Cerebral palsy in Nepal: a descriptive study of 136 disabled children presenting to a cerebral palsy centre in Kathmandu

Abstract

There is little epidemiological data on the nature and causes of cerebral palsy (CP) in developing countries. This study reports 136 consecutive children presenting to a Cerebral Palsy centre in Kathmandu, Nepal. 108 had clinical evidence of nonprogressive disorders of movement or posture due to a defect of the developing brain (i.e. cerebral palsy) of which most (76%) were spastic in type. 90 of these children (82%) were additionally disabled by associated impairments of cognition, hearing or vision. There was a strong male bias in this series (male:female 74%:26%) reflecting in part the lower priority accorded to the girl child. Birth asphyxia of a severity sufficient to cause cerebral palsy always presents in the neonatal period with neonatal encephalopathy (NE). Of the 97 cases for which full historical details were available there was evidence of NE in 27 (28%). In only 19 cases (20%) was there good evidence of obstetric complications and birth asphyxia is the cause of the NE. The proportion of CP resulting from birth asphyxia in this series is similar to that found in industrialised countries. Even with improving maternity service provision in developing countries CP rates are unlikely to change dramatically. Provision of child disability services will remain a continuing priority for the foreseeable future.