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Ostojic K, Karem I, Paget SP, Berg A, Dee-Price BJ, Lingam R, Dale RC, Eapen V, Woolfenden S. Social determinants of health for children with cerebral palsy and their families. Dev Med Child Neurol 2024; 66:32-40. [PMID: 37179527 DOI: 10.1111/dmcn.15640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/15/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023]
Abstract
Social determinants of health (SDH) influence health and social outcomes in positive and negative ways. Understanding the impact of SDH on children with cerebral palsy (CP) is essential to improve health equity, optimize health outcomes, and support children with CP and their families to thrive in society. In this narrative review, we summarize the landscape of SDH impacting children with CP and their families worldwide. In high-income countries, children from poorer neighbourhoods are more likely to have severe comorbidities, present with spastic bilateral CP, and report lower frequency of participation in community activities. In low- and middle-income countries, socioeconomic disadvantage is associated with increased risk of malnutrition, living in poorer housing conditions, not having access to proper sanitation, and living below the poverty line. Low maternal education is associated with increased likelihood of the child with CP experiencing increased severity of gross motor and bimanual functioning challenges, and poorer academic performance. Lower parental education is also associated with reduced child autonomy. On the other hand, higher parental income is a protective factor, associated with greater diversity of participation in day-to-day activities. A better physical environment and better social support are associated with higher participation in daily activities. Clinicians, researchers, and the community should be aware of these key challenges and opportunities. Then adopt a range of approaches that target adverse SDH/social needs and foster positive SDH in the clinical setting. WHAT THIS PAPER ADDS: Understanding how social determinants of health influence health and social outcomes is a critical step towards improving health equity and outcomes. Approaches are required that target the impact of adverse SDH on access to health care for children with cerebral palsy and that work towards ensuring equity of access for all.
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Affiliation(s)
- Katarina Ostojic
- Population Child Health Research Group, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
| | - Isra Karem
- Population Child Health Research Group, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
| | - Simon P Paget
- Kids Rehab, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Faculty of Medicine and Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Alison Berg
- Kids Rehab, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Betty-Jean Dee-Price
- Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Raghu Lingam
- Population Child Health Research Group, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
| | - Russell C Dale
- Faculty of Medicine and Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
- Neurology Department, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Valsamma Eapen
- Population Child Health Research Group, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Sue Woolfenden
- Population Child Health Research Group, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
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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: 0] [Impact Index Per Article: 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.
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Luo Y, Qu J, He Z, Zhang M, Zou Z, Li L, Zhang Y, Ye J. Human Umbilical Cord Mesenchymal Stem Cells Improve the Status of Hypoxic/Ischemic Cerebral Palsy Rats by Downregulating NogoA/NgR/Rho Pathway. Cell Transplant 2023; 32:9636897231210069. [PMID: 37982384 PMCID: PMC10664427 DOI: 10.1177/09636897231210069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/31/2023] [Accepted: 09/28/2023] [Indexed: 11/21/2023] Open
Abstract
Human umbilical cord mesenchymal stem cells (hUCMSC) have shown promising potential in ameliorating brain injury, but the mechanism is unclear. We explore the role of NogoA/NgR/Rho pathway in mediating hUCMSC to improve neurobehavioral status and alleviate brain injury in hypoxia/ischemia-induced CP (cerebral palsy) rat model in order to promote the clinical application of stem cell therapy in CP. The injury model of HT22 cells was established after 3 h hypoxia, and then co-cultured with hUCMSC. The rat model of CP was established by ligation of the left common carotid artery for 2.5 h. Subsequently, hUCMSC was administered via the tail vein once a week for a total of four times. The neurobehavioral status of CP rats was determined by behavioral experiment, and the pathological brain injury was determined by pathological staining method. The mRNA and protein expressions of NogoA, NgR, RhoA, Rac1, and CDC42 in brain tissues of rats in all groups and cell groups were detected by real-time quantitative polymerase chain reaction (RT-qPCR), Western blot, and immunofluorescence. The CP rats exhibited obvious motor function abnormalities and pathological damage. Compared with the control group, hUCMSC transplantation could significantly improve the neurobehavioral situation and attenuate brain pathological injury in CP rats. The relative expression of NogoA, NgR, RhoA mRNA, and protein in brain tissues of rats in the CP group was significantly higher than the rats in the sham and CP+hUCMSC group. The relative expression of Rac1, CDC42 mRNA, and protein in brain tissues of rats in the CP group was significantly lower than the rats in the sham and CP+hUCMSC group. The animal experiment results were consistent with the experimental trend of hypoxic injury of HT22 cells. This study confirmed that hUCMSC can efficiently improve neurobehavioral status and alleviate brain injury in hypoxia/ischemia-induced CP rat model and HT22 cell model through downregulating the NogoA/NgR/Rho pathway.
