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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.
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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
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Gelineau-Morel R, Usman F, Shehu S, Yeh HW, Suwaid MA, Abdulsalam M, Jibril Y, Satrom KM, Shapiro SM, Zinkus TP, Head HW, Slusher TM, Le Pichon JB, Farouk ZL. Predictive and diagnostic measures for kernicterus spectrum disorder: a prospective cohort study. Pediatr Res 2024; 95:285-292. [PMID: 37689774 PMCID: PMC10842628 DOI: 10.1038/s41390-023-02810-z] [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: 02/24/2023] [Revised: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Kernicterus spectrum disorder (KSD) resulting from neonatal hyperbilirubinemia remains a common cause of cerebral palsy worldwide. This 12-month prospective cohort study followed neonates with hyperbilirubinemia to determine which clinical measures best predict KSD. METHODS The study enrolled neonates ≥35 weeks gestation with total serum bilirubin (TSB) ≥ 20 mg/dl admitted to Aminu Kano Hospital, Nigeria. Clinical measures included brain MRI, TSB, modified bilirubin-induced neurologic dysfunction (BIND-M), Barry-Albright Dystonia scale (BAD), auditory brainstem response (ABR), and the modified KSD toolkit. MRI signal alteration of the globus pallidus was scored using the Hyperbilirubinemia Imaging Rating Tool (HIRT). RESULTS Of 25 neonates enrolled, 13/25 completed 12-month follow-up and six developed KSD. Neonatal BIND-M ≥ 3 was 100% sensitive and 83% specific for KSD. Neonatal ABR was 83% specific and sensitive for KSD. Neonatal HIRT score of 2 was 67% sensitive and 75% specific for KSD; this increased to 100% specificity and sensitivity at 12 months. BAD ≥ 2 was 100% specific for KSD at 3-12 months, with 50-100% sensitivity. CONCLUSIONS Neonatal MRIs do not reliably predict KSD. BIND-M is an excellent screening tool for KSD, while the BAD or HIRT score at 3 or 12 months can confirm KSD, allowing for early diagnosis and intervention. IMPACT The first prospective study of children with acute bilirubin encephalopathy evaluating brain MRI findings over the first year of life. Neonatal MRI is not a reliable predictor of kernicterus spectrum disorders (KSD). Brain MRI at 3 or 12 months can confirm KSD. The modified BIND scale obtained at admission for neonatal hyperbilirubinemia is a valuable screening tool to assess risk for developing KSD. The Barry Albright Dystonia scale and brain MRI can be used to establish a diagnosis of KSD in at-risk infants as early as 3 months.
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Affiliation(s)
- Rose Gelineau-Morel
- Division of Neurology, Children's Mercy Hospital Kansas City, Kansas City, MO, USA.
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| | - Fatima Usman
- Department of Pediatrics, Bayero University Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Saadatu Shehu
- Department of Pediatrics, Bayero University Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Hung-Wen Yeh
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Division of Health Services & Outcomes Research, Children's Mercy Hospital Kansas City, Kansas City, MO, USA
| | - Mohammad A Suwaid
- Department of Radiology, Bayero University Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Mohammed Abdulsalam
- Department of Pediatrics, Bayero University Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Yasir Jibril
- Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Steven M Shapiro
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Timothy P Zinkus
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Division of Radiology, Children's Mercy Hospital Kansas City, Kansas City, MO, USA
| | - Hayden W Head
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Division of Radiology, Children's Mercy Hospital Kansas City, Kansas City, MO, USA
| | - Tina M Slusher
- Department of Pediatrics, Global Health Program, Critical Care Division, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, USA
| | - Jean-Baptiste Le Pichon
- Division of Neurology, Children's Mercy Hospital Kansas City, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Zubaida L Farouk
- Department of Pediatrics, Bayero University Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
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Kapapa MM, Bearden DR, Somwe SW, Birbeck GL, Ramdharry G, Kvalsund M. Genetic Neuromuscular Disorders and Health Services Access, Utilization, and Needs in Zambia. Pediatr Neurol 2023; 148:173-177. [PMID: 37738885 PMCID: PMC10642628 DOI: 10.1016/j.pediatrneurol.2023.08.038] [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: 04/12/2023] [Revised: 07/26/2023] [Accepted: 08/28/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Medical and rehabilitative advances increasingly transform management of rare genetic neuromuscular diseases (GNMDs) for children in the global north. Lack of information about GNMDs and related health care needs in sub-Saharan Africa threatens to widen pre-existing health disparities. METHODS This is a cross-sectional study of probands enrolling in a study of GNMDs at the University Teaching Hospital in Lusaka, Zambia, a member of the International Consortium for Genomic Medicine in Neuromuscular Disease. Probands/caregivers were interviewed about utilization of medical, rehabilitative, and other support services by a research assistant. A neuromuscular neurologist and/or physiotherapist examined each case and completed an independent questionnaire regarding health service utilization for each proband. Diagnoses were made on available clinical and electrophysiologic data. Molecular findings were unavailable at the time of this analysis. RESULTS Among 50 probands, 52% were male with median age 12 (absolute range 2 months to 54 years). Motor neuron diseases (n = 16; 32%), muscle disorders (n = 20; 40%), and inherited polyneuropathies (n = 5; 10%) were most common. Six (15%) cases had insufficient clinical data to classify the GNMDs. Outside of primary care, patient/caregiver-reported access to recommended health services (n = 34; 69%) was challenging. Large disparities in current utilization of health care services versus clinician-recommended services are reported. CONCLUSIONS Paradigms to improve access to diagnostics and therapeutic interventions are needed for GNMDs in Zambia. Multidisciplinary clinics may improve access and utilization of needed health services. Qualitative and other research focused on improving referrals, access, and quality of available health services are greatly needed.
