1
|
Murugasen S, Springer P, Olusanya BO, Gladstone M, Newton C, Kakooza-Mwesige A, Donald KA. Cerebral palsy in African paediatric populations: A scoping review. Dev Med Child Neurol 2024; 66:990-1012. [PMID: 38351549 DOI: 10.1111/dmcn.15878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 07/05/2024]
Abstract
AIM To review the epidemiology and outcomes of African children with cerebral palsy (CP) over a 21-year period. METHOD The PubMed, Scopus, and Web of Science online databases were searched for original research on African children with CP aged 18 years and younger published from 2000 to 2021. RESULTS A total of 1811 articles underwent review against explicit criteria; 93 articles were selected for inclusion in the scoping review. The reported prevalence of CP ranged from 0.8 to 10 per 1000 children. Almost half had perinatal risk factors, but up to 26% had no identifiable risk factor. At least one-third of children with CP had one or more comorbidities, most commonly epilepsy, intellectual disability, and malnutrition. African children with CP demonstrated excess premature mortality approximately 25 times that of the general population, predominantly from infections. Hospital-based and younger populations had larger proportions of children with severe impairments. African children with CP had inadequate access to care and education, yet showed functional improvements compared to controls for all evaluated interventions. INTERPRETATION The prevalence of CP in Africa remains uncertain. African children with CP have different risk profiles, greater premature mortality, and more severe functional impairments and comorbidities compared to the Global North. Several barriers prevent access to optimal care. Larger African studies on validated and effective interventions are needed.
Collapse
Affiliation(s)
- Serini Murugasen
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Priscilla Springer
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Melissa Gladstone
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Charles Newton
- Department of Psychiatry, University of Oxford, Oxford, UK
- Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Kilifi, Kenya
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Kirsten A Donald
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
2
|
Kibrom Y, Tekeste E, Tesfamariam S, Ogbe Z, Mohammed M. Clinical profile and associated comorbidities of cerebral palsy in children visiting Orotta National Referral Hospital, Eritrea: a cross-sectional study. BMC Pediatr 2024; 24:458. [PMID: 39026171 PMCID: PMC11256470 DOI: 10.1186/s12887-024-04938-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 07/09/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Cerebral Palsy (CP) is one of the most common physical disabilities in children. This study aimed to explore the clinical spectrum of CP at Orotta National Referral and Teaching Hospital, including CP subtypes, gross motor function, patterns of associated comorbidities, and possible risk factors in children aged 2 to 12 years. METHODS A hospital-based cross-sectional study was conducted from January to April 2022 in 153 children with suspected motor symptoms. The Surveillance of CP in Europe (SCPE) decision tree was used as an inclusion criteria guideline and the evaluation of the participants was done using a standardized questionnaire and clinical examination. Descriptive statistics, chi-square test, and logistic regression were employed to statistically analyze the data. RESULTS Eighty-four children who fulfilled the clinical criteria were included in the study. The median age was 5-years [IQR: 3.8] with an equal distribution of males and females. Quadriplegic CP was the most common subtype (51.2%) followed by unilateral (hemiplegic) CP (22.6%), and dyskinetic CP (14.3%). Most children had severe gross motor impairment GMFCS level IV-V and females were almost three times more likely to have GMFCS level IV/V than males (AOR: 2.70; CI: 1.08-6.72; p-value = 0.033.) More than half (52.4%) of the neonates either did not cry within five minutes and/or needed breathing resuscitation, 55.3% had to be admitted to the NICU with a median of 5 days' hospital stay. Between the first week of birth and the first year of life, 28.6% had trouble feeding, 26.2% had an infection, 10.7% had difficulty breathing, 20.2% had seizures and 6% had jaundice. Feeding problems (64.3%), speech problems of some sort (91.7%), and epilepsy (46.4%) were the most commonly associated comorbidities with CP. CONCLUSIONS The clinical profile of the CP patients was found to be dominated by the spastic subtype and moderate to severe disability. Since perinatal risk factors were found to be dominant, strengthening maternal and child healthcare systems is recommended to minimize incidents of preventable risk factors and the burden of the disability.
Collapse
Affiliation(s)
- Yohannes Kibrom
- Orotta National Referral and Teaching Hospital, Asmara, Eritrea.
| | | | - Sirak Tesfamariam
- Product Evaluation and Registration Unit, National Medicines and Food Administration, Asmara, Eritrea
| | - Zemichael Ogbe
- Orotta National Referral and Teaching Hospital, Asmara, Eritrea
- Orotta School of Medicine and Health Sciences, Asmara, Eritrea
| | - Mahmud Mohammed
- Orotta National Referral and Teaching Hospital, Asmara, Eritrea
- Orotta School of Medicine and Health Sciences, Asmara, Eritrea
| |
Collapse
|
3
|
Abate BB, Tegegne KM, Zemariam AB, Wondmagegn Alamaw A, Kassa MA, Kitaw TA, Abebe GK, Azmeraw Bizuayehu M. Magnitude and clinical characteristics of cerebral palsy among children in Africa: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003003. [PMID: 38905321 PMCID: PMC11192420 DOI: 10.1371/journal.pgph.0003003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/22/2024] [Indexed: 06/23/2024]
Abstract
Cerebral palsy (CP) is the most common motor disability in childhood which causes a child's behavioral, feeding, and sleep difficulties. It remains a poorly studied health problem in Africa. The main aim of this study was assessing the pooled prevalence of Cerebral Palsy (CP) and its clinical characteristics in Africa context. Systematic review and meta-analysis were conducted using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to search articles from electronic databases (Cochrane library, Ovid platform) (Medline, Embase, and Emcare), Google Scholar, CINAHL, PubMed, Maternity and Infant Care Database (MIDIRS). The last search date was on 12/05/ 2023 G. C. A weighted inverse variance random-effects model was used to estimate the pooled estimates of cerebral palsy and its types. The subgroup analysis, publication bias and sensitivity analysis were done. Studies on prevalence and clinical characteristics of cerebral palsy were included. The primary and secondary outcomes were prevalence and clinical characteristics of cerebral palsy respectively. A total of 15 articles with (n = 498406 patients) were included for the final analysis. The pooled prevalence of cerebral palsy in Africa was found to be 3·34 (2·70, 3·98). The most common type is spastic cerebral palsy accounting 69·30% (66·76, 71·83) of all cases. The second one is quadriplegic cerebral palsy which was found to be 41·49% (33·16, 49·81). Ataxic cerebral palsy accounted 5·36% (3·22, 7·50). On the other hand, dyskinetic cerebral palsy was found to be 10.88% (6·26, 15·49). About 32·10% (19·25, 44.95) of cases were bilateral while 25·17% (16·84, 33·50) were unilateral. The incidence of cerebral palsy in Africa surpasses the reported rates in developed nations. Spastic and quadriplegic subtypes emerge as the most frequently observed. It is recommended to channel initiatives toward the strategic focus on preventive measures, early detection strategies, and comprehensive management protocols.
