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Survival of South African children with cerebral palsy
J C Brooks1, R D D Campbell, G A Whittaker
1Life Expectancy Project, California, USA. gregory@algorithm-ca.com.
Insights
Life expectancy for children with cerebral palsy (CP) in South Africa is lower than in high-income countries. This study provides crucial survival data for South African children with CP, impacting birth injury claim settlements.
Area of Science:
- Public Health
- Pediatrics
- Biostatistics
Background:
- South Africa faces rising birth injury claims, particularly for cerebral palsy (CP).
- Accurate survival data for children with CP in South Africa is lacking.
- Life expectancy for children with CP internationally varies by disability severity.
Purpose of the Study:
- To create survival curves for children with CP in South Africa based on gross motor skills.
- To compare these survival curves with international data.
- To inform birth injury claim settlements by providing empirical survival estimates.
Main Methods:
- Data collected on mortality and functional status for 339 children with CP.
- Gross Motor Function Classification System (GMFCS) used for motor skill classification.
- Kaplan-Meier method employed to estimate survival curves and mortality rates.
Main Results:
- No deaths observed in GMFCS levels I-IV; 20 deaths among 220 children in GMFCS V.
- Survival to age 10 was 85%, and to age 15 was 55% for GMFCS V children.
- Mortality rates for severe motor impairments in SA were higher than in California.
Conclusions:
- Children with CP in South Africa have a lower life expectancy compared to those with similar disabilities in high-income nations.
- The findings highlight disparities in outcomes for children with CP.
- This study provides essential data for legal and healthcare contexts in South Africa.
Background:
The South African (SA) public healthcare sector has experienced a surge in birth injury claims in recent years, particularly in respect of cerebral palsy (CP). The lump sum settlements in these matters are a function of the expected survival curve of the individual concerned. It is known from international studies that the life expectancy of children with CP is shorter than that of the general population, and depends on the pattern and severity of their disabilities. However, empirical estimates of survival for children with CP in SA are not available.
Objectives:
To construct survival curves according to the pattern of gross motor skills for CP children in SA and compare these with international studies.
Methods:
We collected data on mortality and functional status for 339 CP children on whose behalf claims for medical negligence had been instituted. Motor disabilities were classified according to the five-level Gross Motor Function Classification System (GMFCS). Children who were unable to walk unaided were further classified according to more basic motor skills, including the ability to lift their heads or chests in the prone position, rolling and sitting. Mortality rates were calculated and survival curves were estimated using the Kaplan-Meier method.
Results:
No deaths were observed among 119 children in GMFCS levels I - IV. Among the 220 children in GMFCS V, there were 20 observed deaths. The proportions surviving to ages 10 and 15 years were 85% (standard error (SE) 5%) and 55% (SE 11%), respectively. The former is comparable to what has been reported for children in California and Sweden, but the survival to age 15 is lower. Among 82 children who could not lift their heads in the prone position, there were 11 observed deaths for a mortality rate of 48.5 (95% confidence interval (CI) 24.2 - 86.9) deaths per 1 000 person-years. Among 72 children who could lift their heads but not their chests, there were 6 observed deaths for a mortality rate of 33.5 (95% CI 12.3 - 73.0) deaths per 1 000 person-years. These mortality rates are 22% and 15% higher than the corresponding figures documented for children with comparable abilities and disabilities in California.
Conclusions:
Life expectancy of children with CP in SA is lower than that of children with comparably severe disabilities in high-income countries.