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Affiliation(s)
- Yaoling Luo
- Subcenter for Stem Cell Clinical Translation, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Clinical Medicine Research Center, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Ganzhou Key Laboratory of Stem Cell and Regenerative Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Jiayang Qu
- Subcenter for Stem Cell Clinical Translation, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- School of Rehabilitation Medicine Gannan Medical University, Ganzhou, China
| | - Zhengyi He
- Subcenter for Stem Cell Clinical Translation, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Clinical Medicine Research Center, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Ganzhou Key Laboratory of Stem Cell and Regenerative Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Minhong Zhang
- Subcenter for Stem Cell Clinical Translation, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Clinical Medicine Research Center, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Ganzhou Key Laboratory of Stem Cell and Regenerative Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Zhengwei Zou
- Subcenter for Stem Cell Clinical Translation, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Clinical Medicine Research Center, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Ganzhou Key Laboratory of Stem Cell and Regenerative Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Lincai Li
- Subcenter for Stem Cell Clinical Translation, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Clinical Medicine Research Center, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Ganzhou Key Laboratory of Stem Cell and Regenerative Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | | | - Junsong Ye
- Subcenter for Stem Cell Clinical Translation, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Ganzhou Key Laboratory of Stem Cell and Regenerative Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, China
- Key Laboratory of Biomaterials and Biofabrication in Tissue Engineering of Jiangxi Province, Gannan Medical University, Ganzhou, China
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Smith SE, Chowdhury MK, Doherty M, Morgan DD. Serious health-related suffering experienced by children with disability and their families living in Bangladesh: A scoping review. Palliat Med 2022; 37:602-626. [PMID: 36428280 DOI: 10.1177/02692163221136896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In 2020, the International Association for Hospice and Palliative Care redefined palliative care to incorporate the concept of serious health-related suffering. An estimated 21 million children globally live with conditions which would benefit from a palliative approach to relieve suffering. Bangladesh is a lower-middle income country with isolated provision of palliative care. AIM To synthesise existing evidence describing serious health-related suffering of children with disability and their families living in Bangladesh and the intersection between this suffering, palliative care and rehabilitation. DESIGN Scoping review methodology. DATA SOURCES A search strategy related to serious health-related suffering and childhood disability was applied to online databases and grey literature. English language studies (1990-2021) were included. Papers pertaining to serious health-related suffering of typically developing children and those over eighteen years were excluded. Data which addressed the three domains of serious health-related suffering (physical, social and emotional/spiritual) were extracted. Palliative care interventions were assessed with a pre-existing checklist. RESULTS Forty-six studies were included, representing ten different methodologies. Sample sizes ranged from 11 to 2582 participants, with 87% of studies including children with cerebral palsy. Serious health-related suffering was described in 100% of the studies, only 14 of the studies described specific interventions to mitigate suffering. Convergence between palliative care and rehabilitation approaches was evident. CONCLUSION Findings document the extensive nature and burden of serious childhood health-related suffering that may be remediated by a palliative approach. They highlight the urgent need to prioritise service development and research in this area.