Collapse
Affiliation(s)
- Biruk Beletew Abate
- Assistant Professor in Pediatrics and Child Health Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| | | | - Alemu Birara Zemariam
- MSc in Pediatrics and Child Health Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Addis Wondmagegn Alamaw
- MSc in Emergency Medicine and Critical Care Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Mulat Awoke Kassa
- MSc in Psychiatry, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Tegene Atamenta Kitaw
- MSc in Adult Health Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Gebremeskel Kibret Abebe
- MSc in Emergency Medicine and Critical Care Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Molla Azmeraw Bizuayehu
- MSc in Pediatrics and Child Health Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| |
Collapse
|
4
|
Campbell JE, Beetch J, Cooper T, Cheng J. Infant mortality and its determinants in Uganda 2016: Using a geographically weighted regression approach. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002669. [PMID: 38117756 PMCID: PMC10732401 DOI: 10.1371/journal.pgph.0002669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/01/2023] [Indexed: 12/22/2023]
Abstract
Infant mortality (IM) represents the overall health of a country or region as it relates to access to medicine, health care, and clean water in a population. IM remains understudied in many areas of Uganda, as many studies are from urban the capital (Kampala). The long-term goal of this research is the mitigation of IM and poor pregnancy outcomes in Uganda. Insights gained from geographic distribution of IM will allow adaptation of diagnosis, treatments, and interventions within the studied areas. Through using OLS and geographically weighted regression, this study has explored the significant factors and their heterogeneous and scaling effects in 2016 across Uganda. The empirical findings from this study include a significant association between IM and both being unmarried and preferring to speak Luganda when interviewed. Those unmarried may lack a social network to assist with income, childcare, and household chores representing decreased resources. Additionally, being interviewed in Luganda was associated over a large geographic area, which may represent not being comfortable in English, which is the language of education, commerce, and presumably health care, thus suggesting a disconnect with health care settings. These data suggest that strides can be made in Uganda by providing targeted resources to areas with high rates of unmarried mothers and those areas with high rates of Luganda as their language of choice.
Collapse
Affiliation(s)
- Janis E. Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Jessica Beetch
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Townsend Cooper
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Jianquan Cheng
- Department of Natural Sciences, Manchester Metropolitan University, Chester, United Kingdom
- Key Laboratory of Environment Change and Resources Use in Beibu Gulf, Centre for Health Geographic Information and Education, Nanning Normal University, Nanning, PR China
| |
Collapse
|
5
|
Gong C, Liu X, Fang L, Liu A, Lian B, Qi X, Chen S, Li H, Zhao M, Guo J, Zhou S. Prevalence of cerebral palsy comorbidities in China: a systematic review and meta-analysis. Front Neurol 2023; 14:1233700. [PMID: 37840931 PMCID: PMC10568468 DOI: 10.3389/fneur.2023.1233700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/25/2023] [Indexed: 10/17/2023] Open
Abstract
Objectives This systematic review aimed to comprehensively understand the comorbidity of cerebral palsy (CP) in China. Methods We searched through databases in both Chinese and English until December 2022 to gather cross-sectional studies on the comorbidity of CP in China. After two reviewers independently screened the articles, collected the data, and assessed the bias risk, a meta-analysis was conducted using the Stata 17.0 software. Results A total of 73 articles were included. Of these, 16 articles reported total comorbidity, with a prevalence of 79.7% (95% CI: 73.8-85.7%); 56 articles reported epilepsy, with a prevalence of 17.9% (95% CI: 15.4-20.4%); 48 articles reported intellectual disability, with a prevalence of 58.0% (95% CI: 51.8-64.3%); 32 articles reported speech disorders, with a prevalence of 48.0% (95% CI: 41.6-54.4%); 41 articles reported hearing disorders, with a prevalence of 17.2% (95% CI: 13.0-21.4%); and 35 articles reported vision disorders, with a prevalence of 23.1% (95% CI: 16.3-29.8%). The topographical type of CP was the primary source of heterogeneity in the prevalence of epilepsy. Diagnostic criteria for CP, clinical type of CP, GMFCS, publishing time, and topographical type of CP were the primary sources of heterogeneity in the prevalence of intellectual disability. Clinical type of CP and topographical type were the primary sources of heterogeneity in the prevalence of speech disorders. Finally, the region was the primary source of heterogeneity in the prevalence of hearing disorders. Conclusion The prevalence of comorbidities in CP is high in China. Comorbidities are related to the characteristics, severity, and risk factors of brain insult and have a particular relationship with regional economic development and medical and health levels.
Collapse
Affiliation(s)
- Chao Gong
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Xiaopei Liu
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
- Jiamusi University Affiliated No. 3 Hospital, Jiamusi, China
| | - Liya Fang
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Annan Liu
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Beibei Lian
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Xunzhong Qi
- Jiamusi University Affiliated No. 1 Hospital, Jiamusi, China
| | - Shuyue Chen
- College of Basic Medicine, Jiamusi University, Jiamusi, China
| | - Huiqing Li
- College of Basic Medicine, Jiamusi University, Jiamusi, China
| | - Ming Zhao
- College of Public Health, Jiamusi University, Jiamusi, China
| | - Jin Guo
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
- Jiamusi University Affiliated No. 3 Hospital, Jiamusi, China
| | - Shaobo Zhou
- School of Science, Faculty of Engineering and Science, University of Greenwich, Medway Campus Central Avenue, Chatham Maritime, Kent, England
| |
Collapse
|
6
|
Gong C, Liu A, Lian B, Wu X, Zeng P, Hao C, Wang B, Jiang Z, Pang W, Guo J, Zhou S. Prevalence and related factors of epilepsy in children and adolescents with cerebral palsy: a systematic review and meta-analysis. Front Pediatr 2023; 11:1189648. [PMID: 37576141 PMCID: PMC10416728 DOI: 10.3389/fped.2023.1189648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Objective To study the worldwide prevalence and associated factors of epilepsy in children and adolescents with Cerebral Palsy (CP) and to analyze the differences between various subgroups. Method We identified all potential studies on the prevalence of epilepsy in children and adolescents with CP from PubMed, Web of Science, and Embase. The search time was from the establishment of the database to November 2022. Randomized effects meta-analysis models were used to calculate the prevalence of epilepsy in CP. Subgroup analysis and meta-regression were utilized to further explore heterogeneity between articles and prevalence disparities between subgroups. The funnel plot and Egger's test were used to investigate potential publication bias. Results Seventy-two articles, comprising 53,969 children and adolescents with CP, were included in this study. The results indicated a total epilepsy prevalence of 38.0% (95% CI: 34.8%-41.2%) in CP. The prevalence of epilepsy was 46.4% (95% CI: 41.4%-51.5%) in clinical sample-based studies and 31.6% (95% CI: 28.7%-34.5%) in population-based studies. Meta-regression demonstrated that the sample source, neonatal seizure, family history of epilepsy, EEG or cranial imaging abnormalities, intellectual/cognitive impairment, and topographical types of CP were heterogeneous contributors to the epilepsy prevalence in CP. Conclusion Approximately one-third of children and adolescents with CP have epilepsy, and the sample source can significantly impact the total prevalence of epilepsy. Neonatal seizures, family history of epilepsy, EEG abnormalities, cranial imaging abnormalities, severe intellectual disability, and quadriplegia may be contributing factors to epilepsy comorbid in CP. Further study is required to verify the strength of these associations with epilepsy. This study aids in identifying the clinical characteristics of young people with CP at risk of developing epilepsy, which may assist clinicians in the early prevention and diagnosis of epilepsy within this population.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=367766, identifier CRD42022367766.
