Pediatric Cerebral Palsy in Botswana: Etiology, Outcomes, and Comorbidities

Abstract

Background: Cerebral palsy is the most common cause of motor dysfunction in children worldwide and is often accompanied by multiple comorbidities. Although cerebral palsy has been studied extensively in high-resource settings, there are few published studies on cerebral palsy etiology, outcomes and comorbidities in low-resource settings.

Methods: Children with cerebral palsy were prospectively enrolled from inpatient and outpatient settings at a referral center in Gaborone, Botswana, in a cross-sectional study conducted from 2013 to 2014. Cerebral palsy etiology, outcomes, and comorbidities were determined through caregiver interviews, review of medical records, and direct physical examination.

Results: Sixty-eight children with cerebral palsy were enrolled. Subjects were 41% male, with a median age of 4 years (interquartile range = 2 to 7). The most common etiologies for cerebral palsy in our cohort were intrapartum hypoxic events (18%), postnatal infections (15%), prematurity (15%), focal ischemic strokes (10%), and prenatal infections (10%). Severe motor impairment was common, with the most severe category present in 41%. The predominant comorbidities were cognitive impairment (84%), epilepsy (77%), and visual impairment (46%).

Conclusions: Cerebral palsy in Botswana has different etiologies and is associated with poorer outcomes and higher prevalence of comorbidities than what has been reported in high-resource settings. Further studies are necessary to determine optimal preventative and treatment strategies in this population.

Keywords: Africa; International Child Health; cerebral palsy; neurologic disorders.

Conflict of interest statement

Conflict of Interest: Dr. D.R.B. has served as an expert witness in legal cases involving cerebral palsy. The other authors have no conflicts of interest to disclose.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

FIGURE 1

Etiology of cerebral palsy in Botswana.

FIGURE 2

Cerebral Palsy Outcomes, by Etiology. There were no significant differences in outcomes between etiologies. Gross Motor Function was rated using the Gross Motor Function Classification System, a scale from 1 (least severe) to 5 (most severe). Cognitive Function was rated using the Pediatric Cerebral Performance Category Scale, a scale from 1 (normal) to 6 (brain death). Overall function was rated using the Pediatric Overall Performance Scale, a scale from 1 (normal) to 6 (brain death).