Global disparities in prevalence, aetiology, motor impairment severity, access to health care, and mortality in childhood cerebral palsy: A scoping review
Beaudelaire Romulus Assan, Méhomé Wilfried Dossou, Yannelle Audrey Agbodjogbé, Salvatore Metanmo, Lindsay Osei, Narcisse ElengaAbstract
Aim
To map and synthesize the global literature on socioeconomic and structural inequalities in cerebral palsy (CP).
Method
A scoping review according to the framework proposed by Arksey and O'Malley was conducted and reported according to the PRISMA‐ScR guidelines. The PubMed/MEDLINE, Embase, World Health Organization Global Medical Index, African Journals Online, Scopus, Science Direct, Web of Science, and Wiley Online Library databases were searched. A manual search of Google Scholar was also conducted to capture grey literature. Observational studies reporting disparities in CP across high‐income countries (HICs) and low‐ and middle‐income countries (LMICs) were included. Data were extracted and synthesized narratively across five prespecified domains of inequality: prevalence, aetiology, severity, access to health care, and mortality.
Results
Forty‐three studies met the inclusion criteria. Registry‐based studies from HICs reported a birth prevalence of CP ranging from 1.4 to 2.5 per 1000 live births, most recently estimated at 1.6 per 1000 live births (95% confidence interval = 1.5–1.6). Registry‐based prevalence in LMICs remained scarce, with estimates of up to 3.4 per 1000 live births and period‐prevalence of 2.3 to 3.7 per 1000 children. A modelled estimate of 16.2 per 1000 children aged under 5 years has been reported in the World Health Organization African Region. Preventable causes, such as hypoxic‐ischaemic encephalopathy, kernicterus, and infection, were more frequently reported in low‐resource settings, whereas preterm birth as a major risk factor was predominantly reported in HICs. Socioeconomic disadvantage, lower parental education, and minority ethnic status were associated with greater functional severity, higher comorbidity burden, and unmet health care needs. Physiotherapy was the main form of care reported in many LMICs. Studies from LMICs generally reported lower survival estimates and higher mortality rates than those from HICs. However, comparisons were limited by differences in study populations, severity profiles, and methodological approaches.
Interpretation
This review identified pronounced disparities in CP across prevalence, severity, access to health care, and survival in diverse settings. The findings highlight important gaps in the evidence base and underscore the need for further research to better understand the mechanisms underlying these disparities and to inform equity‐oriented health policies.