Peer-reviewed article
Epidemiology of cerebral palsy in Malawi.
Katangwe-Chirwa TJ, Jahan I, Chitedze A, Mankhokwe T, Mughogho A et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study describes the epidemiology of cerebral palsy (CP) in rural Malawi by screening 911 children and registering 538 with CP. Bilateral spastic CP was the most common type, affecting mostly severe cases. Preventable perinatal causes like asphyxia and prolonged labour were identified as the main drivers of CP, suggesting that improvements in obstetric care could reduce CP incidence in Malawi.
Key points
- Observed cerebral palsy prevalence was 1.7 per 1000 children in rural Malawi
- Bilateral spastic CP was the most common type (46.3%), with 90.5% of children having severe motor impairment (GMFCS levels III-V)
- Perinatal asphyxia (40.5%) and cerebral malaria (12.3%) were the most common probable causes
- Despite 95.1% institutional delivery rate, prolonged or obstructed labour was the most reported labour complication (42.7%)
- Preventable causes are identified as the main drivers of CP in the population
Limitations
This cross-sectional study describes prevalence and risk factors but cannot establish causal relationships or compare outcomes across different interventions. The study is limited to a rural district and may not represent urban areas or the entire country.
Abstract
Aim To describe the epidemiology of cerebral palsy (CP) among children in rural areas of Malawi. Method This was a cross-sectional study on children with CP younger than 18 years from a rural district registered in the Malawi Cerebral Palsy Register. Community child protection workers, trained as CP key informants, identified children with CP using a population-based approach. A multidisciplinary medical team ascertained the CP diagnosis before registration. The children's baseline characteristics, CP risk factors, and comorbidities were documented. Descriptive and inferential analyses were completed. Results A total of 911 children were screened (December 2023-June 2024), and 538 were registered (median [interquartile range] age = 5 years 11 months [range: 2 years 7 months-11 years 10 months], 59.3% male). Bilateral spastic CP was the most common type (46.3%), with most children (90.5%) classified in Gross Motor Function Classification System levels III to V. The observed CP prevalence was 1.7 per 1000 children. Perinatal asphyxia (40.5%) and cerebral malaria (12.3%) were the most common 'probable causes'. Institutional deliveries were reported in 95.1% and prolonged or obstructed labour was the most reported labour complication (42.7%). Interpretation Our findings suggest that preventable causes are the main drivers of CP in Malawi. As such, factors in the health care system that contribute to these causes need to be evaluated.