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Affiliation(s)
- Musambo M Kapapa
- University Teaching Hospital Neurology Research Office, Lusaka, Zambia
| | - David R Bearden
- University Teaching Hospital Neurology Research Office, Lusaka, Zambia; Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Somwe Wa Somwe
- University Teaching Hospital Neurology Research Office, Lusaka, Zambia
| | - Gretchen L Birbeck
- University Teaching Hospital Neurology Research Office, Lusaka, Zambia; Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | | | - Michelle Kvalsund
- University Teaching Hospital Neurology Research Office, Lusaka, Zambia; Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia.
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Sogbossi ES, Sotindjo Adon S, Adjagodo L, Dossou S, Dakè H, Ebner-Karestinos D, Araneda R, Saussez G, Paradis J, Kpadonou TG, Bleyenheuft Y. Efficacy of hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) in young children with bilateral cerebral palsy (GMFCS III-IV) in a low and middle-income country: protocol of a randomised controlled trial. BMJ Open 2021; 11:e050958. [PMID: 34610941 PMCID: PMC8493925 DOI: 10.1136/bmjopen-2021-050958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is highly prevalent in sub-Saharan Africa, where clinically-based studies have shown a considerable over-representation of the severe bilateral subtype. However, children's access to rehabilitation care is limited by many local factors, notably the lacking of rehabilitation services, insufficient knowledge of caregivers and financial constraints. In such a context there is an urgent need for studies of the evidence-based rehabilitation approach. Here, we describe the protocol of a randomised controlled study to investigate the efficacy of Hand-Arm Bimanual Intensive Therapy Including the Lower Extremities (HABIT-ILE) in young children with bilateral CP in Benin Republic, a representative low and middle-income country of western Africa. METHODS AND ANALYSIS Forty children with bilateral CP aged between 24 and 59 months and with level III-IV in the gross motor function classification will be randomised to either a high intensity conventional therapy or HABIT-ILE therapy. Both therapies will be delivered as a day-camp model over 2 weeks to a total of 50 hours (5 hours per day). The assessor-blinded primary outcomes will include the gross motor function measure and both hands assessment. Secondary outcomes will be the adapted version of the ACTIVLIM-CP questionnaire, the Canadian Occupational Performance Measure, and a perception of CP interview form. Children will be assessed at baseline, after intervention and at 6-week follow-up. A 2 (group)×3 (test sessions) repeated analysis of variance will evaluate changes after the interventions. ETHICS AND DISSEMINATION This study has been approved by the ethics committee of the rehabilitation department of the National Teaching Hospital Hubert Koutoukou Maga of Cotonou, Benin (approval decision: N°01-2019/MS/CNHU-HKM/CEI/CUMPR). All participants' parents/caregivers will provide their written informed consent. Data will be managed with confidentiality. TRIAL REGISTRATION NUMBER PACTR201911894444879.
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Affiliation(s)
- Emmanuel Segnon Sogbossi
- Institute of Neuroscience, Université catholique de Louvain, Bruxelles, Belgium
- School of Physiotherapy, Université d'Abomey-Calavi, Faculté des Sciences de la Santé, Cotonou, Benin
| | - Solange Sotindjo Adon
- Service de Kinésithérapie et d'Appareillage Orthopédique, Centre Hospitalier Universitaire Départemental de Borgou/Alibori, Parakou, Benin
| | | | - Solange Dossou
- Centre Medico-social Sainte Elisabeth de la Trinité, Calavi, Benin
| | - Hyppolite Dakè
- Clinique universitaire de médecine physique et réadaptation, Centre National Hospitalier Universitaire Hubert Koutoukou Maga de Cotonou, Cotonou, Benin
| | | | - Rodrigo Araneda
- Institute of Neuroscience, Université catholique de Louvain, Bruxelles, Belgium
| | - Geoffroy Saussez
- Physical and Occupational Therapy, Haute Ecole Louvain en Hainaut - Montignies-sur-Sambre, Montignies-sur-Sambre, Belgium
| | - Julie Paradis
- Département Ergothérapie, HE Vinci, Italia, Vinci, Italy
| | - Toussaint G Kpadonou
- School of Physiotherapy, Université d'Abomey-Calavi, Faculté des Sciences de la Santé, Cotonou, Benin
- Clinique universitaire de médecine physique et réadaptation, Centre National Hospitalier Universitaire Hubert Koutoukou Maga de Cotonou, Cotonou, Benin
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Bruxelles, Belgium
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