Collapse
Affiliation(s)
- Chao Gong
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Annan Liu
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Beibei Lian
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Xixi Wu
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Pei Zeng
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Chaoli Hao
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Bobo Wang
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Zhimei Jiang
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
- Jiamusi University Affiliated No.3 Hospital, Jiamusi, China
| | - Wei Pang
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
- Jiamusi University Affiliated No.3 Hospital, Jiamusi, China
| | - Jin Guo
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
- Jiamusi University Affiliated No.3 Hospital, Jiamusi, China
| | - Shaobo Zhou
- School of Science, Faculty of Engineering and Science, University of Greenwich, Medway Campus Central Avenue, Chatham Maritime, Kent, England
| |
Collapse
|
7
|
Viswanath M, Jha R, Gambhirao AD, Kurup A, Badal S, Kohli S, Parappil P, John BM, Adhikari KM, Kovilapu UB, Sondhi V. Comorbidities in children with cerebral palsy: a single-centre cross-sectional hospital-based study from India. BMJ Open 2023; 13:e072365. [PMID: 37429681 DOI: 10.1136/bmjopen-2023-072365] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVE To describe the comorbidities in children with cerebral palsy (CP) and determine the characteristics associated with different impairments. DESIGN Cross-sectional study. SETTING Tertiary care referral centre in India. PATIENTS Between April 2018 and May 2022, all children aged 2-18 years with a confirmed diagnosis of CP were enrolled by systematic random sampling. Data on antenatal, birth and postnatal risk factors, clinical evaluation and investigations (neuroimaging and genetic/metabolic workup) were recorded. MAIN OUTCOME MEASURES Prevalence of the co-occurring impairments was determined using clinical evaluation or investigations as indicated. RESULTS Of the 436 children screened, 384 participated (spastic CP=214 (55.7%) (spastic hemiplegic=52 (13.5%); spastic diplegia=70 (18.2%); spastic quadriplegia=92 (24%)), dyskinetic CP=58 (15.1%) and mixed CP=110 (28.6%)). A primary antenatal/perinatal/neonatal and postneonatal risk factor was identified in 32 (8.3%), 320 (83.3%) and 26 (6.8%) patients, respectively. Prevalent comorbidities (the test used) included visual impairment (clinical assessment and visual evoked potential)=357/383(93.2%), hearing impairment (brainstem-evoked response audiometry)=113 (30%), no understanding of any communication (MacArthur Communicative Development Inventory)=137 (36%), cognitive impairment (Vineland scale of social maturity)=341 (88.8%), severe gastrointestinal dysfunction (clinical evaluation/interview)=90 (23%), significant pain (non-communicating children's pain checklist)=230 (60%), epilepsy=245 (64%), drug-resistant epilepsy=163 (42.4%), sleep impairment (Children's Sleep Habits Questionnaire)=176/290(60.7%) and behavioural abnormalities (Childhood behaviour checklist)=165 (43%). Overall, hemiparetic and diplegic CP and Gross Motor Function Classification System ≤3 were predictive of lesser co-occurring impairment. CONCLUSION CP children have a high burden of comorbidities, which increase with increasing functional impairment. This calls for urgent actions to prioritise opportunities to prevent risk factors associated with CP and organise existing resources to identify and manage co-occurring impairments. TRIAL REGISTRATION NUMBER CTRI/2018/07/014819.
Collapse
Affiliation(s)
- Maya Viswanath
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ruchika Jha
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Arjun Kurup
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Sachendra Badal
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Sarvesh Kohli
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Parvathi Parappil
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Biju M John
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Uday Bhanu Kovilapu
- Department of Radiodiagnosis, Armed Forces Medical College, Pune, Maharashtra, India
| | - Vishal Sondhi
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Radiodiagnosis, Armed Forces Medical College, Pune, Maharashtra, India
| |
Collapse
|
8
|
Duma NE, Hlongwa M, Benjamin-Damons N, Hlongwana KW. Physiotherapy management of children with cerebral palsy in low- and middle-income countries: a scoping review protocol. Syst Rev 2023; 12:110. [PMID: 37393357 PMCID: PMC10315018 DOI: 10.1186/s13643-023-02280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 06/19/2023] [Indexed: 07/03/2023] Open
Abstract
INTRODUCTION Cerebral Palsy (CP) is the most common childhood physical disability worldwide. Approximately 1.5 to 4 children per live births live with CP, globally. There have been no specific treatments that can reverse the brain damage responsible for the complex clinical dysfunctions of CP. There are, however, several interventions that are currently being used by physiotherapists, most of which are deemed to be ineffective and unnecessary. We will conduct a scoping review aimed at mapping evidence on the physiotherapy management of children living with CP in low- and middle-income countries (LMICs). METHODS The scoping review will be guided by the Arksey and O'Malley and Levac et al. frameworks. The databases that will be used to search for literature include PubMed, MEDLINE, CINAHL, EBSCOhost, Web of Science, and ProQuest One Academic and Scopus. Gray literature articles will also be included in this review, provided they meet our inclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews (PRIMSA-ScR) guideline will be used to report the results of the scoping review. The screened results will be reported using the PRISMA flow diagram guidelines, and the results will be charted using an electronic data charting form and analyzed using thematic analysis. DISCUSSION Understanding how physiotherapists manage children with CP in LMICs is essential for the development of internationally sound, yet locally relevant, intervention strategy for physiotherapists. It is anticipated that the results of the scoping review will inform the thinking geared towards the development of a contextualised evidence-based framework for physiotherapists to effectively manage CP in children. SYSTEMATIC REVIEW REGISTRATION Open Science Framework. https://doi.org/10.17605/OSF.IO/VTJ84.
Collapse
Affiliation(s)
- Noxolo E. Duma
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Mbuzeleni Hlongwa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Public Health, Societies and Belonging, Human Sciences Research Council, Pretoria, South Africa
| | - Natalie Benjamin-Damons
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Khumbulani W. Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
9
|
Associated Impairments among Children with Cerebral Palsy in Rural Bangladesh-Findings from the Bangladesh Cerebral Palsy Register. J Clin Med 2023; 12:jcm12041597. [PMID: 36836130 PMCID: PMC9966186 DOI: 10.3390/jcm12041597] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND We aimed to describe the burden, severity, and underlying factors of associated impairments among children with cerebral palsy (CP) in rural Bangladesh. METHODS This study reports findings from the Bangladesh Cerebral Palsy Register-the first population-based surveillance of children with CP in any LMIC, where children with confirmed CP aged < 18 years are registered by a multidisciplinary team following a standard protocol. Associated impairments were documented based on clinical assessment, available medical records, and a detailed clinical history provided by the primary caregivers. Descriptive analysis, as well as unadjusted and adjusted logistic regression, were completed using R. RESULTS Between January 2015 and February 2022, 3820 children with CP were registered (mean (SD) age at assessment: 7.6 (5.0) y; 39% female). Overall, 81% of children had ≥1 associated impairment; hearing: 18%, speech: 74%, intellectual: 40%, visual: 14%, epilepsy: 33%. The presence of a history of CP acquired post-neonatally and having a gross motor function classification system levels III-V significantly increased the odds of different types of associated impairments in these children. Most of the children had never received any rehabilitation services and were not enrolled in any mainstream or special education system. CONCLUSIONS The burden of associated impairments was high among children with CP, with comparatively low receipt of rehabilitation and educational services in rural Bangladesh. Comprehensive intervention could improve their functional outcome, participation, and quality of life.
Collapse
|
10
|
Magnetic resonance imaging findings and the clinical characteristics of children with cerebral palsy at a public sector hospital in Gauteng Province, South Africa. SOUTH AFRICAN JOURNAL OF CHILD HEALTH 2022. [DOI: 10.7196/sajch.2022.v16i4.1900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background. Cerebral palsy (CP) is a common cause of physical impairment in children. Brain magnetic resonance imaging (MRI) can define different neuropathological patterns of brain injury in CP. There are limited data available on MRI findings of children with CP in Africa.
Objective. To describe the clinical characteristics, risk factors and MRI findings of children with CP attending a developmental clinic at a tertiary hospital in South Africa; and to assess possible associations between the clinical characteristics and pathogenic neuro-imaging patterns.
Methods. This was a retrospective cross-sectional study. The cohort of 112 children was identified from the clinic’s REDcap database. Clinical information was obtained from existing medical records of the patients. Findings from brain MRI reports were classified according to the MRI classification system (MRICS) for CP. The MRI reports were rated independently by two study investigators. A descriptive analysis was conducted.
Results. A total of 112 patient files and MRI brain reports were reviewed. Spastic CP was the most common type of CP (n=75%). The most common perinatal risk factors included prematurity (31%) and low birthweight (28%). Nineteen (17%) children acquired CP after the neonatal period. CP sub-type showed a significant association with functional motor impairment classified as per the gross motor function classification system (GMFCS), p<0.001. Predominant grey matter injury (PGMI) was the most common pathogenic MRI pattern identified (30%). The radiological findings (per MRICS) had a significant association with both the CP sub-type (p<0.005) and functional impairment according to the GMFCS (p<0.001).
Conclusion. Standardised classification of neuro-imaging findings can assist in defining the pathogenesis and clinical manifestations of CP.
