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Pediatric Cerebral Palsy in Botswana: Etiology, Outcomes, and Comorbidities
David R Bearden1, Baphaleng Monokwane2, Esha Khurana3
1Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia; Department of Pediatrics, University of Botswana, Gaborone, Botswana.
Insights
Cerebral palsy in Botswana presents unique causes and more severe outcomes, with high rates of cognitive and visual impairments, and epilepsy. Further research is needed for tailored interventions in low-resource settings.
Area of Science:
- Pediatrics
- Neurology
- Global Health
Background:
- Cerebral palsy is a leading cause of childhood motor dysfunction globally.
- High-income countries have extensive cerebral palsy research, but low-income settings lack data on etiology, outcomes, and comorbidities.
Purpose of the Study:
- To investigate the etiology, outcomes, and comorbidities of cerebral palsy in children in Botswana, a low-resource setting.
- To compare findings with those from high-resource settings to inform future strategies.
Main Methods:
- Prospective enrollment of 68 children with cerebral palsy from Gaborone, Botswana (2013-2014).
- Data collection via caregiver interviews, medical record review, and physical examinations.
- Cross-sectional study design to assess etiology, motor function, and comorbidities.
Main Results:
- Common etiologies included intrapartum hypoxia (18%), postnatal infections (15%), and prematurity (15%).
- Severe motor impairment affected 41% of children.
- High comorbidity rates observed: cognitive impairment (84%), epilepsy (77%), and visual impairment (46%).
Conclusions:
- Cerebral palsy in Botswana differs from high-resource settings in etiology and is linked to worse outcomes and more frequent comorbidities.
- Further research is essential to develop effective preventative and treatment strategies for this population.
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.
