicable since this was a retrospective study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eH.R. and K.C. are the main supervisors of the research and conceptualized and revised the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe sincerely acknowledge the KCMC Neurosurgery team for their dedicated care and management of the pediatric patients involved in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData cannot be shared openly but are available on request from authors\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAukrust CG, Parikh K, Smart LR, Mdala I, Fjeld HE, Lubuulwa J, et al. Pediatric Hydrocephalus in Northwest Tanzania: A Descriptive Cross-Sectional Study of Clinical Characteristics and Early Surgical Outcomes from the Bugando Medical Centre. World Neurosurg [Internet]. 2022;161:e339\u0026ndash;46. Available from: https://doi.org/10.1016/j.wneu.2022.02.003\u003c/li\u003e\n\u003cli\u003eSantos MM, Rubagumya DK, Dominic I, Brighton A, Colombe S, O\u0026rsquo;Donnell P, et al. Infant hydrocephalus in sub-Saharan Africa: The reality on the Tanzanian side of the lake. J Neurosurg Pediatr. 2017;20(5):423\u0026ndash;31. \u003c/li\u003e\n\u003cli\u003eKahle KT, Kulkarni A V., Limbrick DD, Warf BC. Hydrocephalus in children. Lancet [Internet]. 2016;387(10020):788\u0026ndash;99. Available from: http://dx.doi.org/10.1016/S0140-6736(15)60694-8\u003c/li\u003e\n\u003cli\u003eBothwell SW, Janigro D, Patabendige A. Cerebrospinal fluid dynamics and intracranial pressure elevation in neurological diseases. Fluids Barriers CNS [Internet]. 2019;16(1):1\u0026ndash;18. Available from: https://doi.org/10.1186/s12987-019-0129-6\u003c/li\u003e\n\u003cli\u003eYang YN, Zhang J, Gu Z, Song YL. The risk of intracranial infection in adults with hydrocephalus after ventriculoperitoneal shunt surgery: A retrospective study. Int Wound J. 2020;17(3):722\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eDakurah TK, Adams F, Iddrissu M, Wepeba GK, Akoto H, Bankah P, et al. Management of Hydrocephalus with Ventriculoperitoneal Shunts: Review of 109 Cases of Children. World Neurosurg. 2016 Dec 1;96:129\u0026ndash;35. \u003c/li\u003e\n\u003cli\u003eKingsly EN, Kanumba ES, Lemeri L, Shabbhay Z. Outcome of ventriculo-peritoneal shunts inserted at the parieto-occipital area : a one-year experience at Muhimbili Orthopaedic Institute , Dar es Salaam. Int J Neurosurg. 2012;1(1):1\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003ePaff M, Alexandru-Abrams D, Muhonen M, Loudon W. Ventriculoperitoneal shunt complications: A review. Interdiscip Neurosurg Adv Tech Case Manag. 2018;13(June 2017):66\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eSimon TD, Hall M, Riva-Cambrin J, Albert JE, Jeffries HE, LaFleur B, et al. Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States: Clinical article. J Neurosurg Pediatr. 2009;4(2):156\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eMerkler AE, Ch\u0026rsquo;ang J, Parker WE, Murthy SB, Kamel H. The Rate of Complications after Ventriculoperitoneal Shunt Surgery. World Neurosurg [Internet]. 2017;98:654\u0026ndash;8. Available from: http://dx.doi.org/10.1016/j.wneu.2016.10.136\u003c/li\u003e\n\u003cli\u003eOmrani O, O\u0026rsquo;Connor J, Hartley J, James G. Effect of introduction of a standardised peri-operative protocol on CSF shunt infection rate: a single-centre cohort study of 809 procedures. Child\u0026rsquo;s Nerv Syst. 2018;34(12):2407\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eVlasak A, Okechi H, Horinek D, Albright AL. Pediatric Ventriculoperitoneal Shunts Revision Rate and Costs in High-Volume sub-Saharan Department. World Neurosurg [Internet]. 2019;130:e1000\u0026ndash;3. Available from: https://doi.org/10.1016/j.wneu.2019.07.059\u003c/li\u003e\n\u003cli\u003ePaff M, Alexandru-Abrams D, Muhonen M, Loudon W. Ventriculoperitoneal shunt complications: A review. Interdiscip Neurosurg. 2018 Sep 1;13:66\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eReddy GK. Ventriculoperitoneal shunt surgery and the incidence of shunt revision in adult patients with hemorrhage-related hydrocephalus. Clin Neurol Neurosurg [Internet]. 2012;114(9):1211\u0026ndash;6. Available from: http://dx.doi.org/10.1016/j.clineuro.2012.02.050\u003c/li\u003e\n\u003cli\u003eMorina Q, Kelmendi F, Morina A, Morina D, Bunjaku D. Ventriculoperitoneal shunt complications in a developing country: a single institution experience. Med Arh. 2013;67(1):36\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eHamdan AR. Ventriculoperitoneal shunt complications: a local study at Qena University Hospital: a retrospective study. Egypt J Neurosurg. 2018;33(1). \u003c/li\u003e\n\u003cli\u003eAhmadvand S, Dayyani M, Etemadrezaie H, Ghorbanpour A, Zarei R, Shahriyari A, et al. Rate and Risk Factors of Early Ventriculoperitoneal Shunt Revision: A Five-Year Retrospective Analysis of a Referral Center. World Neurosurg [Internet]. 2020;134(November):e505\u0026ndash;11. Available from: https://doi.org/10.1016/j.wneu.2019.10.108\u003c/li\u003e\n\u003cli\u003eMachaku D, Chilonga K, George J, Rabiel H. Prevalence, causes, and early outcomes of shunt revisions at a tertiary hospital in Northern Tanzania: a cross-sectional study. Int J Surg Open [Internet]. 