Collapse
|
11
|
The Profile of Epilepsy and its characteristics in Children with Cerebral Palsy. Seizure 2022; 101:190-196. [DOI: 10.1016/j.seizure.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
|
12
|
Chaudhary S, Bhatta NK, Poudel P, Agrawal J, Kalawar RPS, Jayswal JP. Profile of children with cerebral palsy at a tertiary hospital in eastern Nepal. BMC Pediatr 2022; 22:415. [PMID: 35831826 PMCID: PMC9277817 DOI: 10.1186/s12887-022-03477-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 06/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background The clinical spectrum of Cerebral palsy (CP) can differ in various places depending upon knowledge of the people and resources for prevention, diagnosis and management. Although studied extensively in high-resource countries, adequate data related to CP from resource-constraint settings are lacking. This study aims to describe the profile of children with CP at a tertiary care center in eastern Nepal. Methods This was a hospital-based cross-sectional descriptive study done from 2017 to 2018. Children 6 months to 15 years who presented with CP were enrolled and their clinical details recorded and described. Results Amongst 110 children with CP, 74.54% were male. Majority (76.36%) were 5 years or below with the median age being 3(2.00–4.75) years. Children with spastic quadriplegia (44.44%) and Gross Motor Function Classification System level III (41.81%) were most common. Etiologically, perinatal factors (64.54%) like perinatal asphyxia (35.45%) and prematurity (20.90%) and postnatal infections (25.45%) were common. The common comorbidities were intellectual disability (71.81%) and epilepsy (66.36%). The main treatment modalities were: antiepileptics (59.09%) and centre-based physiotherapy sessions (35.45%). School education was provided in 23.07% with special education in 11.53%. Conclusions This study describes the profile of CP at our centre in eastern Nepal. Predominance of perinatal complications and postnatal infections points towards the urgent need to further improve the perinatal and neonatal health care delivery system and practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03477-x.
Collapse
Affiliation(s)
| | | | | | - Jyoti Agrawal
- B P Koirala Institute of Health Sciences, Dharan, Nepal
| | | | | |
Collapse
|
13
|
Frequência de comorbidades em crianças com paralisia cerebral de diferentes níveis de função motora grossa. CONSCIENTIAE SAÚDE 2022. [DOI: 10.5585/21.2022.21189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ResumoIntrodução: A paralisia cerebral (PC) é uma desordem predominantemente motora, no entanto, pode estar associada a outras disfunções, que também impactam a funcionalidade das crianças. Objetivo: Documentar a frequência das comorbidades em crianças com PC nos diferentes níveis do Sistema de Classificação da Função Motora Grossa (GMFCS). Métodos: Estudo observacional, descritivo, de corte transversal. Foram coletados dados de 70 crianças com diagnóstico de PC, que recebiam tratamento fisioterapêutico em Belo Horizonte e na região metropolitana, por meio de entrevistas, e realizada análise descritiva e quantitativa. Resultados: As comorbidades mais frequentes foram as limitações do uso das mãos e dos braços, deficiências de continência urinária e fecal, deficiências da voz e da fala, deficiências de comportamento limitação para andar e epilepsia. Um número maior de comorbidades foi encontrado em crianças com maior comprometimento da função motora grossa. Conclusão: Profissionais da saúde devem observar com atenção a ocorrência das comorbidades na PC, proporcionando intervenções para preveni-las ou tratá-las, melhorando a funcionalidade desses indivíduos.
Collapse
|
14
|
Chen D, Huang M, Yin Y, Gui D, Gu Y, Zhuang T, Chen C, Huo K. Risk factors of cerebral palsy in children: a systematic review and meta-analysis. Transl Pediatr 2022; 11:556-564. [PMID: 35558974 PMCID: PMC9085939 DOI: 10.21037/tp-22-78] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/07/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study aimed to explore the main risk factors for cerebral palsy in children by meta-analysis of the literature on the risk factors of cerebral palsy. METHODS We performed a literature search of the PubMed, EMBASE, Medline, and CENTRAL databases using the following search terms: ("cerebrl plsy" or "cerebrl plsis" or "infantile cerebral palsy") and ("risk factors"). Case-control or cohort studies of children with cerebral palsy and healthy children were included for meta-analysis. The Newcastle-Ottawa Scale (NOS) of case-control studies was used to evaluate the quality of the included studies. The Chi-square test was used to test the heterogeneity of the literature. This study used subgroup analysis and sensitivity analysis to identify sources of heterogeneity. If subgroup analyses and sensitivity analyses could not identify the source of heterogeneity, no pooling between study results was performed, and only individual study results were described. In this study, Egger's test was used to test for publication bias. The random-effects model was used when heterogeneity existed, and the fixed-effect model was applied when heterogeneity did not exist. RESULTS A total of 1,836 related articles were retrieved. After screening, 13 articles were included in the analysis, involving a total of 2,489 children with cerebral palsy and 4,782 children without cerebral palsy. None of the included articles achieved a NOS score of 9, four articles scored 8, eight articles scored 7, and one article scored 6. Meta-analysis showed that maternal hypertension during pregnancy, premature rupture of membranes, premature delivery and emergency cesarean section were risk factors for cerebral palsy in children, and there was no heterogeneity among the literatures and no publication bias. CONCLUSIONS This study identified gestational hypertension, preterm birth, premature rupture of membranes, and emergency cesarean section as risk factors for cerebral palsy in children through meta-analysis, providing a reference for risk monitoring and clinical intervention.
Collapse
Affiliation(s)
- Dandan Chen
- Department of Pediatrics, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Meiyuan Huang
- Department of Neonatology, Hainan Women and Children's Medical Center, Haikou, China
| | - Yangyan Yin
- Department of Pediatrics, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Dongmei Gui
- Department of Pediatrics, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yuniao Gu
- Department of Neonatology, Hainan Women and Children's Medical Center, Haikou, China
| | - Taiping Zhuang
- Department of Neonatology, Hainan Women and Children's Medical Center, Haikou, China
| | - Caihua Chen
- Department of Neonatology, Hainan Women and Children's Medical Center, Haikou, China
| | - Kaiming Huo
- Department of Pediatrics, The Second Affiliated Hospital of Hainan Medical College, Haikou, China
| |
Collapse
|
15
|
Andrews C, Namaganda L, Eliasson AC, Kakooza-Mwesige A, Forssberg H. Functional development in children with cerebral palsy in Uganda: population-based longitudinal cohort study. Dev Med Child Neurol 2022; 64:70-79. [PMID: 34346507 DOI: 10.1111/dmcn.14996] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 01/29/2023]
Abstract
AIM To follow the functional development of a population-based cohort of children with cerebral palsy (CP) in rural Uganda and compare their development with the developmental trajectories of children from high-income countries (HIC). METHOD Eighty-one children (33 females, 48 males) aged 2 to 17 years (mean 8y 6mo, SD 4y 6mo) with CP were initially assessed in 2015 and then 4 years later using the 66-item Gross Motor Function Measure (GMFM-66), Pediatric Evaluation of Disability Inventory, Ugandan version (PEDI-UG), and functional classification systems. We calculated actual and reference scores (level of deviation from the developmental trajectories in HIC). A Wilcoxon signed-rank test was used for statistical analyses. RESULTS Children and young people with CP in Uganda exhibited no differences in scores between the first and second assessments for the GMFM-66 and PEDI-UG mobility skills, whereas they exhibited increased PEDI-UG social function (p<0.001) and self-care skills scores (p<0.001). Reference scores were more negative at the second assessment than at the first for the GMFM-66 (p=0.002) and PEDI-UG mobility (p=0.036) but not for PEDI-UG self-care. The increased difference in reference scores over the 4 years was primarily driven by younger children (2-5y) and children with milder impairments. INTERPRETATION The increased difference in reference scores between assessments suggests that children with CP in Uganda develop motor skills at a slower rate than peers in HIC. Limited access to health care and rehabilitation likely contributed to the lower scores and slower rate of development.
