Cerebral Palsy In Children: Subtypes, Motor Function And Associated Impairments; Addis Ababa, Ethiopia

Abstract

\n Background: Cerebral Palsy is one of the most common developmental disabilities among children seeking health care services in Ethiopia as well as in other low income countries. Yet, there is no national data relating to CP in Ethiopia. The overall aim of this study is to describe the clinical subtype, gross and fine motor function and presence and pattern of associated impairments and possible risk factors in children with Cerebral Palsy aged 2 to 18 years in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods: A hospital based descriptive cross-sectional study conducted among 207 children with Cerebral Palsy. Surveillance for Cerebral Palsy in Europe (SCPE) decision tree was used to include 174 illegible children then a pretested and pre-coded questionnaire administered to caregivers assessing socio demographic characteristics, associated impairments and possible risk factors; evaluated with proper neurologic examination to classify them; and severity of gross and fine motor impairment was assessed by evaluating level of function by grading according to GMFCS and MACS. The IBM SPSS V.21 was used for data analysis, and a significance level of 0.05 was chosen. Result: A total of 174 children who fulfilled the clinical criteria were included sampled consecutively. Mean age 5.6 (SD 3.6) year; Males 55.2%. Under five children were 50.6%. Majority of the children had Bilateral spastic CP (60.4%) followed by unilateral spastic CP 21.8%, Dyskinetic CP 10.4%, Ataxic CP 3.4% and 4% were unclassifiable. Of all the children 95.4% had speech and language impairments, 87.4% learning disabilities; 60.9% epilepsy, 24.7% Visual impairment and 8.6% has hearing impairment. On gross motor functions and manual ability assessment 75.3% of the children had level 4and 5 functional impairment. More than 80% of the mothers had complications during delivery (fetal distress followed by PROM). Half of the neonates did not cry immediately after birth; 77 neonates were resuscitated with BMV at birth and 111 immediately admitted to NICU. Subsequently during the first month of life; 50% had infection, 62% trouble feeding, 49.4 % difficulty breathing, 35% seizure and 13.8% had deep jaundice. Conclusion; the severe forms of CP prevail and most children are dependent on their parents for routine activities and cannot communicate well. Multidisciplinary care approach and focused functional rehabilitation services need to be instituted. Causal relationship cannot be drawn from this study but makes a strong argument for improving maternal and child health care.