CHOP Global Health Center performs first rigorous study of CP outcomes in Africa

Cerebral palsy (CP) is the most common cause of childhood disability in the world, affecting between 1 and 2 infants per thousand. But the neurological condition tends to be understudied, especially in developing countries.

Based on an ongoing medical project in Botswana, pediatric researchers in the Global Health Center of The Children's Hospital of Philadelphia performed the first rigorous study of CP outcomes in Africa. In this and related studies, they summarized the scope and overall public health challenges of CP in this low-resource setting.

"For a variety of reasons, children with cerebral palsy tend to have poorer outcomes and a higher prevalence of comorbidities in Botswana compared to those in higher-resource countries," said study leader David Bearden, M.D., a pediatric neurologist at CHOP. "Our research represents a first step toward designing better prevention and treatment of CP in settings such as Botswana."

Loeto Mazhani, M.D., acting head of the Department of Pediatrics and Adolescent Health at the University of Botswana, agreed: "Our research represents a first step toward designing better prevention and treatment of CP in settings such as Botswana."

Bearden's team presented their findings recently at the American Academy of Neurology annual meeting last month in Washington, D.C. The Academy selected one of their studies for a session entitled "highlights in the field."

CP encompasses a variety of motor dysfunctions resulting from brain injury during the fetal period, infancy or early childhood. Patients with this lifelong condition often have poor muscle control and speech problems.

CHOP Global Health has an ongoing partnership in Botswana with the University of Pennsylvania and the Faculty of Medicine of the University of Botswana.

In their study cohort of 68 children with CP at a referral center in Gaborone, Botswana, Bearden and colleagues found the most common causes of the condition were prematurity, intrapartum hypoxic events (periods of low oxygen during labor or birth), and infections during infancy. Severe motor impairments were common, with the most severe category occurring in 41 percent of the patients. In U.S. and European studies, less than 20 percent of children with CP are in the most severe category.

The children with CP in this study had high rates of comorbidities—accompanying conditions. The most predominant was cognitive impairment, found in 83.8 percent of the children, followed by epilepsy (76.5 percent) and visual impairment (45.6 percent). These rates of epilepsy and cognitive impairment were more than double the rates reported in studies of CP in high-resource settings.

The researchers interviewed parents and caregivers about health beliefs, cultural values and other barriers to care for children with CP. In this resource-limited setting, parents expressed major concerns about lack of access to physical therapy, adaptive medical equipment and good nutrition.

For Bearden, who has participated in the Botswana/UPenn Partnership (BUP) since 2007, spending 2 to 3 months there every year, the current studies provide a foundation for further medical work, both in improving health education and devising better public health interventions. "We need to work closely with doctors in low-resource settings to develop low-cost interventions for children with cerebral palsy," he said. "For example, a community-based rehabilitation approach, teaching parents basic rehabilitation techniques, combined with regular check-ins by a community health worker in the family's home, is much more likely to succeed than an approach that depends on parents regularly bringing children to the hospital for therapies."