Collapse
Affiliation(s)
- Carin Andrews
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Lukia Namaganda
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Angelina Kakooza-Mwesige
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Hans Forssberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Stockholm, Sweden
| |
Collapse
|
16
|
Tsige S, Moges A, Mekasha A, Abebe W, Forssberg H. Cerebral palsy in children: subtypes, motor function and associated impairments in Addis Ababa, Ethiopia. BMC Pediatr 2021; 21:544. [PMID: 34861837 PMCID: PMC8641229 DOI: 10.1186/s12887-021-03026-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 11/24/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Although, there is no population-level data in Ethiopia, a previous retrospective hospital-based study identified CP as the most common developmental disability in children. The overall aim of this study is to describe the clinical spectrum of CP in Tikur Anbessa Specialized Hospital in Addis Ababa, including CP subtype, gross and fine motor function, presence and pattern of associated impairments, and possible risk factors in children aged 2 to 18 years. METHODS A hospital-based descriptive cross-sectional study conducted- July - September of 2018 among 207 children with suspected motor symptoms. The Surveillance of CP in Europe (SCPE) decision tree was used as a guideline for inclusion and evaluation was by standardized questionnaire and clinical examination. Descriptive, bivariate and multivariate statistical analyses, Chi-square test, crudes association and adjusted odds ratio with 95% confidence interval employed. RESULT One hundred seventy four children who fulfilled the clinical criteria were included. Half (50.6%) were under the age of 5 years with a mean age of 5.6 (SD 3.6) years; 55.2 were male. The majority had bilateral spastic CP (60.4%) followed by unilateral spastic CP 21.8%, dyskinetic CP 10.4%, and ataxic CP 3.4%; 4% were unclassifiable. Of the children, 95.4% had speech difficulty, 87.4% learning disabilities, 60.9% epilepsy, 24.7% visual impairment and 8.6% hearing impairment. On gross motor function (GMFCS) and manual ability (MACS) classification systems, 75.3% of the children had level IV and V functional impairment. More than 80% of the mothers had complications during delivery Half of the neonates did not cry immediately after birth,44% were resuscitated with bag mask ventilation at birth and 64% immediately admitted to NICU. During the first month of life, 50% had infection, 62% had trouble feeding, 49.4% had difficulty breathing, 35% had seizure and 13.8% had jaundice. CONCLUSION The severe forms of CP predominate; most children are dependent on their parents for routine activities of daily living and cannot communicate well. Multidisciplinary care approaches and focused functional habilitation services are needed. Causal relationships cannot be drawn from these data but findings make a strong argument for improving maternal and child health care.
Collapse
Affiliation(s)
- Selamenesh Tsige
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Ayalew Moges
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amha Mekasha
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workeabeba Abebe
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hans Forssberg
- Department of Women's and Children's Health, Karolinska Institute and Astrid Lindgren Children's Hospital, Stockholm, Sweden
| |
Collapse
|
17
|
Duke RE, Torty C, Okorie U, Kim MJ, Eneli N, Edadi U, Burton K, Tann C, Bowman R. Pattern of comorbidities in school-aged children with cerebral palsy in Cross River State, Nigeria. BMC Pediatr 2021; 21:165. [PMID: 33832457 PMCID: PMC8028192 DOI: 10.1186/s12887-021-02637-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/25/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND To describe the pattern of comorbidities in school-aged children with cerebral palsy (CP) and to identify which, if any, were associated with poor school attendance. A cross-sectional study, using the key informant methodology, between December 2017 and July 2018 was conducted in Cross River State, Nigeria. Assessments, confirmation of CP and identification of systemic comorbidities using standard tools and questionnaires were performed. Children confirmed to have CP between the ages 4 to 15 years were included. RESULTS Three hundred and eighty-eight children were confirmed to have CP, 59% males. The mean age was 9.2 years ± SD 4.0; 28% were non-ambulatory (gross motor function classification system (GMFCS) level IV-V) and spastic CP was seen in 70%. Comorbidities included Speech impairment 85%, feeding difficulties 86%, and swallowing difficulties 77%, learning difficulties 88%, abnormal behaviour 62%, visual acuity impairment 54%, objective perceptual visual disorders 46%, communication difficulties 45%, epilepsy 35%, hearing impairment 12% and malnutrition 51%. Learning difficulties (OR 10.1, p < 0.001; CI: 3.6-28.1), visual acuity impairment (OR 2.8, p = 0.002; CI: 1.5-5.3), epilepsy (OR 2.3, p = 0.009; CI:1.2-4.3) manual ability classification scale 4-5 (OR 4.7,p = 0.049; CI:1.0-22.2) and CP severity (GMFCS V-VI) OR 6.9 p = 0.002, CI: 2.0-24.0.) were seen as increasing the likelihood of poor school attendance. CONCLUSION Comorbidities were common, and some were associated with limited school attendance. A multidisciplinary tailored approach to care, with application of available therapeutic interventions for comorbidities is suggested. This may be useful in reducing barriers to school attendance.
Collapse
Affiliation(s)
- Roseline E. Duke
- London School of Hygiene & Tropical Medicine, International Centre for Eye Health, London, UK
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar Children’s Eye Centre, Calabar, Cross River State Nigeria
| | - Chimaeze Torty
- Department of Paediatrics, Neurology Unit, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Uche Okorie
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar Children’s Eye Centre, Calabar, Cross River State Nigeria
| | - Min J. Kim
- London School of Hygiene & Tropical Medicine, International Centre for Eye Health, London, UK
| | - Nnena Eneli
- Department of Physiotherapy, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ukam Edadi
- Primary Health Care Development Agency, Calabar, Cross River State Nigeria
| | | | - Cally Tann
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Bowman
- London School of Hygiene & Tropical Medicine, International Centre for Eye Health, London, UK
| |
Collapse
|
18
|
Peixoto MVDS, Duque AM, Carvalho SD, Gonçalves TP, Novais APDS, Nunes MAP. Características epidemiológicas da paralisia cerebral em crianças e adolescentes em uma capital do nordeste brasileiro. FISIOTERAPIA E PESQUISA 2020. [DOI: 10.1590/1809-2950/20012527042020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo deste estudo foi descrever a prevalência de paralisia cerebral entre crianças e adolescentes, seus subtipos, as possíveis comorbidades e as características socioeconômicas das famílias. Foi realizado um estudo epidemiológico do tipo transversal a partir de um inquérito de base populacional sobre a paralisia cerebral em crianças e adolescentes na cidade de Aracaju (SE), Brasil. O estudo obteve informações sobre 240 crianças e adolescentes com paralisia cerebral a partir das respostas a um questionário feitas por seus responsáveis. Foi encontrada a prevalência de período de 1,37 em cada mil. Alguns bairros possuem prevalência de três a quatro vezes maior, revelando que a taxa de prevalência total não é um indicador homogêneo. A maioria dos participantes foi do sexo masculino (56,25%), de raça/cor declarada como parda ou preta (67,50%), sendo que a média de idade foi de 8,56 anos. A paralisia cerebral de tipo espástica bilateral foi a mais frequente (45,42%) e a comorbidade referida na maioria dos casos foi a epilepsia (48,33%). A renda familiar mensal correspondia a $252,87 dólares. O estudo revelou que as crianças e adolescentes com paralisia cerebral são, em grande parte, pertencentes a minorias sociais, de raça/cor parda ou preta, e suas famílias vivem na linha da extrema pobreza.
