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Enhancing the Development and Growth of Infant Cerebral Palsy Rats Using Selective Spinal Manipulations
Published on: February 2, 2024
Excessive premature mortality among children with cerebral palsy in rural Uganda: A longitudinal, population-based
Lukia H Namaganda1, Rita Almeida2, Dan Kajungu3
1Makerere University School of Public Health, Makerere University, Kampala, Uganda.
Insights
Children with cerebral palsy (CP) in rural Uganda face a significantly higher mortality rate, with severe impairments and malnutrition increasing risk. This highlights a hidden humanitarian crisis in sub-Saharan Africa requiring urgent attention.
Area of Science:
- Global Health
- Pediatrics
- Neurology
Background:
- Cerebral palsy (CP) is associated with reduced life expectancy in high-income countries.
- No prior population-based studies have assessed mortality in children with CP in sub-Saharan Africa.
- This study addresses the critical knowledge gap regarding CP mortality in this region.
Purpose of the Study:
- To estimate the mortality rate (MR) of children with CP in rural Uganda.
- To identify risk factors associated with mortality in this population.
- To determine the primary causes of death (CODs) in children with CP.
Main Methods:
- A population-based, longitudinal cohort study was conducted using data from the Iganga-Mayuge Health and Demographic Surveillance System in eastern Uganda.
- 97 children (aged 2-17 years) with CP identified in 2015 were followed until 2019.
- Comparison was made with an age-matched general population cohort (n = 41,319).
Main Results:
- The MR in children with CP was 3952 per 100,000 person-years, significantly higher than the general population (137 per 100,000 person-years), yielding a standardized MR ratio of 25.3.
- Higher mortality risk was observed in children with severe gross motor impairments (HR 6.8) and severe malnutrition (HR 3.7).
- Mortality was higher in females, and common causes of death included anemia, malaria, and other infections.
Conclusions:
- Children with CP in rural sub-Saharan Africa face an excessively high risk of premature death.
- Severe motor impairments and malnutrition are significant risk factors for mortality.
- The high, unaddressed mortality among children with CP represents a hidden humanitarian crisis requiring urgent intervention.
Background:
Studies from high-income countries reported reduced life expectancy in children with cerebral palsy (CP), while no population-based study has evaluated mortality of children with CP in sub-Saharan Africa. This study aimed to estimate the mortality rate (MR) of children with CP in a rural region of Uganda and identify risk factors and causes of death (CODs).
Methods And Findings:
This population-based, longitudinal cohort study was based on data from Iganga-Mayuge Health and Demographic Surveillance System in eastern Uganda. We identified 97 children (aged 2-17 years) with CP in 2015, whom we followed to 2019. They were compared with an age-matched cohort from the general population (n = 41 319). MRs, MR ratios (MRRs), hazard ratios (HRs), and immediate CODs were determined. MR was 3952 per 100 000 person years (95% CI 2212-6519) in children with CP and 137 per 100 000 person years (95% CI 117-159) in the general population. Standardized MRR was 25·3 in the CP cohort, compared with the general population. In children with CP, risk of death was higher in those with severe gross motor impairments than in those with milder impairments (HR 6·8; p = 0·007) and in those with severe malnutrition than in those less malnourished (HR = 3·7; p = 0·052). MR was higher in females in the CP cohort, with a higher MRR in females (53·0; 95% CI 26·4-106·3) than in males (16·3; 95% CI 7·2-37·2). Age had no significant effect on MR in the CP cohort, but MRR was higher at 10-18 years (39·6; 95% CI 14·2-110·0) than at 2-6 years (21·0; 95% CI 10·2-43·2). Anaemia, malaria, and other infections were the most common CODs in the CP cohort.
Conclusions:
Risk of premature death was excessively high in children with CP in rural sub-Saharan Africa, especially in those with severe motor impairments or malnutrition. While global childhood mortality has significantly decreased during recent decades, this observed excessive mortality is a hidden humanitarian crisis that needs to be addressed.
