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Clinical features and aetiology of cerebral palsy in children from Cross River State, Nigeria
  1. Roseline Duke1,2,
  2. Chimaeze Torty3,
  3. Kennedy Nwachukwu2,
  4. Soter Ameh4,
  5. Min Kim1,
  6. Nnena Eneli5,
  7. Ani Onyedikachi5,
  8. Ada Aghaji1,
  9. Kathryn Burton6,
  10. Leigh Dyet7,
  11. Richard Bowman1
  1. 1International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  2. 2Department of Ophthalmology, Calabar Children’s Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
  3. 3Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
  4. 4Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
  5. 5Department of Physiotherapy, University of Calabar Teaching Hospital, Calabar, Nigeria
  6. 6Cambridge Community Services, Cambridge, UK
  7. 7Neonatology, University College London, London, UK
  1. Correspondence to Dr Roseline Duke, Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River State 540001, Nigeria; Roseline.Duke{at}


Objective There are few studies on cerebral palsy (CP) in African children and our study aimed to describe the aetiology, characteristics and severity of CP in children from Nigeria.

Design A population-based study using key informant methodology (KIM) was conducted as part of a clinical research trial. Children aged 4–15 years were clinically assessed for CP.

Results The estimated prevalence of CP using KIM was 2.3/1000 children (95% CI 2.0 to 2.5/1000). 388 children were diagnosed with CP, with Gross Motor Function Classification System level 1 in 70 (18.1%), II in 156 (40.2%), III in 54 (13.9%), IV in 54 (13.9%), V in 54 (13.9%). 300/388 (77.3%) had Manual Ability Classification Scale of level 1–3 and 88 (22.7%) of level 4–5. CP types were spastic in 271 (70%), with 60% of these bilateral and 40% unilateral, ataxic 38 (9.8%), dystonic 18 (4.6%), choreoathetoid 29 (7.5%) and unclassifiable 32 (8.3%). Postneonatal risk factors for CP were seen in 140 (36.1%) children including malaria with seizures 101/140 (72.1%), malaria with coma 21/140 (15.0%), meningitis 12/140 (8.6%), tuberculosis 2/140 (1.4%), sickle cell disease 3/140 (2.2%), HIV 1/221 (0.7%). Prenatal/perinatal risk factors were seen in 248 (63.9%%), birth asphyxia 118 (47.6%) and clinical congenital rubella syndrome 8 (3.3%) and hyperbilirubinaemia 59 (23.8%) were identified as preventable risk factors for CP.

Conclusion The profile of CP in this population is similar to that found in other low-income and middle-income countries (LMIC). Some risk factors identified were preventable. Prevention and management strategies for CP designed for LMIC are needed.

  • cerebral palsy
  • profile
  • children
  • aetiology
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  • Contributors RD: conceived the idea and design of the study, primary author (drafted and edited the paper), data collection. CT: data collection. MK: data analysis and interpreter. SA: provided access to crucial research components and data interpretation. NE: data collection. AO: data collection. AA: data collection. KB: conceived the design of the study, provided revisions to grammar/scientific content of manuscript. RB: principal investigator (advisor, head of research) conceived the idea and design of the study, provided revisions to grammar/scientific content of manuscript. All authors contributed equally to this research work. All authors provided substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The Queen Elizabeth Diamond Jubilee Trust/Common Wealth Eye Health Consortium funded the research grant number (LSHTM ITCRZ6814).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the London School of Hygiene and Topical Medicine and the Cross River State, health research and ethics committee with number CRS/MH/HREC/015/Vol.211.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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