Cerebral palsy (CP) is indeed more common and presents greater challenges in low-resource hospitals and low- and middle-income countries (LMICs) compared to high-resource settings. This disparity arises from a combination of factors including limited prenatal and perinatal care, higher rates of premature birth and low birth weight, inadequate neonatal intensive care, and insufficient access to early diagnosis and rehabilitation services.
CP is a group of permanent movement and posture disorders caused by non-progressive disturbances in the developing fetal or infant brain. Globally, CP affects about 2 to 3.5 per 1,000 live births, with an estimated 50 million people living with CP worldwide[1]. However, the incidence and severity of CP are disproportionately higher in low-resource settings.
**Key reasons why CP is more common in low-resource hospitals:**
1. **Higher rates of perinatal risk factors:**
Prematurity and low birth weight are major risk factors for CP. In low-resource hospitals, the prevalence of premature births and low birth weight infants is significantly higher due to poor maternal nutrition, infections, and inadequate antenatal care[1][3]. For example, studies show that CP incidence among premature infants can be as high as 9.1%, compared to 0.1% in term infants[3]. Low-resource settings often lack the infrastructure to manage these high-risk births effectively.
2. **Limited access to quality neonatal care:**
Advanced neonatal intensive care units (NICUs) that provide respiratory support, infection control, and neuroprotective interventions are often unavailable or under-resourced in low-income regions. This leads to higher rates of neonatal brain injury, a primary cause of CP. Without timely and adequate care, infants are more vulnerable to hypoxic-ischemic encephalopathy and other brain insults that result in CP[1][3].
3. **Delayed or missed diagnosis:**
Early detection of CP is crucial for initiating interventions that can improve outcomes. However, low-resource hospitals often lack trained personnel and standardized screening tools to identify CP early. This delay in diagnosis can worsen the severity of disability and reduce access to rehabilitation services[4].
4. **Malnutrition and comorbidities:**
Children with CP in low-resource settings frequently suffer from malnutrition, which exacerbates their disabilities and complicates care. A study involving 937 children with CP found that over half were malnourished, with many born prematurely or with low birth weight[1]. Malnutrition impairs motor function and overall health, increasing the burden on families and healthcare systems.
5. **Psychosocial and economic challenges:**
Families in low-resource settings face significant psychosocial stress due to limited social support, stigma, and economic hardship. Caregivers, often mothers, report low quality of life and high caregiving burden, which is compounded by inadequate healthcare infrastructure and rehabilitation services[2]. These factors can indirectly affect the management and outcomes of children with CP.
6. **Lack of rehabilitation and follow-up services:**
Rehabilitation services such as physical therapy, occupational therapy, and speech therapy are essential for children with CP to maximize their functional abilities. In many low-resource hospitals, these services are scarce or nonexistent, leading to poorer long-term outcomes[2].
**Supporting evidence from authoritative sources:**
– A comprehensive study on children with CP showed that nearly half were born prematurely or had low birth weight, an
