Outpatient Management of Clinical Comorbidities in Children With Cerebral Palsy in Low- and Middle-Income Countries

Abstract

Background

Cerebral palsy (CP) is the most common physical disability of childhood. Its prevalence in low-and middle-income countries (LMICs) is over 3/1000 live births, about double the 1.6/1000 in high income countries (HICs). Multimorbidity is highly prevalent in CP. In LMICs, there are higher rates of prevalence, severity, comorbidities and mortality in children with CP. The evidence base for the recommendations in CP emanates overwhelmingly from studies conducted in HICs. Research conducted in LMICs settings, involving local clinicians, considering local context and investigating local solutions are urgently needed.

Methods

This scoping review aimed to identify and synthesise current evidence on management of clinical comorbidities in children with CP in LMICs. The Joanna Briggs Institute guidelines were followed for the data extraction and analysis phases. The following questions guided the scoping review: What are the main clinical comorbidities in children with CP? What are the gold standards for diagnosis and treatment of these comorbidities? What options do we have to diagnose and treat these comorbidities in LMICs when gold standards are not available?

Results

A total of 22 188 citations were identified by our search strategy, with 21 380 remaining after the removal of 808 duplicates. After screening titles and abstracts, 1918 citations progressed to full text review. A total of 194 articles met the eligibility criteria and were included in the review. The guiding questions of the review were answered for the following morbidities: respiratory impairments, dysphagia and aspiration, gastroesophageal reflux disease, drooling, obstructive sleep apnea syndrome, malnutrition, constipation, epilepsy, sleep disorders, spasticity, dystonia, pain, hip disorders, scoliosis and osteoporosis.

Conclusion

This article highlights the need for interventions adapted to the realities of LMICs. Empowering paediatricians and healthcare professionals in LMICs is crucial for early diagnosis and proactive interventions. Specific guidelines for LMICs can better guide professionals in managing these complex conditions.