Predictors of Rehabilitation Service Utilisation among Children with Cerebral Palsy (CP) in Low- and Middle-Income Countries (LMIC): Findings from the Global LMIC CP Register.

Mahmudul Hassan Al Imam,Gulam Khandaker,Nadia Badawi,Mohammad Muhit,Denny Hardianto,Francis Laryea,Sarah Mcintyre,Hayley Smithers-Sheedy,Israt Jahan,Amir Banjara Chhetri

doi:10.3390/brainsci11070848

Abstract

Background: We assessed the rehabilitation status and predictors of rehabilitation service utilisation among children with cerebral palsy (CP) in selected low- and middle-income countries (LMICs). Methods: Data from the Global LMIC CP Register (GLM-CPR), a multi-country register of children with CP aged <18 years in selected countries, were used. Descriptive and inferential statistics (e.g., adjusted odds ratios) were reported. Results: Between January 2015 and December 2019, 3441 children were registered from Bangladesh (n = 2852), Indonesia (n = 130), Nepal (n = 182), and Ghana (n = 277). The proportion of children who never received rehabilitation was 49.8% (n = 1411) in Bangladesh, 45.8% (n = 82) in Nepal, 66.2% (n = 86) in Indonesia, and 26.7% (n = 74) in Ghana. The mean (Standard Deviation) age of commencing rehabilitation services was relatively delayed in Nepal (3.9 (3.1) year). Lack of awareness was the most frequently reported reason for not receiving rehabilitation in all four countries. Common predictors of not receiving rehabilitation were older age at assessment (i.e., age of children at the time of the data collection), low parental education and family income, mild functional limitation, and associated impairments (i.e., hearing and/or intellectual impairments). Additionally, gender of the children significantly influenced rehabilitation service utilisation in Bangladesh. Conclusions: Child’s age, functional limitation and associated impairments, and parental education and economic status influenced the rehabilitation utilisation among children with CP in LMICs. Policymakers and service providers could use these findings to increase access to rehabilitation and improve equity in rehabilitation service utilisation for better functional outcome of children with CP.

Highlights

Cerebral palsy (CP) is a group of disorders of movement and posture caused by non-progressive lesions in the developing brain [1]
This study utilised data collected as part of the Global low- and middle-income countries (LMICs) cerebral palsy (CP) Register (GLMCPR), an ongoing collaboration between CP registers based in LMICs
Our study revealed that nearly half of the children with CP registered into the Global LMIC CP Register (GLM-CPR) had never received rehabilitation services in their lifetime, and the age of commencing rehabilitation was substantially delayed in all four countries

Summary

Introduction

Cerebral palsy (CP) is a group of disorders of movement and posture caused by non-progressive lesions in the developing brain [1]. Children with CP and their families can benefit from working with a multidisciplinary team of rehabilitation professionals to tackle impairments, activity limitations, and participation restrictions [6]. This is problematic in LMICs, where there are severe shortages of rehabilitation professionals and services [7]. Young age (i.e., early diagnosis), parental education, and financial status have been found positively associated with rehabilitation service utilisation among children with CP in both HICs [13,14,15,16] and LMICs [9,10]

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