R. Isbell

Background: A significant disparity exists in the care of children with cerebral palsy (CP) between low-middle-income countries and high-income countries. Though data is limited, the prevalence of CP in low-middle-income countries doubles that of high-income countries, and 98% of affected children under five live in low-middle-income countries¹. This review aims to summarize differences in etiology, diagnosis, and treatment of children with CP.

Methods: PubMed searches included the terms “cerebral palsy Africa”, “cerebral palsy etiology”, and “low-resource cerebral palsy” published 2014-2024.

Results: Compared to the United States, Uganda reports a 15% higher rate of acquired CP, indicating a higher incidence of injuries more than 28 days after birth leading to CP². In Uganda, the primary causes of CP are birth complications, neonatal infections, and maternal HIV, none of which are primary causes in the US and all of which are preventable with disease control and improved infrastructure². Most countries in Africa have not established a screening system for CP, and there is low access to specialists and medication for children if they are diagnosed^3,4. Additionally, it is difficult to transport children with mobility issues long distances to appointments. While wheelchairs offer some assistance, they pose other challenges in navigating unpaved roads, adapting to the growth of the child, and fitting in small homes⁵. Diapers and other single-use-materials are often reused due to high cost, leading to hygiene concerns for children with CP⁵. Malnutrition is another serious issue for children with CP due to their eating restrictions in conjunction with other family financial burdens and pre-existing food insecurity, increasing risk of infection⁵. Lastly, negative stigma towards functionally disabled people poses a higher burden of care for parents caring for their child with CP and other children. Some programs exist to help ease this burden through community education for caregivers and construction of assistive devices in low-resource settings^6,7.

Conclusion: Improving the quality of life for children with CP in Africa requires a multifaceted approach. Prevention strategies, including disease control and improved infrastructure, are crucial. Advancements in diagnosis and treatment, such as standardized screening processes and increased access to telehealth or travelling specialists, are imperative. Socioeconomically-conscious innovations, including nutrition interventions, adaptable wheelchairs, and cost-effective alternatives to single-use materials, must be developed. Additionally, community education initiatives to foster social support and reduce stigma are essential. The high incidence of CP in Africa is preventable, and steps should be taken to reduce risk and improve care for children with CP.

Works Cited

1. McIntyre S, Goldsmith S, Webb A, et al. Global prevalence of cerebral palsy: A systematic analysis. Developmental Medicine & Child Neurology. 2022;64(12). doi:https://doi.org/10.1111/dmcn.15346
2. Kakooza-Mwesige A, Andrews C, Peterson S, Wabwire Mangen F, Eliasson AC, Forssberg H. Prevalence of cerebral palsy in Uganda: a population-based study. The Lancet Global Health. 2017;5(12):e1275-e1282. doi:https://doi.org/10.1016/s2214-109x(17)30374-1
3. Burton A. Fighting cerebral palsy in Africa. The Lancet Neurology. 2015;14(9):876-877. doi:https://doi.org/10.1016/s1474-4422(15)00189-1
4. Donald KA, Samia P, Kakooza-Mwesige A, Bearden D. Pediatric Cerebral Palsy in Africa: A Systematic Review. Seminars in Pediatric Neurology. 2014;21(1):30-35. doi:https://doi.org/10.1016/j.spen.2014.01.001
5. Seroke S, Mkhize SW. Psychosocial experiences of mothers caring for children with cerebral palsy in the eThekwini district. Health SA. 2023;28:2072. Published 2023 May 22. doi:10.4102/hsag.v28i0.2072
6. Onward M. Malamulele Onwards. www.cpchildren.org. Accessed March 22, 2024. https://www.cpchildren.org/
7. Cerebral Palsy Africa – The new foundation based in the Netherlands. https://www.cerebralpalsyafrica.eu/