Excessive premature mortality among children with cerebral palsy in rural Uganda: a longitudinal, population-based study
SND-ID: 2020-178-1. Version: 1. DOI: https://doi.org/10.5878/xr97-2a37
Associated documentation
Citation
Creator/Principal investigator(s)
Hans Forssberg
- Karolinska Institutet, Department for Women's and Children's Health
Angelina Kakooza-Mwesige
- Makerere University, Department of Pediatrics and Child Health
Research principal
Karolinska Institutet
- Department for Women's and Children's Health
Description
Background
Studies from high-income countries reported reduced life expectancy in children with cerebral palsy (CP), while no population-based study has evaluated mortality of children with CP in sub-Saharan Africa. This study aimed to estimate the mortality rate (MR) of children with CP in a rural region of Uganda and identify risk factors and causes of death (CODs).
Methods and Findings
This population-based, longitudinal cohort study was based on data from Iganga-Mayuge Health and Demographic Surveillance System in eastern Uganda. We identified 97 children (aged 2–17 years) with CP in 2015, whom we followed to 2019. They were compared with an age-matched cohort from the general population (n=41 319). MRs, MR ratios (MRRs), hazard ratios (HRs), and immediate CODs were determined.
MR was 3952 per 100 000 person years (95% CI 2212–6519) in children with CP and 137 per 100 000 person years (95% CI 117–159) in the general population. Standardized MRR was 25·3 in the CP cohort, compared with the general population. In children with CP, risk of death was higher in those with severe gross motor im
Studies from high-income countries reported reduced life expectancy in children with cerebral palsy (CP), while no population-based study has evaluated mortality of children with CP in sub-Saharan Africa. This study aimed to estimate the mortality rate (MR) of children with CP in a rural region of Uganda and identify risk factors and causes of death (CODs).
Methods and Findings
This population-based, longitudinal cohort study was based on data from Iganga-Mayuge Health and Demographic Surveillance System in eastern Uganda. We identified 97 children (aged 2–17 years) with CP in 2015, whom we followed to 2019. They were compared with an age-matched cohort from the general population (n=41 319). MRs, MR ratios (MRRs), hazard ratios (HRs), and immediate CODs were determined.
MR was 3952 per 100 000 person years (95% CI 2212–6519) in children with CP and 137 per 100 000 person years (95% CI 117–159) in the general population. Standardized MRR was 25·3 in the CP cohort, compared with the general population. In children with CP, risk of death was higher in those with severe gross motor impairments than in those with milder impairments (HR 6·8; p=0·007) and in those with severe malnutrition than in those less malnourished (HR=3·7; p=0·052). MR was higher in females in the CP cohort, with a higher MRR in females (53·0; 95% CI 26·4–106·3) than in males (16·3; 95% CI 7·2–37·2). Age had no significant effect on MR in the CP cohort, but MRR was higher at 10–18 years (39·6; 95% CI 14·2–110·0) than at 2–6 years (21·0; 95% CI 10·2–43·2). Anaemia, malaria, and other infections were the most common CODs in the CP cohort.
Conclusions
Risk of premature death was excessively high in children with CP in rural sub-Saharan Africa, especially in those with severe motor impairments or malnutrition. While global childhood mortality has significantly decreased during recent decades, this observed excessive mortality is a hidden humanitarian demand that needs to be addressed.
The dataset contains of the following files:
- CP_cohort–Children_and_youth_at_the_IM-HDSS.csv
- CoD–General_population_of_children_and_youth_IM-HDSS.csv
- Variable_list.pdf
Details about the variables in the tables can be found in the variable list. Show less..
Data contains personal data
Yes
Code key exists
Yes
Language
Unit of analysis
Population
Children and youth with cerebral palsy
Study design
Observational study
Description of study design
Longitudinal cohort study
Sampling procedure
Time period(s) investigated
2015-03-01 – 2019-12-15
Variables
21
Number of individuals/objects
97
Response rate/participation rate
100%
Data format / data structure
Geographic spread
Geographic location: Uganda, Africa, Sub-Saharan Africa
Geographic description: Iganga, Uganda
Lowest geographic unit
Municipality
Highest geographic unit
Region
Responsible department/unit
Department for Women's and Children's Health
Contributor(s)
Lukia Namaganda
- Makerere University, School of Public Health
Ethics Review
Other - Ref. HS 2608 - Uganda National Council for Science and Technology
Research area
Medical and health sciences (Standard för svensk indelning av forskningsämnen 2011)
Clinical medicine (Standard för svensk indelning av forskningsämnen 2011)
Pediatrics (Standard för svensk indelning av forskningsämnen 2011)
Health sciences (Standard för svensk indelning av forskningsämnen 2011)
Public health, global health, social medicine and epidemiology (Standard för svensk indelning av forskningsämnen 2011)
Namaganda LH, Almeida R, Kajungu D, Wabwire-Mangen F, Peterson S, Andrews C, Eliasson AC, Kakooza-Mwesige A, Forssberg H. Excessive premature mortality among children with cerebral palsy in rural Uganda: A longitudinal, population-based study. PLoS One. 2020 Dec 29;15(12):e0243948. doi: 10.1371/journal.pone.0243948.
DOI:
https://doi.org/10.1371/journal.pone.0243948
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