A review of the incidence and prevalence, types and aetiology of childhood cerebral palsy in resource-poor settings.

Background: With 80% of children with disabilities living in resource-poor settings, it is likely that there is a high prevalence of cerebral palsy (CP) and neurological impairment in these settings. The prevalence and incidence rates of disability, in particular of children with CP in resource-poor settings, are difficult to access and clarify.

Aim: To review the recent literature relating to the prevalence, incidence, type and aetiology of cerebral palsy in low-income settings.

Methods: A systematic search of studies published between 1990 and 2009 was performed using PubMed, Cinahl on Ovid, the Cochrane database, SCOPUS and information from international disability organisations. All studies with information about neurodisability, CP or disability in resource-poor settings were included. Titles and/or abstracts of all studies were reviewed and full texts of relevant studies were obtained.

Results: Disparities in methodology, age range, classification systems and populations made studies difficult to compare. Population-based studies provided rates of childhood disability of 31-160/1000. When using limited age ranges of 2-9 years with the Ten Question Questionnaire, rates were 82-160/1000 for children disability and 19-61/1000 for neurological impairment. Rates of CP in population-based settings in China and India gave figures of 2-2.8/1000 births, similar to western settings. Hospital-based studies of CP showed increased rates of spastic quadriplegia rather than diplegia or hemiplegia and possibly increased rates of meningitis, jaundice and asphyxia and lower rates of low birthweight and prematurity in CP populations. These studies were small and not case-controlled or population-based.

Conclusions: Rates of CP and neurological impairment are difficult to obtain in resource-poor settings. Methods of identifying children with CP and causal factors and the effects of disability need to be better classified in order to improve management and help shape preventive measures.