Collapse
|
19
|
Ikeudenta BA, Rutkofsky IH. Unmasking the Enigma of Cerebral Palsy: A Traditional Review. Cureus 2020; 12:e11004. [PMID: 33209560 PMCID: PMC7669254 DOI: 10.7759/cureus.11004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/17/2020] [Indexed: 11/30/2022] Open
Abstract
Cerebral palsy is a group of neuromuscular diseases that is primarily common in the pediatric population and is the most common cause of neurological and motor disability in children. Cerebral palsy is comprised of various subtypes with the most common type being spastic cerebral palsy. It is highly associated with prematurity and affects nerve function, motor function, and intellectual capacity. It is also associated with nutritional deficiencies and gastrointestinal dysfunction. Cerebral palsy is diagnosed via clinical evaluation and does not have specific laboratory or image findings, but certain imaging findings are positively correlated with it. There are numerous interventions and treatment modalities that are aimed at ensuring the highest quality of life for the patient and their families. This article was compiled with peer-reviewed publications from the PubMed database in which various keywords were utilized in the search engine. These peer-reviewed articles were selected without geographical restrictions and selected based on the use of the English language. These articles were also selected on the restriction of publication within the last 10 years. This review article on cerebral palsy will serve as a medium of education for the physician, healthcare team, and family involved in the management of children or adults with cerebral palsy. It is important because it discusses the possible etiologies, diagnostic and assessment techniques, prevention methods, and possible rehabilitation interventions. This article aims to broaden the reader's understanding of cerebral palsy and answer any questions that may arise during the management of this disease. The management of cerebral palsy is often plagued with frustration, depression, and anxiety. The main goal of treatment is to attain the highest quality of life for the family and the child.
Collapse
Affiliation(s)
- Bryan A Ikeudenta
- Psychiatry, Neuroscience, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ian H Rutkofsky
- Psychiatry, Neuroscience, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| |
Collapse
|
20
|
Duke R, Torty C, Nwachukwu K, Ameh S, Kim M, Eneli N, Onyedikachi A, Aghaji A, Burton K, Dyet L, Bowman R. Clinical features and aetiology of cerebral palsy in children from Cross River State, Nigeria. Arch Dis Child 2020; 105:625-630. [PMID: 31959596 DOI: 10.1136/archdischild-2019-317932] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE There are few studies on cerebral palsy (CP) in African children and our study aimed to describe the aetiology, characteristics and severity of CP in children from Nigeria. DESIGN A population-based study using key informant methodology (KIM) was conducted as part of a clinical research trial. Children aged 4-15 years were clinically assessed for CP. RESULTS The estimated prevalence of CP using KIM was 2.3/1000 children (95% CI 2.0 to 2.5/1000). 388 children were diagnosed with CP, with Gross Motor Function Classification System level 1 in 70 (18.1%), II in 156 (40.2%), III in 54 (13.9%), IV in 54 (13.9%), V in 54 (13.9%). 300/388 (77.3%) had Manual Ability Classification Scale of level 1-3 and 88 (22.7%) of level 4-5. CP types were spastic in 271 (70%), with 60% of these bilateral and 40% unilateral, ataxic 38 (9.8%), dystonic 18 (4.6%), choreoathetoid 29 (7.5%) and unclassifiable 32 (8.3%). Postneonatal risk factors for CP were seen in 140 (36.1%) children including malaria with seizures 101/140 (72.1%), malaria with coma 21/140 (15.0%), meningitis 12/140 (8.6%), tuberculosis 2/140 (1.4%), sickle cell disease 3/140 (2.2%), HIV 1/221 (0.7%). Prenatal/perinatal risk factors were seen in 248 (63.9%%), birth asphyxia 118 (47.6%) and clinical congenital rubella syndrome 8 (3.3%) and hyperbilirubinaemia 59 (23.8%) were identified as preventable risk factors for CP. CONCLUSION The profile of CP in this population is similar to that found in other low-income and middle-income countries (LMIC). Some risk factors identified were preventable. Prevention and management strategies for CP designed for LMIC are needed.
Collapse
Affiliation(s)
- Roseline Duke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom .,Department of Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Chimaeze Torty
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Kennedy Nwachukwu
- Department of Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Soter Ameh
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Min Kim
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nnena Eneli
- Department of Physiotherapy, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ani Onyedikachi
- Department of Physiotherapy, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ada Aghaji
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Leigh Dyet
- Neonatology, University College London, London, UK
| | - Richard Bowman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
21
|
Abdel Malek S, Rosenbaum P, Gorter JW. Perspectives on cerebral palsy in Africa: Exploring the literature through the lens of the International Classification of Functioning, Disability and Health. Child Care Health Dev 2020; 46:175-186. [PMID: 31856343 PMCID: PMC7028076 DOI: 10.1111/cch.12733] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The prevalence of cerebral palsy (CP) in countries in Africa is suggested to be higher than in Western countries. Research in Western resource-rich contexts has demonstrated the importance of environmental factors in the activities and participation of individuals with CP, as illustrated by the International Classification of Functioning, Disability and Health (ICF). Although the domains of the ICF are often acknowledged in research on CP in western contexts, the extent to which these domains have been explored in resource-limited areas is unknown. The current review aims to describe the nature of the current published literature on CP in African countries and how it aligns with the domains of the ICF. METHODS Key informants familiar with the literature on CP in Africa were consulted, and a literature search was conducted to identify articles on CP originating from countries in Africa. Identified articles were assessed to determine the ICF domains that align with the studies. Themes relating to each domain were identified. RESULTS Twenty-seven studies were included. The majority of studies were quantitative (70.3%) and focused on children or caregivers. Most studies included a body functions and structures component (70.4%), focusing on impairment rather than functioning. Activities and participation domains were addressed, but often focused solely on mobility. Environmental factors typically related to resources and policies and personal factors were often unexplored. CONCLUSIONS Research on CP in Africa tends to be grounded in a biomedical approach to disability and does not explicitly use the ICF as a guiding framework. Studies exploring body function and structures tend to be descriptive in nature, whereas activities and participation, and environmental and personal factors, represent modifiable factors that may be addressed with interventions. Knowledge translation activities that promote the ideas of the ICF in an African context should therefore be considered.
Collapse
Affiliation(s)
- Sandra Abdel Malek
- School of Rehabilitation ScienceMcMaster UniversityHamiltonOntarioCanada,CanChild Centre for Childhood Disability ResearchMcMaster UniversityHamiltonOntarioCanada
| | - Peter Rosenbaum
- School of Rehabilitation ScienceMcMaster UniversityHamiltonOntarioCanada,CanChild Centre for Childhood Disability ResearchMcMaster UniversityHamiltonOntarioCanada,Department of PaediatricsMcMaster UniversityHamiltonOntarioCanada
| | - Jan Willem Gorter
- School of Rehabilitation ScienceMcMaster UniversityHamiltonOntarioCanada,CanChild Centre for Childhood Disability ResearchMcMaster UniversityHamiltonOntarioCanada,Department of PaediatricsMcMaster UniversityHamiltonOntarioCanada
| |
Collapse
|
22
|
Philip SS, Guzzetta A, Chorna O, Gole G, Boyd RN. Relationship between brain structure and Cerebral Visual Impairment in children with Cerebral Palsy: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 99:103580. [PMID: 32004872 DOI: 10.1016/j.ridd.2020.103580] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Cerebral Visual Impairment (CVI) is very common yet often unrecognised visual dysfunction in children with Cerebral Palsy (CP). Magnetic Resonance Imaging (MRI) is the diagnostic tool in the investigation of brain lesions in children with CP and CVI. AIM The aim of this systematic review is to evaluate the relationship between brain structure and CVI, as determined by MRI in children with CP. METHODS AND PROCEDURES A comprehensive search of 5 database (PubMed, EMBASE, SCOPUS, CINAHL and Cochrane Database) was undertaken up until June 2019. The PRISMA checklist was then utilised to report on the process of selecting eligible papers. A total of 30 observational studies met the full inclusion criteria. Further, STROBE checklist was employed to report on the observational studies. OUTCOMES AND RESULTS Periventricular leucomalacia on MRI was found to have a strong association with CVI in all 30 studies. Only 13 (43 %) studies described dorsal and/ ventral stream dysfunction. There was ambiguity in the definition of CVI. CONCLUSIONS AND IMPLICATIONS The overall level of evidence correlating different patterns of CVI and CP (based on GMFCS, motor type and distribution) and MRI was low. Further studies utilising advances in MRI are needed to understand brain reorganisation and patterns of CVI and suggest rehabilitation therapy inclusive of vision.