2024;62(4). Available from: https://journals.lww.com/ijsopen/fulltext/2024/08000/prevalence,_causes,_and_early_outcomes_of_shunt.19.aspx\u003c/li\u003e\n\u003cli\u003eWu Y. V Entriculoperitoneal S Hunt C Omplications in C Alifornia : 1990 To 2000. 2007;61(3):557\u0026ndash;63. \u003c/li\u003e\n\u003cli\u003eStone JJ, Walker CT, Jacobson M, Phillips V, Silberstein HJ. Revision rate of pediatric ventriculoperitoneal shunts after 15 years: Clinical article. J Neurosurg Pediatr. 2013;11(1):15\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eGhritlaharey RK, Budhwani KS, Shrivastava DK, Srivastava J. Ventriculoperitoneal shunt complications needing shunt revision in children: A review of 5 years of experience with 48 revisions. African J Paediatr Surg. 2012;9(1):32\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eHeij H. The fate of ventriculo-peritonea1 shunts and outcome of revision surgery. East Cent African J Surg. 1998;5(2):2\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eKinasha A, Kahamba J, Semali I. Complications of ventriculoperitoneal shunts in children in Dar es Salaam. East Cent African J Surg. 2005;10(2):55\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eKelly A. Evaluating the Incidence and Risk factors for ventriculo-peritoneal shunt sepsis. Neurosci Neurol Surg. 2018;2(4):01\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eHasanain AA, Abdullah A, Alsawy MFM, Soliman MAR, Ghaleb AA, Elwy R, et al. Incidence of and Causes for Ventriculoperitoneal Shunt Failure in Children Younger Than 2 Years: A Systematic Review. J Neurol Surgery, Part A Cent Eur Neurosurg. 2019;80(1):26\u0026ndash;33. \u003c/li\u003e\n\u003cli\u003eGonzalez DO, Mahida JB, Asti L, Ambeba EJ, Kenney B, Governale L, et al. Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision. Pediatr Neurosurg. 2016;52(1):6\u0026ndash;12. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hydrocephalus, Ventriculoperitoneal shunt, Kocher’s point","lastPublishedDoi":"10.21203/rs.3.rs-7075425/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7075425/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBACKGROUND\u003c/h2\u003e\u003cp\u003eThe mainstay treatment for patients with hydrocephalus is surgical, with VPS placement being a routine practice in hospitals with limited resources and workforce. However, VP shunt-related infections continue to exert a significant clinical and economic burden, particularly in low-resource settings such as Tanzania; where infection control infrastructure may be limited. Despite advances in surgical technique and perioperative care, the persistence of these infections raises critical concerns regarding outcomes and system preparedness.\u003c/p\u003e\u003ch2\u003eMETHODS\u003c/h2\u003e\u003cp\u003eA cohort study was carried out at a tertiary hospital from 2020 to 2023. It included 263 patients who underwent initial VPS surgeries. Postoperatively, the patients had routine follow-up care for three months, at which time their characteristics in relation to post-operative VP shunt infections were evaluated. SPSS version 26 was utilized for analyzing the data that had been gathered.\u003c/p\u003e\u003ch2\u003eRESULTS\u003c/h2\u003e\u003cp\u003eA total of 263 pediatric patients underwent VP shunt procedures at a tertiary hospital in northern Tanzania. Most were aged\u0026thinsp;\u0026le;\u0026thinsp;5 years (56.3%), with increased head size (74.9%) and fever (42.2%) as common symptoms. VP shunt infections occurred in 23.2% of cases, with children aged\u0026thinsp;\u0026le;\u0026thinsp;5 years (OR\u0026thinsp;=\u0026thinsp;1.87, p\u0026thinsp;=\u0026thinsp;0.043) and those with ASA score III (AOR\u0026thinsp;=\u0026thinsp;5.34, 95% CI: 2.02\u0026ndash;14.1, p\u0026thinsp;=\u0026thinsp;0.001) being at higher risk. Shunt revisions were performed in 35.7% of patients, and 35.0% experienced prolonged hospital stays. Staphylococcus aureus (22.2%) was the most frequent isolate. These findings underscore the ongoing burden of shunt infections and highlight the importance of early risk identification and improved perioperative care in pediatric neurosurgery.\u003c/p\u003e\u003ch2\u003eCONCLUSION\u003c/h2\u003e\u003cp\u003eYes, VPS infections remain a significant threat in pediatric patients in northern Tanzania, with infection rates reaching 27% in children five years and younger. These infections contribute to serious clinical and resource challenges. Children with poorer preoperative health were over five times more likely to develop infections, emphasizing the vulnerability of this group. These findings highlight the urgent need to improve infection prevention and perioperative care to reduce complications and improve outcomes in this resource-limited setting.\u003c/p\u003e","manuscriptTitle":"Is VP Shunt Infection Still a Threat? Clinical Burden and Outcomes of Paediatric Ventriculoperitoneal Shunts in Tanzania","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 12:27:33","doi":"10.21203/rs.3.rs-7075425/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b5f36a99-2595-40d8-a537-0ce22614f559","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-22T06:53:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-19 12:27:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7075425","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7075425","identity":"rs-7075425","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}