Epidemiology of cerebral palsy in Bangladesh: a population‐based surveillance study

Abstract

Aim To examine the prevalence, clinical characteristics, and risk factors of cerebral palsy (CP) in children in Bangladesh. Method The Bangladesh CP Register is an ongoing population‐based surveillance database of children with CP from a geographically defined area in Bangladesh. Cases were defined based on Surveillance of CP in Europe and Australian CP Register criteria after clinical assessments and identification by the key informant's method. Results In total, 726 children with CP were identified between January 2015 and December 2016. Mean age was 7 years 7 months (standard deviation [SD] 4y 6mo; range: 4.8mo–18y; median 7y 1.2mo; 61.8% male, 38.2% female). Mean age at CP diagnosis was 5 years 2 months (SD 3.8). Observed prevalence was 3.4 per 1000 children (95% confidence interval [CI]: 3.2–3.7), resulting in an estimated 233 514 children (95% CI: 219 778–254 118) with CP in Bangladesh. The majority (79.6%) had spastic CP. Altogether, 79.6% of the children with CP had at least one associated impairment (speech 67.6%, intellectual 39.0%, epilepsy 23.7%, visual 10.2%, and hearing 10.2%). In total, 78.2% never received rehabilitation. Interpretation In Bangladesh, the burden of CP is high, and diagnosis is substantially delayed, limiting opportunities for early intervention. There is a lack of available services and the majority of the children had preventable risk factors. What this paper adds Prevalence of cerebral palsy (CP) is 3.4 per 1000 children in rural Bangladesh. There are an estimated 233 514 children with CP in Bangladesh. The majority have potentially preventable risk factors. Diagnosis of CP is delayed, limiting opportunities for early intervention. There is a lack of available services for children with CP in rural Bangladesh.

Mortality in children with cerebral palsy in rural Bangladesh: a population‐based surveillance study

“…As reported in our previous publication, diagnosis of CP is substantially delayed in children in the surveillance area; the mean age of diagnosis of CP in the BCPR cohort is 5 years 2 months . Hence, we speculate that the observed mortality rate in our study is an underestimate of the true burden as more children with CP in the surveillance area may have died before being diagnosed and registered in the BCPR …”

“…This study used data from the Bangladesh Cerebral Palsy Register (BCPR); the first population‐based CP register operating in a LMIC to date . The BCPR was established in 2015 in Shahjadpur, a northern sub‐district of the Rajshahi division in Bangladesh.…”

“…epilepsy, intellectual, visual, hearing, and speech) were also recorded as part of the BCPR registration based on detailed clinical history, available medical records, and clinical assessment by the medical assessment team. The working definitions of the associated impairments have been discussed previously …”

“…Globally, the estimated prevalence of CP is 2.1 per 1000 live births . However, the burden is higher in low‐ and middle‐income countries (LMICs) . A recent study from Bangladesh found that the prevalence of CP in rural communities could be as high as 3.4 (95% confidence interval [CI] 3.2–3.7) per 1000 live births …”

Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta‐analyses

“…Most studies included wide age ranges of participants, from infancy to late teenage years, without differentiating the age groups in the prevalence data. Furthermore, 10 studies provided limited background information on the degree of intellectual disabilities for included participants, but no stratified prevalence data were reported based on categories of intellectual functioning . Nineteen studies described GMFCS levels of their participants, of which all but four presented prevalence data by GMFCS level .…”