Trends in prevalence and characteristics of cerebral palsy among Icelandic children born 1991 to 2010

rian children with CP seen at a tertiary centre. Study Design: Prospective, cohort study. Study Participants & Setting: Consecutive new cases of CP seen at a tertiary centre in Nigeria over a period of 2 years. Materials/Methods: All new cases of CP were prospectively followed for 12 months to determine access to neuro-rehabilitative care and educational opportunities. Results: 304 children with CP were enrolled, 187 males and 117 females. Age at presentation to our service ranged from 6 months to 14 years, median 16.0 months. The leading risk factors for CP were severe perinatal asphyxia (42.4%), bilirubin encephalopathy (23.4%), intracranial infections (20.0%) and prematurity (6.6%). Spastic CP was predominant (83.2%) and about two-thirds of the children had severe functional impairment in GMFCS classes IV and V. Of the 117 children who were of school age, 46 (39.3%) were enrolled in school; 37 (31.6%) were in main-stream/regular schools and only 9 (7.7%) were in special schools. The major reasons for keeping the children away from school were financial constraints, severe functional impairment, lack of access to assistive mobility devices, fear of stigma and the assumption that the children were not capable of learning. Children with severe functional impairment and associated malnutrition were less likely to be enrolled in school (p < 0.001, OR 9.41, 95% CI 3.371, 26.265) and (p = 0.001, OR 0.152, 95% CI 0.042, 0.545) respectively. Twelve months post-enrolment, 199 (65.5%) had defaulted from rehabilitative care. Children with associated epilepsy were less likely to default from care (p = 0.024, OR 2.394, 95% CI 1.082, 5.293). There was increased likelihood of default from rehabilitative care in children with spastic quadriparesis (p = 0.012, OR 5.8, 95% CI 1.519, 22.145) and those with severe functional impairment (p = 0.025, OR 0.270, 95% CI 0.087, 0.839). Conclusions/Significance: CP remains a leading cause of neurodisability in Nigerian children. The major risk factors are preventable causes. Two-third of the affected children have severe functional disability, which adversely affects outcomes. There is a high default rate from rehabilitative care and presence of associated epilepsy appears to encourage continuation with care. Only about one-third of affected children are given opportunities for any form of education at all and access to specialised education is greatly limited. This has major implications for future independence and the overall quality of life in affected children. There is an urgent need to provide adequate social support services and optimal educational opportunities for Nigerian children with CP.