Makerere University School of Public Health, Makerere University, Kampala, Uganda.
Stockholm University Brain Imaging Center (SUBIC), Stockholm University, Stockholm, Sweden.
PLoS One. 2020 Dec 29;15(12):e0243948. doi: 10.1371/journal.pone.0243948. eCollection 2020.
Studies from high-income countries reported reduced life expectancy in children with cerebral palsy (CP), while no population-based study has evaluated mortality of children with CP in sub-Saharan Africa. This study aimed to estimate the mortality rate (MR) of children with CP in a rural region of Uganda and identify risk factors and causes of death (CODs).
This population-based, longitudinal cohort study was based on data from Iganga-Mayuge Health and Demographic Surveillance System in eastern Uganda. We identified 97 children (aged 2-17 years) with CP in 2015, whom we followed to 2019. They were compared with an age-matched cohort from the general population (n = 41 319). MRs, MR ratios (MRRs), hazard ratios (HRs), and immediate CODs were determined. MR was 3952 per 100 000 person years (95% CI 2212-6519) in children with CP and 137 per 100 000 person years (95% CI 117-159) in the general population. Standardized MRR was 25·3 in the CP cohort, compared with the general population. In children with CP, risk of death was higher in those with severe gross motor impairments than in those with milder impairments (HR 6·8; p = 0·007) and in those with severe malnutrition than in those less malnourished (HR = 3·7; p = 0·052). MR was higher in females in the CP cohort, with a higher MRR in females (53·0; 95% CI 26·4-106·3) than in males (16·3; 95% CI 7·2-37·2). Age had no significant effect on MR in the CP cohort, but MRR was higher at 10-18 years (39·6; 95% CI 14·2-110·0) than at 2-6 years (21·0; 95% CI 10·2-43·2). Anaemia, malaria, and other infections were the most common CODs in the CP cohort.
Risk of premature death was excessively high in children with CP in rural sub-Saharan Africa, especially in those with severe motor impairments or malnutrition. While global childhood mortality has significantly decreased during recent decades, this observed excessive mortality is a hidden humanitarian crisis that needs to be addressed.
高收入国家的研究报告显示，脑瘫（CP）患儿的预期寿命缩短，而在撒哈拉以南非洲地区，尚无基于人群的研究评估 CP 患儿的死亡率。本研究旨在估计乌干达农村地区 CP 患儿的死亡率（MR），并确定死亡原因（COD）和危险因素。
这是一项基于乌干达东部伊甘加-马尤盖健康和人口监测系统数据的基于人群的纵向队列研究。我们在 2015 年发现了 97 名（年龄 2-17 岁）CP 患儿，并对他们进行了随访至 2019 年。将他们与一般人群中年龄匹配的队列（n=41319）进行比较。确定了 MR、MR 比（MRR）、危险比（HR）和即时 COD。CP 患儿的 MR 为每 100000 人年 3952 例（95%CI 2212-6519），一般人群为每 100000 人年 137 例（95%CI 117-159）。CP 队列的标准化 MRR 为 25.3，与一般人群相比。在 CP 患儿中，严重运动障碍患儿的死亡风险高于轻度运动障碍患儿（HR 6.8；p=0.007）和严重营养不良患儿（HR=3.7；p=0.052）。CP 队列中女性的死亡率更高，女性的 MRR 更高（53.0；95%CI 26.4-106.3），而男性的 MRR 更低（16.3；95%CI 7.2-37.2）。年龄对 CP 队列的 MR 没有显著影响，但 10-18 岁的 MRR 更高（39.6；95%CI 14.2-110.0），而 2-6 岁的 MRR 较低（21.0；95%CI 10.2-43.2）。贫血、疟疾和其他感染是 CP 队列中最常见的 COD。
在撒哈拉以南非洲农村地区，CP 患儿过早死亡的风险过高，尤其是那些有严重运动障碍或营养不良的患儿。虽然近年来全球儿童死亡率显著下降，但这种明显过高的死亡率是一个需要解决的隐藏人道主义危机。
