Cerebral palsy (CP) is a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain [1]. CP is the most common motor disability in childhood, affecting approximately 2 to 2.5 per 1000 live births globally [2]. The prevalence of CP varies significantly worldwide due to differences in diagnostic criteria, healthcare practices, and reporting standards.

CP encompasses a spectrum of clinical manifestations, including spasticity, dystonia, athetosis, and ataxia, often accompanied by disturbances of sensation, cognition, communication, perception, and behaviour, as well as by secondary musculoskeletal problems [3]. The etiology of CP is multifactorial, with risk factors spanning prenatal, perinatal, and postnatal periods. These include preterm birth, low birth weight, multiple pregnancies, and infections during pregnancy, and complications during delivery such as birth asphyxia [4].

Understanding the prevalence and causes of CP in different regions is crucial for developing effective prevention and management strategies. Despite advances in obstetric and neonatal care, the incidence of CP has not declined significantly in many parts of the world, highlighting the need for ongoing research and targeted interventions [5]. In low- and middle-income countries, the burden of CP may be exacerbated by limited access to quality prenatal and perinatal care, inadequate healthcare infrastructure, and socioeconomic factors [6].  

This retrospective study aimed to assess the prevalence of CP in the University of Medical Sciences Teaching Hospital (UNIMEDTH), Ondo, over a five-year period (2016-2021). By examining the demographic characteristics and potential causative factors of CP cases, this study seeks to provide insights that could inform clinical practices and public health policies aimed at reducing the incidence of CP. Specifically, the study evaluates the association between the prevalence of CP and factors such as gender, birth order, and delivery complications.

The importance of this research lies in its potential to identify trends and risk factors specific to the local population, which can guide healthcare providers and policymakers in designing targeted interventions. Previous studies have emphasized the need for improved perinatal care to mitigate the risk of CP, especially in resource-limited settings [7]. This study contributes to the body of knowledge by providing data from a Nigerian teaching hospital, offering a regional perspective that is often underrepresented in global CP research.

By understanding the epidemiology and etiology of CP in this context, we can better address the gaps in healthcare delivery and implement strategies that may ultimately reduce the burden of this debilitating condition.

A retrospective analysis was conducted on data from the case files of CP patients admitted to UNIMEDTH between 2016 and 2021. Ethical approval was obtained from the Ethics and Health Research Committee of the University of Medical Sciences Ondo (Approval No. UNIMEDTH/EHRC/2021/02). Permission to access the case files was granted by the record officers at UNIMEDTH.

A total number of 120 case files were retrieved and patient were diagnosed with CP.  Data extraction included patient demographics (age, gender, and birth order), delivery history (gestational age, type of delivery, and complications), and probable cause of CP (e.g., birth asphyxia, infections, traumatic birth injuries). Data were anonymized to ensure patient confidentiality.

Descriptive statistics, including means, standard deviations, frequencies, and percentages, were used to summarize the data. Chi-square tests were employed to determine associations between CP prevalence and factors such as gender and cause of CP. Statistical significance was set at p < 0.05. All analyses were performed using SPSS version 23.0.

Out of 120 CP cases retrieved, 88 (73%) were from UNIMEDTH Akure and 32 (27%) from UNIMEDTH Ondo Complex. The mean age of patients was 3.2 years (SD = 1.5), with the highest prevalence observed in patients aged one year (20.8%). 

Gender Distribution: Males constituted 52% (n=63) of the cases, while females constituted 48% (n=57).

Figure1: Pie chart showing the percentages of the prevalence of cerebral palsy per gender.

Family Position: First child in birth order represented 42% of the cases which indicated that there are higher incidence of CP in primiparity.

Figure 2: Pie chart showing the percentages of position of cerebral palsy patients in their family.

Yearly Distribution: The highest number of cases was recorded in 2018, accounting for 22% of the total cases.

Figure 3: Pie chart showing the percentages of the prevalence of cerebral palsy per year.

Keys

A – 2016; B – 2017; C – 2018; D – 2019; E – 2020; F – 2021.

Delivery History: It was observed that 33(27%) patients experienced asphyxia during birth and just 2(2%) cases had uneventful births. The delivery history of 44(37%) patients were not specified.

Figure 4: Pie chart showing the percentages of the delivery history of cerebral palsy patients recorded.

Cause of CP: Birth asphyxia was identified as the leading cause of CP, accounting for 59% of the cases, followed by infections (20%), traumatic birth injuries (12%), and other causes (9%).

Figure 5: Pie chart showing the percentage of causes of cerebral palsy in recorded cases.

Association between the Prevalence and Cause of Cerebral Palsy Using Chi-Square

There was no significant association found between the prevalence of CP according to yearly distribution and its causes (χ² = 13.941, p = 0.530) as seen in Table 1.

Table 1: Showing the association between the prevalence and cause of cerebral palsy using chi-square.

Key: N= 120, ?² – chi square value, p –level of significance, p<0.05.

Association between the Prevalence of Cerebral Palsy According to Yearly Distribution and Gender

There was no significant association between the prevalence of cerebral palsy and gender of cerebral palsy patients (?² = 6.852, p = 0.232) as seen in Table 2.

Table 2: Showing the association between the prevalence of cerebral palsy according to yearly distribution and gender using chi-square.

Key: N= 120, ?² – chi square value, p – level of significance, p<0.05.

This study revealed a male preponderance cases of cerebral palsy (CP). This finding was similar to studies in Africa [8-15]. This was dissimilar to a study carried out by Peters and Ojo (2012) that revealed an equal proportion of male and female cerebral palsy patients [16].

This study revealed that most of children with cerebral palsy were the first child of the family which is similar to previous studies that first children accounted for more than 2/3rd of cases of cerebral palsy [11,17]. Primigravid women are more likely to experience prolonged obstructed labor, which can result in birth asphyxia and subsequent cerebral palsy [18]. Hashim (2012) in their study concluded that primigravids were a high-risk factor for poor maternal and perinatal outcome as they were prone to prolonged 2nd stage labour and fetal distress [19,20].

This study identified asphyxia as the commonest cause of cerebral palsy which was observed in other studies [9,17,21-27]. However, another study observed that the leading cause of cerebral palsy was jaundice [11], bacterial meningitis [16], intraventricular hemorrhage is the commonest risk factor [28,29] and prematurity as the second commonest predisposing factor after birth asphyxia in developing countries [8].

There was no significant associations of CP prevalence with causes and gender which suggests that certain demographic factors may influence CP incidence, the condition's etiology is multifactorial and complex such Genetic predispositions, environmental influences, and healthcare practices all play roles in the development of CP [30].

The outcome of this study revealed that cerebral palsy occurred more in males than in females with the known cause with highest percentage of asphyxia. Cerebral palsy occurred more in first children. There was no significant association of the prevalence of CP according to yearly distribution with cause and gender.

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