State of Cerebral Palsy in Africa
What was the context of the study?
Cerebral palsy is a prevalent disorder among children, affecting roughly 2 out of every 1,000 live births, globally. Knowledge of the disorder is not well known in low and middle come areas. Additionally, very little research has been conducted on the condition of cerebral palsy in Africa. Donald et al., arranged for a meeting of delegates to cultivate strategies and goals to manage cerebral palsy in children.
What were the methods of the study?
20 doctors from Africa, whom tended to be the only child neurologist in their country, 5 representatives from outside of Africa, and key leaders in child neurology in Africa came together for discussion in the diagnosis and management of CP in African children. Before the meeting, each delegate completed a questionnaire regarding to care of children with cerebral palsy in their country. These questionnaires provided a foundation for discussion, along with presentations by selected delegates.
What did the study find?
It was reported based on cases from hospitals, that the common etiologies associated with cerebral palsy in Africa were asphyxia, kernicterus, and neonatal infections. Pre-maturity and low birth weight were not as commonly reported as they are in the United States and Europe. It was also concluded that doctors reported treating a greater amount of severe cases of CP than the western cultures. This could be a result of lack of access to medical services - so only patients with severe cases of CP seek medical attention, while less severe cases do not. Additionally, the stigma around neurological disorders result in "hiding" patients with cerebral palsy and only seeking medical attention when the case is severe. Through discussion, it was found that caregivers reported the finances associated with CP served as a barrier for seeking medical treatment, especially if they were in poverty. There is also a lack of early intervention and early detection, and as a result of delayed treatment the severity of CP worsens. It was also inferred that limited availability of medical professionals with experience and knowledge on managing CP and lack of medications and diagnostic testing result in lower basic levels of care for children with CP. It was also brought to light that there is a lack of surgical procedures and access to regular physical therapy. Doctors reported that there is lack of access to medications for the comorbidities of epilepsy (seizures) and spasticity (constant contraction of muscles).
What were the conclusions of the study?
The meeting brought to the surface issues that providers face when treating children with CP. It is important to conduct more research to gain knowledge on the prevalence and etiology, specifically in Africa. There were a few objectives and goals that were established as a result of the meeting. Firstly, there needs to be standardized training for neurological disorders at the graduate and the undergraduate level. The curriculum needs to focus on prevention, recognition, and early intervention. Policy to expand availability of training to assistants, nurses, doctors, traditional healers, rehabilitation therapists also should be implemented. Promotion of training in Africa and the incentive to remain in Africa post training is necessary to increase resources available to communities. It also exemplified that there needs to be better implementation of logistics for delivery of medications to clinics.
Donald, K. A., Kakooza, A. M., Wammanda, R. D., Mallewa, M., Samia, P., Babakir, H., Bearden, D., Majnemer, A., Fehlings, D., Shevell, M., Chugani, H., Wilmshurst, J. (2015). Pediatric Cerebral Palsy in Africa: Where Are We?. Journal of Child Neurology, 30(8), 963-971. doi: 10.1177/0883073814549245