Browsing by Author "Eliasson, Ann-Christin"

Now showing 1 - 6 of 6
  • Thumbnail Image
    Item
    Cerebral Palsy in Children in Kampala, Uganda: Clinical Subtypes, Motor Function and Co-Morbidities
    (BMC research notes, 2015) Kakooza-Mwesige, Angelina; Forssberg, Hans; Eliasson, Ann-Christin; Tumwine, James K
    Cerebral palsy (CP) is a common chronic childhood disorder worldwide. There is limited information about the CP panorama in sub-Saharan Africa. Our aim was to describe the clinical subtypes, gross and fine motor functions and presence of co-morbidities in a group of children with CP attending a tertiary hospital in Uganda.
  • Thumbnail Image
    Item
    Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy Advances in Diagnosis and Treatment
    (JAMA pediatrics, 2017) Novak, Iona; Morgan, Cathy; Adde, Lars; Blackman, James; Boyd, Roslyn N.; Hernandez, Janice Brunstrom; Cioni, Giovanni; Damian, Diane; Darrah, Johanna; Eliasson, Ann-Christin; Vries, Linda S. de; Einspieler, Christa; Fahey, Michael; Fehlings, Darcy; Ferriero, Donna M.; Fetters, Linda; Fiori, Simona; Forssberg, Hans; Gordon, Andrew M.; Greaves, Susan; Guzzetta, Andrea; Hadders-Algra, Mijna; Harbourne, Regina; Mwesige, Angelina Kakooza; Karlsson, Petra; Sundholm, Lena Krumlinde; Latal, Beatrice; Fowlds, Alison Loughran; Maitre, Nathalie; McIntyre, Sarah; Noritz, Garey; Pennington, Lindsay; Badawi, Nadia
    Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months’ corrected age.To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy–specific early intervention that should follow early diagnosis to optimize neuroplasticity and function.This study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument.atic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months’ corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months’ corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence. Early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.
  • Thumbnail Image
    Item
    Grey Matter Brain Injuries Are Common in Ugandan Children with Cerebral Palsy Suggesting a Perinatal Aetiology in Full-Term Infants
    (Acta Paediatrica, 2016) Mwesige, Angelina Kakooza; Byanyima, Rosemary K.; Tumwine, James K.; Eliasson, Ann-Christin; Forssberg, Hans; Flodmark, Olof
    There is limited literature on brain imaging studies of children with cerebral palsy (CP) in low and middle income countries. We investigated neuroimaging patterns of children with CP attending a tertiary referral centre in Uganda to determine how they differed from studies reported from high income countries and their relationship with prenatal and postnatal factors.Precontrast and postcontrast computed tomography (CT) scans of 78 CP children aged 2–12 years were conducted using a Philips MX 16-slice CT scanner. Two radiologists, blinded to the patient's clinical status, independently reviewed the scans.Abnormal CT scans were detected in 69% of the children sampled, with very few having primary white matter injuries (4%). Primary grey matter injuries (PGMI) (44%) and normal scans (31%) were most frequent. Children with a history of hospital admission following birth were three times more likely to have PGMI (odds ratio [OR] 2.8; 95% CI 1.1–7.1), suggesting a perinatal period with medical complications.Brain imaging patterns in this group of CP children differed markedly from imaging studies reported from high income countries, suggesting a perinatal aetiology in full-term infants and reduced survival in preterm infants.