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Affiliation(s)
- Suzanne E Smith
- Master of Palliative Care student, Flinders University, Australia; Victorian Paediatric Rehabilitation Service, Australia
| | | | - Megan Doherty
- University of Ottawa, ON, Canada; Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Deidre D Morgan
- Research Centre for Palliative Care, Death and Dying (RePaDD), College of Nursing and Health Sciences, Flinders University, SA, Australia
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McConkey R. Responding to Autism in Low and Middle Income Countries (LMIC): What to Do and What Not to Do. Brain Sci 2022; 12:1475. [PMID: 36358400 PMCID: PMC9688501 DOI: 10.3390/brainsci12111475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 01/12/2024] Open
Abstract
Autism is a spectrum disorder that occurs globally with increasing numbers of children and adults being identified with this condition. Although rates are higher in more affluent nations, the bulk of people with autism reside in Low and Middle Income Countries (LMICs). However, most do not have access to timely and appropriate support. The types of services delivered in high income countries are often ill-suited to the needs and resources of LMICs. Rather alternative forms of provision need to be devised. In common with other public health initiatives, these should be family-focused and community based, with suitably qualified and experienced leaders who in turn train and supervise a cadre of knowledgeable support workers drawn from local communities and cultures. As well as providing personalized, home-based guidance to people with autism and to their primary carers, regular group-based advocacy and training activities are undertaken in partnership with available mainstream services such as schools and social services. The principles and operations of these new forms of services are described in this paper albeit with an acknowledgment of their limitations. In recent decades, the cost-effectiveness of these approaches have been demonstrated with other chronic illnesses and disabling conditions in LMICs but their extension to autism has barely begun. More affluent countries are being forced to adopt similar strategies in response to the increased numbers of people identified with autism. A transformation in research strategies is essential to building better international support for persons with autism.
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Affiliation(s)
- Roy McConkey
- Institute of Nursing and Health Research, Ulster University, Belfast BT15 1ED, N. Ireland, UK
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Jahan I, Al Imam MH, Muhit M, Chhetri AB, Badawi N, Khandaker G. Epidemiology of cerebral palsy among children in the remote Gorkha district of Nepal: findings from the Nepal cerebral palsy register. Disabil Rehabil 2022:1-10. [PMID: 36102553 DOI: 10.1080/09638288.2022.2118871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To describe the epidemiology of cerebral palsy (CP) among children in Gorkha, Nepal. METHODS We established the first population-based register of children with CP aged <18 y in Gorkha, Nepal (i.e., Nepal CP Register). Children with suspected CP underwent detailed neurodevelopmental assessment by a multidisciplinary assessment team. Socio-demographic, etiology, motor severity, rehabilitation, and educational status were documented. RESULTS Between January and October 2018, 182 children with confirmed CP were registered (mean (standard deviation (SD)) age: 10 years 1 months (4 years 10 months), 37.4% females). The majority (88.3%) had CP acquired pre- or perinatally. Mean (SD) age of CP diagnosis was four years five months. Mothers who did not receive any formal schooling had 4.5, 3.1, and 6.3 times higher odds of having inadequate antenatal care, homebirth, and unskilled birth attendants, respectively, when adjusted for other factors. Most children had spastic CP (77.5%) and Gross Motor Function Classification System level III-V (54.9%). Overall, 45.8% had never received rehabilitation services, 58.0% of school-aged children were not attending schools. The median age of receiving rehabilitation services was three years zero months. CONCLUSIONS The delayed diagnosis and clinical severity indicate the overall poor health status of children with CP in Nepal which could be improved by ensuring early diagnosis and intervention. Implications for rehabilitationThe first population-based cerebral palsy register in Nepal suggests diagnosis of CP is considerably delayed among children.The high burden of severe motor impairment and poor communication skill with limited access to timely rehabilitation among children with CP in Nepal is concerning.Capacity development of community-based health workers and mothers of children with CP could help implementing community-based programs for prevention and early diagnosis of CP, and to promote early intervention for children with CP in remote Gorkha, Nepal.
