Hammersmith Infant Neurological Examination for early detection of cerebral palsy in Ethiopia: A feasibility and knowledge translation study
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Published on: June 21, 2024
Selamenesh Tsige Legas1, Atsede Teklehaimanot2, Behaylu Yibe2
1Division of Developmental Paediatrics, Department of Paediatrics, Children's Hospital, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Insights
The Hammersmith Infant Neurological Examination (HINE) was successfully implemented in Ethiopia, enabling early detection of cerebral palsy (CP) in infants under 12 months. This facilitated timely referral to rehabilitation services for affected children.
Area of Science:
- Global Health
- Pediatric Neurology
- Implementation Science
Background:
- Cerebral palsy (CP) diagnosis and management in low-resource settings present significant challenges.
- The Hammersmith Infant Neurological Examination (HINE) is a valuable tool for assessing neurodevelopment in infants.
- Effective implementation strategies are crucial for adapting evidence-based tools to diverse healthcare contexts.
Purpose of the Study:
- To implement the HINE in Ethiopia, a low-resource setting, utilizing the Knowledge-to-Action Framework.
- To determine the percentage of infants identified with CP or a high probability of CP.
- To evaluate the age of CP detection and referral to rehabilitation services.
Main Methods:
- The Knowledge-to-Action Framework guided the implementation strategy.
- Paediatric staff received HINE training and administered the examination in clinics.
- Infants were classified based on HINE global scores into categories indicating normal development, developmental monitoring, or high probability of CP.
Main Results:
- Out of 98 infants assessed, 36% scored below the CP cut-off, indicating a high probability of CP.
- The mean age for detection of CP or high probability of CP was 10.6 months.
- All infants identified with CP or high probability of CP were referred to rehabilitation services.
Conclusions:
- The HINE implementation in Ethiopia was feasible and effective for early CP detection in infants under 12 months.
- This initiative enabled timely referral to rehabilitation, potentially improving outcomes for children with CP.
- The study highlights the successful adaptation of a neurodevelopmental assessment tool in a low-resource environment.
Aim:
To implement the Hammersmith Infant Neurological Examination (HINE) in the low-resource setting of Ethiopia using the Knowledge-to-Action Framework, report on the percentage of infants classified as having cerebral palsy (CP) or a high probability of CP, and evaluate age at CP detection and referral.
Method:
Implementation strategies were identified using the Knowledge-to-Action Framework. Paediatric staff and residents received HINE training and administered it in selected clinics. Based on the HINE global score, infants were classified into (1) above the 10th centile score (accepted score), (2) between the 10th centile and a high probability of CP cut-off score, and (3) below the high probability of CP cut-off score. Age at CP detection and referral were assessed.
Results:
Ninety-eight infants with CP risk factors were classified on clinical reasoning and the HINE global score; 48 (49%) scored above the HINE 10th centile score, 15 (15%) fell into the 'developmental monitoring and coaching' category, and 35 (36%) scored below the high probability of the CP cut-off score. The mean age of children in the third category who received a diagnosis of CP or high probability of CP was 10.6 months (SD = 6.6, range = 3-23 months). All were referred to rehabilitation centres at the time of diagnosis.
Interpretation:
Implementing the HINE in Ethiopia enabled detection of CP or high probability of CP in children aged under 12 months and timely referral to rehabilitation services.
