Epidemiology of cerebral palsy among children in the remote Gorkha district of Nepal: findings from the Nepal cerebral palsy register

Israt Jahan; Mahmudul Hassan Al Imam; Mohammad Muhit; Amir Banjara Chhetri; Nadia Badawi; Gulam Khandaker

doi:10.1080/09638288.2022.2118871

Epidemiology of cerebral palsy among children in the remote Gorkha district of Nepal: findings from the Nepal cerebral palsy register

Disabil Rehabil. 2023 Aug;45(17):2808-2817. doi: 10.1080/09638288.2022.2118871. Epub 2022 Sep 14.

Authors

Israt Jahan^{1

2

3}, Mahmudul Hassan Al Imam^{1

2

3

4}, Mohammad Muhit^{1

2}, Amir Banjara Chhetri⁵, Nadia Badawi^{6

7}, Gulam Khandaker^{3

4

8}

Affiliations

¹ CSF Global, Dhaka, Bangladesh.
² Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.
³ School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia.
⁴ Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia.
⁵ CSF Global-Nepal, Kathmandu, Nepal.
⁶ Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.
⁷ Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, The University of Sydney, Westmead, Australia.
⁸ Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.

PMID: 36102553
DOI: 10.1080/09638288.2022.2118871

Abstract

Purpose: To describe the epidemiology of cerebral palsy (CP) among children in Gorkha, Nepal.

Methods: We established the first population-based register of children with CP aged <18 y in Gorkha, Nepal (i.e., Nepal CP Register). Children with suspected CP underwent detailed neurodevelopmental assessment by a multidisciplinary assessment team. Socio-demographic, etiology, motor severity, rehabilitation, and educational status were documented.

Results: Between January and October 2018, 182 children with confirmed CP were registered (mean (standard deviation (SD)) age: 10 years 1 months (4 years 10 months), 37.4% females). The majority (88.3%) had CP acquired pre- or perinatally. Mean (SD) age of CP diagnosis was four years five months. Mothers who did not receive any formal schooling had 4.5, 3.1, and 6.3 times higher odds of having inadequate antenatal care, homebirth, and unskilled birth attendants, respectively, when adjusted for other factors. Most children had spastic CP (77.5%) and Gross Motor Function Classification System level III-V (54.9%). Overall, 45.8% had never received rehabilitation services, 58.0% of school-aged children were not attending schools. The median age of receiving rehabilitation services was three years zero months.

Conclusions: The delayed diagnosis and clinical severity indicate the overall poor health status of children with CP in Nepal which could be improved by ensuring early diagnosis and intervention. Implications for rehabilitationThe first population-based cerebral palsy register in Nepal suggests diagnosis of CP is considerably delayed among children.The high burden of severe motor impairment and poor communication skill with limited access to timely rehabilitation among children with CP in Nepal is concerning.Capacity development of community-based health workers and mothers of children with CP could help implementing community-based programs for prevention and early diagnosis of CP, and to promote early intervention for children with CP in remote Gorkha, Nepal.

Keywords: Cerebral palsy (CP); Nepal; children; disability; epidemiology; register; risk factor.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cerebral Palsy*
Child
Child, Preschool
Female
Humans
Male
Mothers
Nepal / epidemiology
Pregnancy
Registries
Risk Factors