  • Thumbnail Image
    Item
    Impairments, Functional Limitations, and Access to Services And Education for Children with Cerebral Palsy in Uganda: A Population-Based Study
    (Developmental Medicine & Child Neurology, 2020) Andrews, Carin; Mwesige, Angelina Kakooza; Almeida, Rita; Peterson, Stefan Swartling; Mangen, Fred Wabwire; Eliasson, Ann-Christin; Forssberg, Hans
    To describe the functional limitations and associated impairments of children with cerebral palsy (CP) in rural Uganda, and care-seeking behaviour and access to assistive devices and education.Ninety-seven children with CP (42 females, 55 males; age range 2–17y) were identified in a three-stage population-based screening with subsequent medical examinations and functional assessments. Information on school and access to care was collected using questionnaires. The data were compared with Swedish and Australian cohorts of children with CP. We used the χ2 test and linear regression models to analyse differences between groups.Younger children were more severely impaired than older children. Two-fifths of the children had severe impairments in communication, about half had intellectual disability, and one third had seizures. Of 37 non-walking children, three had wheelchairs and none had walkers. No children had assistive devices for hearing, seeing, or communication. Care-seeking was low relating to lack of knowledge, insufficient finances, and ‘lost hope'. One-third of the children attended school. Ugandan children exhibited lower developmental trajectories of mobility and self-care than a Swedish cohort.The needs for children with CP in rural Uganda are not met, illustrated by low care-seeking, low access to assistive devices, and low school attendance. A lack of rehabilitation and stimulation probably contribute to the poor development of mobility and self-care skills. There is a need to develop and enhance locally available and affordable interventions for children with CP in Uganda.
  • Thumbnail Image
    Item
    Important Report on Cerebral Palsy in Bangladesh: But Different Findings Compared with other Countries Need Further Exploration
    (Developmental Medicine & Child Neurology, 2019) Andrews, Carin; Mwesige, Angelina Kakooza; Eliasson, Ann-Christin; Forssberg, Hans
    Data from a population-based study of cerebral palsy (CP) in Bangladesh1 could help bridge the knowledge gap regarding developmental disabilities in low- and middle-income countries (LMICs). Prevalence data are particularly crucial for developing appropriate health, social, and education services, and the lack of rigorous population-based studies in LMICs has severely hampered both national and international programmes and likely contributed to widespread neglect of children with disabilities. Despite attempts to bridge this critical gap using sophisticated modelling as described in a recent Global Burden of Disease report regarding developmental disabilities, the ‘true’ global burden and worldwide distribution of children living with disabilities remain unknown due to poor primary data sources.2 It was therefore encouraging to read the population-based study by Khandaker et al.1 The authors used a key informant methodology in a two-stage process in which community-based key informants identified children with suspected CP and referred them to local day camps. There, a team comprised of a paediatrician, a physiotherapist, and a counsellor examined the children to confirm the CP diagnosis and assess them for functional limitations and associated impairments. We recently performed a population-based study of CP in Uganda using a three-stage screening process.3 As these are the first population-based studies of CP in LMICs using contemporary classification and assessment methods, it would be interesting to compare the results to identify commonalities that could be used to construct a global database and also explore differences to identify geographic variations and aid in developing customized preventions and interventions. Both studies reported a higher prevalence of CP (3.4/1000 [Bangladesh] and 3.1/1000 [Uganda after triangulation]) relative to high-income countries (HICs) (2/1000). In the Ugandan study, the prevalence changed with age, declining from 4/1000 at 2 to 7 years of age to approximately 2/1000 at 8 to 17 years of age, driven by fewer older severely affected children in Gross Motor Function Classification System (GMFCS) levels IV to V. Variation with age was not observed in the Bangladesh cohort, which included children as young as 4.8 months, introducing uncertainty regarding the prevalence data, as it is difficult to diagnose CP at this young age. However, the high death rate (20/1000) during the 2-year study supported a similar age-associated trend in the Bangladesh cohort; most of the deceased children were stunted and were in GMFCS levels III to V. Collectively, these studies support earlier speculation that CP is more common in LMICs, thus constituting a significant global burden. Both studies also suggest that mortality is high among severely affected children. The studies differed in terms of risk factors. Children born preterm (<37 gestational weeks) constituted 19% of the Bangladesh cohort, approximately half the reported percentage in HICs. This is in stark contrast to the Ugandan cohort, only 2% of which was born preterm. This discrepancy likely reflects the state of maternal and neonatal care, as very few infants born preterm survive in rural