Andrews Carin, Namaganda Lukia, Eliasson Ann-Christin, Kakooza-Mwesige Angelina, Forssberg Hans
Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
Dev Med Child Neurol. 2022 Jan;64(1):70-79. doi: 10.1111/dmcn.14996. Epub 2021 Aug 4.
To follow the functional development of a population-based cohort of children with cerebral palsy (CP) in rural Uganda and compare their development with the developmental trajectories of children from high-income countries (HIC).
Eighty-one children (33 females, 48 males) aged 2 to 17 years (mean 8y 6mo, SD 4y 6mo) with CP were initially assessed in 2015 and then 4 years later using the 66-item Gross Motor Function Measure (GMFM-66), Pediatric Evaluation of Disability Inventory, Ugandan version (PEDI-UG), and functional classification systems. We calculated actual and reference scores (level of deviation from the developmental trajectories in HIC). A Wilcoxon signed-rank test was used for statistical analyses.
Children and young people with CP in Uganda exhibited no differences in scores between the first and second assessments for the GMFM-66 and PEDI-UG mobility skills, whereas they exhibited increased PEDI-UG social function (p<0.001) and self-care skills scores (p<0.001). Reference scores were more negative at the second assessment than at the first for the GMFM-66 (p=0.002) and PEDI-UG mobility (p=0.036) but not for PEDI-UG self-care. The increased difference in reference scores over the 4 years was primarily driven by younger children (2-5y) and children with milder impairments.
The increased difference in reference scores between assessments suggests that children with CP in Uganda develop motor skills at a slower rate than peers in HIC. Limited access to health care and rehabilitation likely contributed to the lower scores and slower rate of development.
追踪乌干达农村地区以人群为基础的脑瘫（CP）儿童队列的功能发育情况，并将其发育情况与高收入国家（HIC）儿童的发育轨迹进行比较。
2015年对81名年龄在2至17岁（平均8岁6个月，标准差4岁6个月）的CP儿童（33名女性，48名男性）进行了初步评估，4年后使用66项粗大运动功能测量量表（GMFM - 66）、乌干达版儿童残疾评估量表（PEDI - UG）和功能分类系统再次进行评估。我们计算了实际得分和参考得分（与HIC发育轨迹的偏差水平）。采用Wilcoxon符号秩检验进行统计分析。
乌干达CP儿童和青少年在GMFM - 66和PEDI - UG移动技能的首次和第二次评估得分上没有差异，而PEDI - UG社会功能得分（p<0.001）和自我护理技能得分有所提高（p<0.001）。GMFM - 66（p = 0.002）和PEDI - UG移动性（p = 0.036）的参考得分在第二次评估时比第一次更负，但PEDI - UG自我护理方面并非如此。4年间参考得分差异的增加主要由年幼儿童（2 - 5岁）和损伤较轻的儿童驱动。
评估之间参考得分差异的增加表明，乌干达CP儿童运动技能的发展速度比HIC的同龄人慢。获得医疗保健和康复服务的机会有限可能导致了较低的得分和较慢的发育速度。