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Affiliation(s)
- Israt Jahan
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | | | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
- Grace Centre for Newborn Intensive Care, Sydney Children’s Hospital Network, The University of Sydney, Westmead, Australia
| | - Gulam Khandaker
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia
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Nanyunja C, Sadoo S, Kohli-Lynch M, Nalugya R, Nyonyintono J, Muhumuza A, Katumba KR, Trautner E, Magnusson B, Kabugo D, Cowan FM, Zuurmond M, Morgan C, Lester D, Seeley J, Webb EL, Otai C, Greco G, Nampijja M, Tann CJ. Early care and support for young children with developmental disabilities and their caregivers in Uganda: The Baby Ubuntu feasibility trial. Front Pediatr 2022; 10:981976. [PMID: 36177453 PMCID: PMC9513138 DOI: 10.3389/fped.2022.981976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Early care and support provision for young children with developmental disabilities is frequently lacking, yet has potential to improve child and family outcomes, and is crucial for promoting access to healthcare and early education. We evaluated the feasibility, acceptability, early evidence of impact and provider costs of the Baby Ubuntu participatory, peer-facilitated, group program for young children with developmental disabilities and their caregivers in Uganda. Materials and methods A feasibility trial, with two parallel groups, compared Baby Ubuntu with standard care. Caregivers and children, aged 6-11 months with moderate-severe neurodevelopmental impairment, were recruited and followed for 12 months. Quantitative and qualitative methods captured information on feasibility (ability to recruit), acceptability (satisfactory attendance), preliminary evidence of impact (family quality of life) and provider costs. Results One hundred twenty-six infants (median developmental quotient, 28.7) were recruited and randomized (63 per arm) over 9 months, demonstrating feasibility; 101 (80%) completed the 12-month follow-up assessment (9 died, 12 were lost to follow up, 4 withdrew). Of 63 randomized to the intervention, 59 survived (93%); of these, 51 (86%) attended ≥6 modules meeting acceptability criteria, and 49 (83%) completed the 12 month follow-up assessment. Qualitatively, Baby Ubuntu was feasible and acceptable to caregivers and facilitators. Enabling factors included community sensitization by local champions, positive and caring attitudes of facilitators toward children with disability, peer support, and the participatory approach to learning. Among 101 (86%) surviving children seen at 12 months, mixed methods evaluation provided qualitative evidence of impact on family knowledge, skills, and attitudes, however impact on a scored family quality of life tool was inconclusive. Barriers included stigma and exclusion, poverty, and the need to manage expectations around the child's progress. Total provider cost for delivering the program per participant was USD 232. Conclusion A pilot feasibility trial of the Baby Ubuntu program found it to be feasible and acceptable to children, caregivers and healthcare workers in Uganda. A mixed methods evaluation provided rich programmatic learning including qualitative, but not quantitative, evidence of impact. The cost estimate represents a feasible intervention for this vulnerable group, encouraging financial sustainability at scale. Clinical trial registration [https://doi.org/10.1186/ISRCTN44380971], identifier [ISRCTN44380971].
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Affiliation(s)
- Carol Nanyunja
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Samantha Sadoo
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Maya Kohli-Lynch
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Academic Child Health, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Ruth Nalugya
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Spina Bifida and Hydrocephalus Association of Uganda (SHA-U), Mbale, Uganda
| | - James Nyonyintono
- Kiwoko Hospital, Nakaseke, Uganda
- Adara Development, Edmonds, WA, United States
| | | | | | - Emily Trautner
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Brooke Magnusson
- Kiwoko Hospital, Nakaseke, Uganda
- Adara Development, Edmonds, WA, United States
| | - Daniel Kabugo
- Kiwoko Hospital, Nakaseke, Uganda
- Adara Development, Edmonds, WA, United States
| | - Frances M Cowan
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Maria Zuurmond
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emily L Webb