Collapse
Affiliation(s)
- Swetha Sara Philip
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Brisbane, Australia.
| | - Andrea Guzzetta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Olena Chorna
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Glen Gole
- Dept of Ophthalmology, Queensland Children's Hospital, Brisbane, Australia
| | - Roslyn N Boyd
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Brisbane, Australia
| |
Collapse
|
23
|
Sogbossi ES, Houekpetodji D, Kpadonou TG, Bleyenheuft Y. A Cross-sectional Study of the Clinical Profile of Children With Cerebral Palsy in Benin, a West African Low-Income Country. J Child Neurol 2019; 34:842-850. [PMID: 31339409 DOI: 10.1177/0883073819864516] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cerebral palsy is a common cause of pediatric motor disability. Although there are increasing amounts of data on the clinical profile of children with cerebral palsy in high-income countries, corresponding information about low-income countries and developing countries is lacking. Therefore, we aimed to describe the clinical spectrum of cerebral palsy in children in Benin, a representative West African low-income country. Our cross-sectional observational study included 114 children with cerebral palsy recruited from community-based rehabilitation centers and teaching hospitals (median age: 7 years, range 2-17; sex: 66% male). Data were collected through review of medical records and interviews with children's mothers. Assessment included risk factors, clinical subtypes according to the Surveillance of CP in Europe criteria, severity of motor outcome scored by the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System, comorbidities, and school attendance. We recorded a high prevalence of intrapartum adverse events. Seventeen percent of children had postneonatal cerebral palsy, with cerebral malaria being the most common cause. Most children were severely affected (67.5% as bilateral spastic; 54.4% as GMFCS IV or V), but severity declined substantially with age. Only 23% of the children with cerebral palsy had attended school. Poor motor outcomes and comorbidities were associated with school nonattendance. These results suggest that intrapartum risk factors and postnatal cerebral malaria in infants are opportune targets for prevention of cerebral palsy in Sub-Saharan low-income countries.
Collapse
Affiliation(s)
- Emmanuel Segnon Sogbossi
- Motor Skill Learning and Intensive Neurorehabilitation lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,School of Physical Therapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Damienne Houekpetodji
- School of Physical Therapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Toussaint G Kpadonou
- School of Physical Therapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin.,Clinique Universitaire de Médecine Physique et Réadaptation du Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA (CNHU-HKM) de Cotonou, Benin
| | - Yannick Bleyenheuft
- Motor Skill Learning and Intensive Neurorehabilitation lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| |
Collapse
|
24
|
Socioeconomic Status Influences Functional Severity of Untreated Cerebral Palsy in Nepal: A Prospective Analysis and Systematic Review. Clin Orthop Relat Res 2019; 477:10-21. [PMID: 30179955 PMCID: PMC6345316 DOI: 10.1097/corr.0000000000000476] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cerebral palsy (CP) comprises a heterogeneous group of disorders whose clinical manifestations and epidemiologic characteristics vary across socioeconomic and geographic contexts. The functional severity of untreated CP in low-income countries has been insufficiently studied; a better understanding of how these children present for care in resource-constrained environments is important because it will better characterize the natural history of CP, guide clinical decision-making, and aid in the prognostication of children with untreated CP. QUESTIONS/PURPOSES The purposes of this study were (1) to determine the etiologies, motor subtypes, topographic distributions, and functional classifications of a large cohort of Nepali children with untreated CP presenting to a large pediatric rehabilitation center in Nepal; and (2) to compare the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS) scores of a subset of patients with spastic CP in the Nepali cohort with control subjects from high-income countries. METHODS A cross-sectional study was conducted at the Hospital and Rehabilitation Centre for Disabled Children in Nepal. Two hundred six consecutive Nepali children (76 girls; median age 4.0 years [interquartile range {IQR}, 2.5-9.0 years]) were evaluated to determine the demographic, clinical, and functional characteristics of a cohort of Nepali children with untreated CP. A systematic review of the Medline and Cochrane databases was then performed to obtain reference classification scores from high-income countries. Cross-sectional, noninterventional studies reporting at least one functional classification system with a sample size of at least 50 participants were included. Only studies of patients with spastic CP were included to allow for compatible comparisons with a subset of our study sample with spastic CP. A random-effects analysis was used to pool functional scores from participants in the included studies. Among the 206 children in our sample, 102 had spastic CP (35 girls; median age 5.5 years [IQR, 3.5-9.0 years]). Functional scores from these children were compared with pooled scores obtained from the systematic review by assessing the proportions of children in each sample with GMFCS, MACS, and CFCS score categories of I or II versus III to V. RESULTS Children with spastic hemiplegia from high-income countries were more likely to have a GMFCS score of I or II (96% [95% confidence interval {CI}, 92%-99%] versus 78% [95% CI, 62%-89%]) and a MACS score of I or II (83% [95% CI, 77%-88%] versus 50% [95% CI, 32%-68%]) relative to those from Nepal, but they were less likely to have a CFCS score of I or II (67% [95% CI, 51%-80%] versus 97% [95% CI, 87%-99%]). No differences were seen in children with spastic diplegia or quadriplegia. CONCLUSIONS Children in Nepal with hemiplegic CP display less difficulty in communicating and social engagement (CFCS) despite more-severe upper- and lower-extremity impairments in gross motor function (GMFCS) and manual ability (MACS) than do children with hemiplegic CP from high-income countries. Targeted interventions, including perhaps simple orthopaedic interventions to treat soft-tissue contractures, may therefore provide more-substantial improvements in function and quality of life to Nepali children than could be achieved for the same deployment of resources in more-affluent settings. LEVEL OF EVIDENCE Level II, prognostic study.
Collapse
|
25
|
Hassell J, Tann C, Idro R, Robertson NJ. Contribution of perinatal conditions to cerebral palsy in Uganda. Lancet Glob Health 2018; 6:e248-e249. [PMID: 29433660 DOI: 10.1016/s2214-109x(18)30041-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 12/20/2017] [Accepted: 01/03/2018] [Indexed: 12/25/2022]
Affiliation(s)
| | - Cally Tann
- University College London, London, UK; London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Idro
- Makerere University College of Health Sciences, Kampala, Uganda
| | | |
Collapse
|
26
|
Kakooza-Mwesige A, Andrews C, Peterson S, Wabwire Mangen F, Eliasson AC, Forssberg H. Prevalence of cerebral palsy in Uganda: a population-based study. LANCET GLOBAL HEALTH 2017; 5:e1275-e1282. [DOI: 10.1016/s2214-109x(17)30374-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 12/12/2022]
|
27
|
Patel P, Baier J, Baranov E, Khurana E, Gambrah-Sampaney C, Johnson A, Monokwane B, Bearden DR. Health beliefs regarding pediatric cerebral palsy among caregivers in Botswana: A qualitative study. Child Care Health Dev 2017; 43:861-868. [PMID: 28744889 DOI: 10.1111/cch.12490] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is the most common motor disability worldwide with an incidence of 2.5 per 1,000 births globally. Health beliefs among caregivers may be major drivers of health-related behaviours and service utilization, but little is known regarding health beliefs around CP in Africa. METHODS Between July 2013 and September 2015, children with CP were identified in Gaborone, Botswana, and their caregivers were invited to participate in a qualitative study utilizing semistructured in-person one-on-one interviews. Interview questions addressed their understanding of CP, challenges of caring for a handicapped child, and community response to children with CP. RESULTS Sixty-two caregivers participated in the study. Common themes elicited were variable knowledge about CP, financial and physical burden, lack of therapies and educational resources, and the impact of stigma. Caregivers in Botswana generally subscribed to a biomedical explanation of CP but expressed concerns regarding more stigmatizing folks beliefs expressed in the community. CONCLUSION Health beliefs regarding CP in Botswana likely have a significant impact on utilization of healthcare resources. Information from this study should inform future educational interventions for caregivers of children with CP.