Uganda. Presumably, Bangladesh provides better services, enabling more children born preterm to survive. Another difference is the proportion of post-neonatal CP. Although the Bangladesh study reported 6% post-neonatal cases (like the 5% reported in HICs), the Ugandan study reported 25%. The probable cause for the high number of post-neonatal cases in Ugandan children was cerebral malaria, which is endemic in the region. In both countries, however, events that could harm the brain of term infants during the perinatal period were common. The Bangladesh and the Ugandan cohorts differed considerably regarding disease severity, as classified by the GMFCS and Manual Ability Classification System. To illustrate these differences, we compiled a table with data from both cohorts and included distributions from several population-based cohorts in HICs (Table SI, online supporting information). The Ugandan cohort was divided into two age groups due to a dramatic decline in the percentage of severely affected children (GMFCS levels IV–V) at older ages. There were fewer mildly affected children in the Bangladesh cohort compared to both Ugandan cohorts. This could be due in part to differences in aetiology; for example, the post-neonatal patients in Uganda exhibited less impairment (GMFCS levels I–II, 75%). Another possibility could be differences in methodology that precluded identifying all mild cases in the Bangladesh study. The three-stage screening in Uganda was performed at a Health and Demographic Surveillance System facility where each child is registered during annual surveys. This means that every household was screened by well-trained field workers during the first stage. Notably, in the Bangladesh study, key informants did not visit every child but instead used their knowledge, contacts, and community engagement to disseminate information and invite families with children suspected as having CP. In the key informant methodology study, key informants identified 6.2/1000 physically impaired children, whereas a simultaneous household survey identified 8/1000 children, suggesting that key informants missed 23% of physically impaired children.4 Whether those missed children had mild or severe impairments was not reported. Notably, the proportion of milder cases was considerably higher in HICs (Table SI) than in Bangladesh, like the Ugandan cohort, supporting the hypothesis that milder cases were missed in Bangladesh. The prevalence of associated impairments also differed between the two cohorts (Table SI). Seizures were less prevalent in the Bangladesh cohort than in either Ugandan age group, with similar differences in the prevalence of intellectual disabilities. Hearing and vision impairments were also less prevalent in the Bangladesh cohort. Considering the reported positive correlation between severe GMFCS classification and associated impairments in HICs,5 the finding of fewer associated impairments in the Bangladesh cohort is contradictory, given that this cohort had proportionally more severely affected children. Equally puzzling is the observation that Bangladesh children exhibited fewer associated impairments than children in HICs. To better understand the relationship between geographic characteristics and CP, the reasons for these differences must be elucidated. In conclusion, the Bangladesh population-based study of CP represents an important step toward obtaining useful information about the prevalence, functional limitations, associated impairments, and risk factors in LMICs. The study clearly shows that we cannot simply extrapolate data from HICs – or from one LMIC to another – but must also consider economic, cultural, and geographic differences. Comparisons with the Ugandan study also raise questions regarding how much of the observed differences are real or due to differences in screening and assessment methods.
  • Thumbnail Image
    Item
    Malnutrition is Common in Ugandan Children with Cerebral Palsy, Particularly those over the Age of Five and those who had Neonatal Complications
    (Acta Paediatrica, 2015) Mwesige, Angelina Kakooza; Tumwine, James K.; Eliasson, Ann-Christin; Namusoke, Hanifa K.; Forssberg, Hans
    Poor growth and malnutrition are frequently reported in children with cerebral palsy in developed countries, but there is limited information from developing countries. We investigated the nutritional status of Ugandan children with cerebral palsy and described the factors associated with poor nutrition.We examined 135 children from two to 12 years with cerebral palsy, who attended Uganda's national referral hospital. A child was considered underweight, wasted, stunted or thin if the standard deviation scores for their weight for age, weight for height, height for age and body mass index for age were ≤−2.0 using World Health Organization growth standards. Multivariable logistic regression identified the factors associated with nutritional indicators.Over half (52%) of the children were malnourished, with underweight (42%) being the most common category, followed by stunting (38%), thinness (21%) and wasting (18%). Factors that were independently associated with being malnourished were as follows: presence of cognitive impairment, with an adjusted odds ratio (aOR) of 4.5, being 5 years or older (aOR = 3.4) and feeding difficulties in the perinatal period (aOR = 3.2).Malnutrition was common in Ugandan children with cerebral palsy and more likely if they were 5 years or more or had experienced neonatal complications.