Assessment of preventable causes and predictors of independent ambuilation for children with cerebral palsy in Rwanda

Abstract

Background: Cerebral palsy (CP) is commonly source of motor dysfunction in paediatric population worldwide. Its burden to families and country is highly remarkable. Although in developed countries there is increasing information on clinical features of paediatric patients with cerebral palsy, in developing Countries experience significant paucity of clinical data on cerebral palsy. This study has objectives to determine preventable causes and predictors of independent ambulation of CP in our country. Methodology: A retrospective study was carried out in specialized hospital, Centre de ChirurgieOrthopedique (CCO) de Rilima since January 2016 to June 2020. We selected all children diagnosed clinically with cerebral palsy; age limit was 2 years to 18 years. Univariate analysis was performed to determine preventable causes of cerebral palsy and their modes of treatment then we used Chi square and logistic regression to establish the risk factors of independent ambulation in CP patients. Results: Three hundred and ninety-five (395) patients were enrolled in our study of which 53% (n=213) were male and 46% (n=182) were female with median age of 4years. The most common motor type is spastic 71%. Regarding topographic distribution, quadriplegia was the most common 65.6%. The most common motor severity was GMFCS V 48.1%. Significant risk factors found are fetal distress 27.6%, low birth weight 20.5% and congenital malformation 13.67%. A couple of factors were found to be significantly predicting independent ambulation such as ability to sit before 2years (p=0.004), motor severity and topographic distribution (p<0.001), absence of both intellectual disability, visual impairment and epilepsy (p<0.001). The commonest cerebral palsy treatment mode was gait training (55.7%) while tenotomy (4.5%) and tendon lengthening (8.6%) were not frequently used. Conclusion: The most of patients (91.1%) with CP found in this study are term babies same as what found by other authors in LMICs and many risk factors identified are preventable, so establishment of preventive and management strategies in developing countries are highly needed.