TITLE:
Delayed Access to Care for Spinal Dysraphism in West Africa: A Median Birth-to-Admission Interval of Eight Months and Associated Factors in an Ivorian Hospital Cohort
AUTHORS:
Faozo Stéphane Landry Teti, Konan Serge Yao, Yao Bernard Fionko, Koffi Yves Soress Dongo, Kouadio Jean-Baptiste Keke, Adérehime Haidara
KEYWORDS:
Spinal Dysraphism, Spina Bifida, Time to Treatment, Access to Care, Paediatric Neurosurgery
JOURNAL NAME:
Neuroscience and Medicine,
Vol.17 No.3,
September
29,
2026
ABSTRACT: Background: The outcome of spinal dysraphism depends on rapid access to a specialised centre, with the 48-hour window after birth serving as the reference in current guidelines. This interval is poorly documented in West Africa. The authors measured it and explored its associated factors in an Ivorian hospital cohort. Methods: Single-centre ambispective observational study of the 75 patients operated on for spinal dysraphism at Bouaké Teaching Hospital (data cut-off 30 June 2026); the nine children who were admitted but not operated on were excluded. The primary endpoint was the birth-to-admission interval; the admission-to-surgery interval served as a contrast. Associations with six access factors (referral, antenatal diagnosis, antenatal care visit, distance, financial hardship, prior traditional healer consultation) were assessed by non-parametric methods, with exploratory sensitivity analyses at the 3-, 6- and 12-month thresholds, an exploratory logistic model and a median quantile regression. Odds ratios (ORs) are conditional, with exact confidence intervals (CIs); the thirteen p-values are adjusted by the Benjamini-Hochberg procedure. Results: The median birth-to-admission interval was 239 days (≈8 months; IQR 148 - 411; range 17 - 1818). No child had reached the centre within 48 hours of birth and 47 (62.7%) were admitted at least 6 months later. The admission-to-surgery interval was 5 days (IQR 3 - 11), with 69.3% operated on within 7 days; in-hospital time accounted for 2.3% of the total interval. No factor was associated with the interval analysed as a continuous variable. An antenatal care visit was associated with a lower risk of a delay of 6 months or more (conditional OR 0.28; exact 95% CI: 0.09 - 0.82; p = 0.016), but this exploratory signal did not remain significant after Benjamini-Hochberg adjustment of the univariate six-month comparisons (q = 0.097, univariate Fisher test); an a-posteriori multivariable model gave an adjusted OR of 0.27, not itself subjected to this correction. Present at the 3-month threshold, the signal disappeared at 12 months and was found neither in the continuous analysis nor in the quantile regression. All six odds ratios were below 1. Conclusions: The median interval approached eight months, with no child reaching the centre within the recommended window, whereas surgery followed admission by a few days. The delay therefore lies almost entirely before tertiary admission: priorities concern neonatal referral pathways, transport and financial accessibility rather than surgical capacity alone. The observational design permits no causal inference.