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Christine Otai
- Kiwoko Hospital, Nakaseke, Uganda
- Adara Development, Edmonds, WA, United States
| | - Giulia Greco
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Margaret Nampijja
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- African Population and Health Research Center, Nairobi, Kenya
| | - Cally J Tann
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Editorial: Early Detection and Early Intervention Strategies for Cerebral Palsy in Low and High Resource Settings. Brain Sci 2022; 12:brainsci12080960. [PMID: 35892401 PMCID: PMC9331917 DOI: 10.3390/brainsci12080960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 02/05/2023] Open
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Jahan I, Sultana R, Muhit M, Akbar D, Karim T, Al Imam MH, Das MC, Smithers-Sheedy H, McIntyre S, Badawi N, Khandaker G. Nutrition Interventions for Children with Cerebral Palsy in Low- and Middle-Income Countries: A Scoping Review. Nutrients 2022; 14:nu14061211. [PMID: 35334869 PMCID: PMC8951851 DOI: 10.3390/nu14061211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Malnutrition is substantially higher among children with cerebral palsy (CP) in low- and middle-income countries (LMICs) when compared with the general population. Access to appropriate interventions is crucial for better management of malnutrition and nutritional outcomes of those children. We aimed to review the existing evidence on nutrition interventions for children with CP in LMICs. Methods: Online databases, i.e., PubMed and Scopus, and Google Scholar were searched up to 10 January 2022, to identify peer-reviewed publications/evidence on LMIC focused nutritional management guidelines/interventions. Following title screening and abstract review, full articles that met the inclusion/exclusion criteria were retained for data charting. Information about the study characteristics, nutrition interventions, and their effectiveness were extracted. Descriptive data were reported. Results: Eight articles published between 2008 and 2019 were included with data from a total of n = 252 children with CP (age range: 1 y 0 m–18 y 7 m, 42% female). Five studies followed experimental design; n = 6 were conducted in hospital/clinic/center-based settings. Four studies focused on parental/caregiver training; n = 2 studies had surgical interventions (i.e., gastrostomy) and n = 1 provided neurodevelopmental therapy feeding intervention. Dietary modification as an intervention (or component) was reported in n = 5 studies and had better effect on the nutritional outcomes of children with CP compared to interventions focused on feeding skills or other behavioral modifications. Surgical interventions improved nutritional outcomes in both studies; however, none documented any adverse consequences of the surgical interventions. Conclusion: There is a substantial knowledge gap on nutrition interventions for children with CP in LMICs. This hinders the development of best practice guidelines for the nutritional management of children with CP in those settings. Findings suggest interventions directly related to growth/feeding of children had a better outcome than behavioral interventions. This should be considered in planning of nutrition-focused intervention or comprehensive services for children with CP in LMICs.
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Affiliation(s)
- Israt Jahan
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
| | - Risad Sultana
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
| | - Mohammad Muhit
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
| | - Delwar Akbar
- School of Business and Law, Central Queensland University, Rockhampton, QLD 4701, Australia;
| | - Tasneem Karim
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
- Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2145, Australia
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, NSW 2006, Australia; (H.S.-S.); (S.M.); (N.B.)
| | - Mahmudul Hassan Al Imam
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
| | - Manik Chandra Das
- CSF Global, Dhaka 1213, Bangladesh; (I.J.); (R.S.); (M.M.); (T.K.); (M.H.A.I.); (M.C.D.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, NSW 2006, Australia; (H.S.-S.); (S.M.); (N.B.)
| | - Sarah McIntyre
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, NSW 2006, Australia; (H.S.-S.); (S.M.); (N.B.)
| | - Nadia Badawi
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, NSW 2006, Australia; (H.S.-S.); (S.M.); (N.B.)
