Epidemiology of cerebral palsy in Malawi.

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.