Functional development in children with cerebral palsy in Uganda: population-based longitudinal cohort study

Area of Science:

• Global child health
• Developmental pediatrics
• Rehabilitation sciences

Background:

• Cerebral palsy (CP) affects children globally, with developmental trajectories varying significantly based on socioeconomic factors and healthcare access.
• Understanding the functional development of children with CP in low- and middle-income countries (LMICs) is crucial for targeted interventions.

Purpose of the Study:

• To track the functional development of children with CP in rural Uganda.
• To compare their developmental progress against established trajectories in high-income countries (HIC).

Main Methods:

• A cohort of 81 children with CP in Uganda (aged 2-17 years) was assessed twice over four years.
• Evaluations used the Gross Motor Function Measure (GMFM-66) and the Pediatric Evaluation of Disability Inventory, Ugandan version (PEDI-UG).
• Reference scores were calculated to quantify deviation from HIC developmental trajectories; statistical analyses used the Wilcoxon signed-rank test.

Main Results:

• No significant changes in GMFM-66 or PEDI-UG mobility scores were observed between assessments.
• Significant improvements were noted in PEDI-UG social function and self-care skills (p<0.001).
• Reference scores became more negative for GMFM-66 and PEDI-UG mobility, indicating a widening gap compared to HIC peers, particularly in younger children and those with milder CP.

Conclusions:

• Children with CP in Uganda demonstrate slower motor skill development compared to children in HIC.
• Disparities in access to healthcare and rehabilitation services are likely key factors contributing to these slower developmental rates.
• Longitudinal data highlight the need for improved support systems for children with CP in LMICs.