Socio-clinical issues in cerebral palsy in Sagamu, Nigeria

Abstract

Background. Cerebral palsy (CP) is a common neurological disorder of childhood with significant implications.
Objective. To determine the socio-clinical characteristics of children with CP at a paediatric neurology clinic in Sagamu, Nigeria.
Methods. Hospital records of 92 children attending the clinic between 2000 and 2006 were reviewed. Demographic data were extracted and a validated socio-economic classification of parents was used.

Results. The majority of babies had been delivered by primary health workers and traditional birth attendants. The prevalence of CP at the paediatric neurology clinic was 50.3%. Most subjects were aged 1 - 3 years (77.2%), were malnourished (80.4%) and belonged to the lower socio-economic groups (70.6%). The clinical types of CP were spastic (80.4%), hypotonic (12.0%), extrapyramidal (4.3%) and mixed (3.3%). Quadriplegia was the commonest type of spastic CP (66.2%). Asphyxia (57.6%),
kernicterus (36.9%) and CNS infections (21.7%) were the leading identified causes. Co-morbidities such as seizures, microcephaly and speech and auditory deficits were present in 90.2% of the subjects. Seizures and microcephaly were commoner among CP cases associated with asphyxia than those associated with kernicterus (p=0.026 and p=0.005, respectively).
Limitations. The rarity of prenatal causes of CP in this study may reflect our inability to investigate high-risk pregnancies adequately, particularly for intra-uterine infections. This also emphasises the inability of retrospective studies to adequately identify risk factors.
Conclusion. Most patients with CP in this study were of low socio-economic status and had had perinatal problems. Improved perinatal care may reduce the burden of CP. Continuing training of health workers and traditional birth attendants is essential. It is hoped that this study will stimulate  well-designed prospective studies.