Pediatric Cerebral Palsy in Botswana: Etiology, Outcomes, and Comorbidities.
Cerebral palsy is the most common cause of motor dysfunction in children worldwide and is often accompanied by multiple comorbidities. Although cerebral palsy has been studied extensively in high-resource settings, there are few published studies on cerebral palsy etiology, outcomes and comorbidities in low-resource settings.



Children with cerebral palsy were prospectively enrolled from inpatient and outpatient settings at a referral center in Gaborone, Botswana, in a cross-sectional study conducted from 2013 to 2014. Cerebral palsy etiology, outcomes, and comorbidities were determined through caregiver interviews, review of medical records, and direct physical examination.



Sixty-eight children with cerebral palsy were enrolled. Subjects were 41% male, with a median age of 4 years (interquartile range = 2 to 7). The most common etiologies for cerebral palsy in our cohort were intrapartum hypoxic events (18%), postnatal infections (15%), prematurity (15%), focal ischemic strokes (10%), and prenatal infections (10%). Severe motor impairment was common, with the most severe category present in 41%. The predominant comorbidities were cognitive impairment (84%), epilepsy (77%), and visual impairment (46%).



Cerebral palsy in Botswana has different etiologies and is associated with poorer outcomes and higher prevalence of comorbidities than what has been reported in high-resource settings. Further studies are necessary to determine optimal preventative and treatment strategies in this population.
Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia; Department of Pediatrics, University of Botswana, Gaborone, Botswana. Electronic address: bearden@email.chop.edu.
David R
DR
Bearden
Department of Pediatrics, University of Botswana, Gaborone, Botswana.
Baphaleng
B
Monokwane
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Esha
E
Khurana
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
James
J
Baier
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Esther
E
Baranov
Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia; Department of Pediatrics, University of Botswana, Gaborone, Botswana; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Kate
K
Westmoreland
Department of Pediatrics, University of Botswana, Gaborone, Botswana.
Loeto
L
Mazhani
Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia; Department of Pediatrics, University of Botswana, Gaborone, Botswana; Division of Infectious Disease, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Andrew P
AP
Steenhoff
D001902:Botswana / Q000453:epidemiology; D002547:Cerebral Palsy / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012959:Socioeconomic Factors
Africa; International Child Health; cerebral palsy; neurologic disorders