Abstract
Background: Myelomeningocele (MMC), the most severe form of spina bifida, is frequently associated with hydrocephalus, a major contributor to morbidity and mortality. Evidence regarding factors associated with hydrocephalus in MMC remains limited in Northwestern Nigeria.
Objective: To determine the prevalence of hydrocephalus, identify factors associated with its occurrence, and evaluate temporal trends among children with MMC.
Methods: A retrospective cohort study was conducted among children aged ≤26 months who underwent MMC repair at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, over 13 years. Demographic, clinical, and treatment-related data were extracted from patient records. Multivariable logistic regression was used to identify factors independently associated with hydrocephalus. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated.
Results: A total of 371 patients were included. The mean age at presentation was 4.74 ± 3.69 months, and males constituted 51.8% of cases. Lumbosacral lesions were the most common anatomical location (78.2%). Hydrocephalus occurred in 186 patients (50.1%), making it the most frequent associated anomaly. Age at presentation (aOR 1.02, 95% CI 0.96–1.07; p = 0.586), female sex (aOR 1.02, 95% CI 0.67–1.54; p = 0.943), associated anomalies (aOR 1.22, 95% CI 0.78–1.92; p = 0.390), and lesion level were not independently associated with hydrocephalus. Shunt obstruction was the most common complication (10.8%), and 28.0% required revision surgery.
Conclusion: Hydrocephalus affected half of the patients with MMC and was not independently associated with demographic or lesion-related factors, underscoring its multifactorial nature and the need for routine surveillance of all affected children.

Key words: Myelomeningocele; Hydrocephalus; Pediatric neurosurgery; Risk factors; Nigeria