Mortality in children with cerebral palsy in rural Bangladesh: a population-based surveillance study
Israt Jahan1,2, Tasneem Karim1,2,3, Manik Chandra Das1,2
1CSF Global, Dhaka, Bangladesh.
Insights
In rural Bangladesh, children with cerebral palsy (CP) face a high mortality rate of 19.5 per 1000 person-years, often from preventable causes like meningitis and pneumonia. Motor severity and malnutrition increase vulnerability, highlighting the need for improved healthcare and nutrition.
Area of Science:
- Pediatric Neurology
- Global Health
- Public Health
Background:
- Cerebral palsy (CP) affects children globally, with significant disparities in outcomes in low-resource settings.
- Understanding mortality patterns in children with CP in rural Bangladesh is crucial for targeted interventions.
Purpose of the Study:
- To determine the mortality rate, immediate causes of death (CoD), and predictors of death in children with CP in rural Bangladesh.
Main Methods:
- A prospective, population-based surveillance study of 678 children with CP (aged 0-18 years) was conducted in rural Bangladesh from 2015-2017.
- Verbal autopsy was used to determine immediate CoD, and survival analyses were performed to identify predictors of death.
Main Results:
- The crude mortality rate was 19.5 per 1000 person-years.
- Leading causes of death were meningitis and pneumonia.
- Mortality was associated with age, Gross Motor Functional Classification System level, associated impairments, and severe underweight/stunting.
Conclusions:
- The majority of deaths in children with CP in rural Bangladesh were due to potentially preventable causes.
- Improved primary healthcare and nutritional support could extend life expectancy.
- Motor severity, comorbidities, and malnutrition are key risk factors for premature mortality in this population.
Aim:
To determine the mortality rate, immediate cause of death (CoD), and predictors of death in children with cerebral palsy (CP) in rural Bangladesh.
Method:
We carried out a prospective population-based surveillance study of children with CP aged 0 to 18 years registered with the Bangladesh Cerebral Palsy Register (BCPR) between January 2015 and December 2016, with subsequent follow-up until December 2017. Verbal autopsy was applied to assign immediate CoD. Crude mortality rates, hazard ratios of death, and survival probabilities were estimated.
Results:
Twenty-nine of the 678 children in the BCPR died during the study period, resulting in a crude mortality rate of 19.5 per 1000 person-years of observation (total follow-up duration 1486.8 person-years; mean 2y [standard deviation 6mo]). The leading immediate CoD was meningitis (n=9) and pneumonia (n=8). Survival probability and hazard ratio of death was significantly associated with age, Gross Motor Functional Classification System level, and associated impairments. Severe underweight and/or severe stunting was significantly overrepresented among deceased children than others in the cohort (p<0.05) when compared with the World Health Organization reference population.
Interpretation:
The majority of deaths were due to potentially preventable causes. The life expectancy of these children could have been extended by ensuring primary healthcare and nutritional supplementation.
What This Paper Adds:
Mortality rate in children with cerebral palsy (CP) in rural Bangladesh is 19.5 per 1000 person-years. The majority of children with CP died from potentially preventable and treatable conditions. Motor severity, associated impairments, and malnutrition make children with CP vulnerable to premature death in rural Bangladesh.
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