Collapse
Affiliation(s)
- P Patel
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J Baier
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - E Baranov
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - E Khurana
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - C Gambrah-Sampaney
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - A Johnson
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - B Monokwane
- Department of Pediatrics, University of Botswana School of Medicine, Gaborone, Botswana
| | - D R Bearden
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, University of Botswana School of Medicine, Gaborone, Botswana.,Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, Rochester, NY, USA
| |
Collapse
|
28
|
Gunawan PI, Saharso D. Reducing severe spasticity in cerebral palsy following meningoencephalitis by botulinum toxin. MEDICAL JOURNAL OF INDONESIA 2017. [DOI: 10.13181/mji.v26i1.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
A 3-year-old boy diagnosed with diplegic cerebral palsy had received Botulinum toxin injection to reduce severe spasticity. There was an improvement of muscles tone and motor function including better ability of limb flexion of the knees and hip, adduction of the hip, flexion of the toes, and plantar flexion of the foot. No side effect was observed after the procedure.
Collapse
|
29
|
Abas O, Abdelaziem F, Kilany A. Clinical Spectrum of Cerebral Palsy and Associated Disability in South Egypt: A Local Survey Study. Open Access Maced J Med Sci 2017; 5:37-41. [PMID: 28293314 PMCID: PMC5320905 DOI: 10.3889/oamjms.2017.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Cerebral palsy is the most common cause of motor disability in children with a prevalence of 2-10/1,000 live births in the developing areas. AIM The epidemiology, clinical picture, and associated comorbidities in CP have been extensively studied in high-resource countries, but in low-resource areas, including Africa, those studies are still lacking. METHODS Cerebral palsy cases were prospectively recruited from every physiotherapy centre in Bani-Mazar city, Egypt, in a cross-sectional study from May 2015 to November 2015. RESULTS Two hundred cases were enrolled with a prevalence of 1 per 1000 live births. Within the study population, 72.5% were the spastic type, 16% were dyskinetic, 7% were ataxic, and 4.5% were hypotonic. The most common comorbidities were cognitive impairment and epilepsy affecting 77% and 38%, respectively. CONCLUSION Cerebral palsy in developing countries has a higher prevalence and different clinical profile regarding severity and associated disability. The perinatal and high-quality neonatal care together with physical therapy and rehabilitation programs is still lacking in developing countries.
Collapse
Affiliation(s)
- Osama Abas
- Physical Therapy, Ministry of Health, Cairo, Egypt
| | - Faten Abdelaziem
- Department of Physical Therapy for Growth and Development Disorders in Children and Its Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Ayman Kilany
- Department of Research on Children with Special Needs, National Research Centre, Cairo, Egypt
| |
Collapse
|
30
|
Kakooza-Mwesige A, Byanyima RK, Tumwine JK, Eliasson AC, Forssberg H, Flodmark O. Grey matter brain injuries are common in Ugandan children with cerebral palsy suggesting a perinatal aetiology in full-term infants. Acta Paediatr 2016; 105:655-64. [PMID: 26836434 DOI: 10.1111/apa.13352] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 12/10/2015] [Accepted: 01/28/2016] [Indexed: 11/29/2022]
Abstract
AIM There is limited literature on brain imaging studies of children with cerebral palsy (CP) in low and middle income countries. We investigated neuroimaging patterns of children with CP attending a tertiary referral centre in Uganda to determine how they differed from studies reported from high income countries and their relationship with prenatal and postnatal factors. METHODS Precontrast and postcontrast computed tomography (CT) scans of 78 CP children aged 2-12 years were conducted using a Philips MX 16-slice CT scanner. Two radiologists, blinded to the patient's clinical status, independently reviewed the scans. RESULTS Abnormal CT scans were detected in 69% of the children sampled, with very few having primary white matter injuries (4%). Primary grey matter injuries (PGMI) (44%) and normal scans (31%) were most frequent. Children with a history of hospital admission following birth were three times more likely to have PGMI (odds ratio [OR] 2.8; 95% CI 1.1-7.1), suggesting a perinatal period with medical complications. CONCLUSION Brain imaging patterns in this group of CP children differed markedly from imaging studies reported from high income countries, suggesting a perinatal aetiology in full-term infants and reduced survival in preterm infants.
Collapse
Affiliation(s)
- Angelina Kakooza-Mwesige
- Department of Paediatrics & Child Health; Makerere University College of Health Sciences; Kampala Uganda
- Astrid Lindgren Children's Hospital; Department of Women's & Children's Health; Neuropediatric Research Unit; Karolinska Institutet; Stockholm Sweden
| | - Rosemary K. Byanyima
- Mulago Hospital Department of Radiology/Makerere University College of Health Sciences; Kampala Uganda
| | - James K. Tumwine
- Department of Paediatrics & Child Health; Makerere University College of Health Sciences; Kampala Uganda
| | - Ann-Christin Eliasson
- Astrid Lindgren Children's Hospital; Department of Women's & Children's Health; Neuropediatric Research Unit; Karolinska Institutet; Stockholm Sweden
| | - Hans Forssberg
- Astrid Lindgren Children's Hospital; Department of Women's & Children's Health; Neuropediatric Research Unit; Karolinska Institutet; Stockholm Sweden
| | - Olof Flodmark
- Department of Clinical Neuroscience; Karolinska Institutet and Department of Neuroradiology; Karolinska University Hospital; Stockholm Sweden
| |
Collapse
|
31
|
Kakooza‐Mwesige A, Tumwine JK, Eliasson A, Namusoke HK, Forssberg H. Malnutrition is common in Ugandan children with cerebral palsy, particularly those over the age of five and those who had neonatal complications. Acta Paediatr 2015; 104:1259-68. [PMID: 26088908 PMCID: PMC5042112 DOI: 10.1111/apa.13089] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 05/15/2015] [Accepted: 06/15/2015] [Indexed: 11/29/2022]
Abstract
Aim Poor growth and malnutrition are frequently reported in children with cerebral palsy in developed countries, but there is limited information from developing countries. We investigated the nutritional status of Ugandan children with cerebral palsy and described the factors associated with poor nutrition. Methods We examined 135 children from two to 12 years with cerebral palsy, who attended Uganda's national referral hospital. A child was considered underweight, wasted, stunted or thin if the standard deviation scores for their weight for age, weight for height, height for age and body mass index for age were ≤−2.0 using World Health Organization growth standards. Multivariable logistic regression identified the factors associated with nutritional indicators. Results Over half (52%) of the children were malnourished, with underweight (42%) being the most common category, followed by stunting (38%), thinness (21%) and wasting (18%). Factors that were independently associated with being malnourished were as follows: presence of cognitive impairment, with an adjusted odds ratio (aOR) of 4.5, being 5 years or older (aOR = 3.4) and feeding difficulties in the perinatal period (aOR = 3.2). Conclusion Malnutrition was common in Ugandan children with cerebral palsy and more likely if they were 5 years or more or had experienced neonatal complications.
Collapse
Affiliation(s)
- Angelina Kakooza‐Mwesige
- Department of Paediatrics & Child Health Makerere University College of Health Sciences and Mulago Hospital Kampala Uganda
- Neuropaediatric Unit Department of Women's & Children's Health Karolinska Institute Stockholm Sweden
| | - James K. Tumwine
- Department of Paediatrics & Child Health Makerere University College of Health Sciences and Mulago Hospital Kampala Uganda
| | - Ann‐Christin Eliasson
- Neuropaediatric Unit Department of Women's & Children's Health Karolinska Institute Stockholm Sweden
| | - Hanifa K. Namusoke
- Department of Paediatrics & Child Health Makerere University College of Health Sciences and Mulago Hospital Kampala Uganda
| | - Hans Forssberg
- Neuropaediatric Unit Department of Women's & Children's Health Karolinska Institute Stockholm Sweden
| |
Collapse
|