Grey matter brain injuries are common in Ugandan children with cerebral palsy suggesting a perinatal aetiology in full-term infants

Cerebral palsy in African paediatric populations: A scoping review

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.

Magnetic resonance imaging findings and the clinical characteristics of children with cerebral palsy at a public sector hospital in Gauteng Province, South Africa

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. 

Surviving and Thriving: Early Intervention for Neonatal Survivors With Developmental Disability in Uganda

Global attention on early child development, inclusive of those with disability, has the potential to translate into improved action for the millions of children with developmental disability living in low- and middle-income countries. Nurturing care is crucial for all children, arguably even more so for children with developmental disability. A high proportion of survivors of neonatal conditions such as prematurity and neonatal encephalopathy are affected by early child developmental disability. The first thousand days of life is a critical period for neuroplasticity and an important window of opportunity for interventions, which maximize developmental potential and other outcomes. Since 2010, our group has been examining predictors, outcomes, and experiences of neonatal encephalopathy in Uganda. The need for an early child intervention program to maximize participation and improve the quality of life for children and families became apparent. In response, the "ABAaNA early intervention program," (now re-branding as 'Baby Ubuntu') a group participatory early intervention program for young children with developmental disability and their families, was developed and piloted. Piloting has provided early evidence of feasibility, acceptability, and impact and a feasibility trial is underway. Future research aims to develop programmatic capacity across diverse settings and evaluate its impact at scale.

Perspectives on cerebral palsy in Africa: Exploring the literature through the lens of the International Classification of Functioning, Disability and Health

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.

Neighborhood Context and the Risk for Developmental Disabilities in Early Childhood

The effects of place on human health and development have been extensively studied in recent years in the adult and adolescent populations, but minimal research has addressed neighborhood effects in early childhood. This analysis of the National Survey of Children's Health 2011/2012 cross-sectional survey examined relationships between risk for developmental disability in early childhood and neighborhood characteristics in a nationally-representative sample of children ages 0-5 years. Parents reported on their child's development using a well-validated parent report screening tool for developmental problems (the Parent's Evaluation of Developmental Status tool), and neighborhood and family characteristics. Multinomial logistic regression analyses were conducted for each of three neighborhood variables: physical disorder, safety, and isolation. After controlling for parental and child characteristics, the three neighborhood variables were each significantly associated with moderate (but not severe) risk versus low to no risk for developmental disabilities. When all neighborhood characteristics were included simultaneously in the same model, only physical disorder remained statistically significant [OR 1.44 (95% CI 1.09-1.91)], though modestly attenuated. These results suggest that neighborhoods may have effects on early childhood development, after controlling for individual child, parental, and family characteristics.