The child with cerebral palsy in a developing country - diagnosis and beyond

Cerebral palsy (CP) is one of the leading causes of childhood disability worldwide, with the greatest burden found in the developing countries of the world. A longitudinal study was carried out on all consecutive new cases of CP who presented at the neuro-developmental clinic in Nigeria over a period of 6 months to evaluate the continuum of care available to children with CP following diagnosis. At the end of 1-year post-enrolment into the study, all cases were evaluated for survival, on-going rehabilitative care, functional improvement and reasons for default. Eighty-two children were enrolled into the study. Mean age was 25.3 +/- (SD = 25.5) months and the leading causes of CP were birth asphyxia (39.0%), bilirubin encephalopathy (24.4%) and post infectious brain damage (18.3%). By the end of 1 year, 61 (74.4%) had defaulted from follow up, 11 (13.4%) had died and only 21 (25.6%) were still receiving rehabilitative care. The major reasons for default were financial constraints, no improvement in condition and the hospital being too far from place of residence. Presence of severe functional impairment and absence of epilepsy were associated with an increased risk of default from medical care. In conclusion, CP remains a major cause of neurodisability in Nigeria. There is a high default rate with majority of children lacking ready access to medical care and education. There is an urgent need for improvement in medical services in the country and social support for children with CP and their families.