- Grace Centre for Newborn Intensive Care, The Children’s Hospital at Westmead, Sydney Children’s Hospital Network, Westmead, NSW 2145, Australia
| | - Gulam Khandaker
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
- Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2145, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
- Correspondence: ; Tel.: +61-7-49206989
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Al Imam MH, Das MC, Jahan I, Muhit M, Akbar D, Badawi N, Khandaker G. A Social Business Model of Early Intervention and Rehabilitation for People with Disability in Rural Bangladesh. Brain Sci 2022; 12:brainsci12020264. [PMID: 35204026 PMCID: PMC8869949 DOI: 10.3390/brainsci12020264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Despite the high burden of childhood disability in low-and middle-income countries (LMICs), the opportunity for early intervention and rehabilitation is very limited. Studies have found that community-based rehabilitation service is effective for children with cerebral palsy (CP); however, such services are not readily available in LMICs, and services run by non-profit organisations on external funding are often not sustainable. In this study, we report the lesson learnt in establishing a social business model of early intervention and rehabilitation services for children with CP and adults with disabilities in a rural subdistrict of Bangladesh. Methods: Case study of a rural early intervention and rehabilitation centre (i.e., the model centre) implemented between May 2018 and September 2019. An economic evaluation incorporating gross margin analysis along with descriptive statistics was performed to assess the social business potentials of the model centre. Results: The establishment of this model centre cost ~5955 USD with an average monthly running cost of ~994 USD. During the 17 months study period, 7038 therapy sessions (average eight sessions per patient) were offered to 862 patients with musculoskeletal and neurological disorders. The most common clinical presentations were low back pain (35.6%; n = 307). Six percent (n = 52) of the attendees were children with CP (mean (SD) age 6.3 (4.0) years; 35.7% (n = 19) were female), who received 1392 sessions, on average 27 sessions per child. The centre reached the break-even point at the 13th month and remained profitable for the next 4 months of the study period. An average session fee of 2.2 USD resulted in a gross margin of -1458 USD and 1940 USD in 2018 and 2019, respectively. Revenue to cost ratios for the 2 years were 0.27:1 and 0.51:1 while average rates of return were −41.4% and 10.1%, respectively. Sensitivity analysis revealed that session numbers including 5000, 6000, 7000, 8000, 9000, and 10,000 were required to break even at the session fees of 3.0, 2.50, 2.0, 2.0, 1.5, and 1.5 USD, respectively. Conclusion: Our social business model of an early intervention and rehabilitation service provides evidence of enhancing access to services for children with CP as well as adults with disabilities while ensuring the sustainability of the services in rural Bangladesh.
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Affiliation(s)
- Mahmudul Hassan Al Imam
- CSF Global, Dhaka 1213, Bangladesh; (M.H.A.I.); (M.C.D.); (I.J.); (M.M.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1213, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
| | - Manik Chandra Das
- CSF Global, Dhaka 1213, Bangladesh; (M.H.A.I.); (M.C.D.); (I.J.); (M.M.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1213, Bangladesh
| | - Israt Jahan
- CSF Global, Dhaka 1213, Bangladesh; (M.H.A.I.); (M.C.D.); (I.J.); (M.M.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1213, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
| | - Mohammad Muhit
- CSF Global, Dhaka 1213, Bangladesh; (M.H.A.I.); (M.C.D.); (I.J.); (M.M.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1213, Bangladesh
| | - Delwar Akbar
- School of Business and Law, Central Queensland University, Rockhampton, QLD 4701, Australia;
| | - Nadia Badawi
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, NSW 2050, Australia;
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2050, Australia
| | - Gulam Khandaker
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2050, Australia
- Correspondence: ; Tel.: +61-7-49206989
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Hadders-Algra M. The developing brain: Challenges and opportunities to promote school readiness in young children at risk of neurodevelopmental disorders in low- and middle-income countries. Front Pediatr 2022; 10:989518. [PMID: 36340733 PMCID: PMC9634632 DOI: 10.3389/fped.2022.989518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/27/2022] [Indexed: 11/14/2022] Open
Abstract
This paper discusses possibilities for early detection and early intervention in infants with or at increased risk of neurodevelopmental disorders in low- and middle-income countries (LMICs). The brain's high rate of developmental activity in the early years post-term challenges early detection. It also offers opportunities for early intervention and facilitation of school readiness. The paper proposes that in the first year post-term two early detection options are feasible for LMICs: (a) caregiver screening questionnaires that carry little costs but predict neurodevelopmental disorders only moderately well; (b) the Hammersmith Infant Neurological Examination and Standardized Infant NeuroDevelopmental Assessment (SINDA) which are easy tools that predict neurodisability well but require assessment by health professionals. The young brain's neuroplasticity offers great opportunities for early intervention. Ample evidence indicates that families play a critical role in early intervention of infants at increased risk of neurodevelopmental disorders. Other interventional key elements are responsive parenting and stimulation of infant development. The intervention's composition and delivery mode depend on the infant's risk profile. For instance, in infants with moderately increased risk (e.g., preterm infants) lay community health workers may provide major parts of intervention, whereas in children with neurodisability (e.g., cerebral palsy) health professionals play a larger role.
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Affiliation(s)
- Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Division of Developmental Neurology and University of Groningen, Faculty of Theology and Religious Studies, Groningen, The Netherlands
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