Uptake of Mobility Assistive Devices According to Gross Motor Scores Among Children Living With Cerebral Palsy at Kenyatta National Hospital.

Abstract

Background : Cerebral palsy (CP) is one of the commonest causes of paediatric neuro-disability worldwide. CP children present with gross motor dysfunction and limited mobility of varying degrees and therefore the need to stratify this using the gross motor functional classification system expanded and revised (GMFCS-ER) to guide on the appropriate mobility device becomes very important in determining the scope of their service need and resource planning. Appropriate and timely provision of mobility devices is core in the management of these children. x There is limited access to these mobility devices in Africa Kenya specifically. Data has been published in some African countries such as Nigeria showing low proportion of uptake of mobility assistive devices (MAD) but a corresponding information is insufficient in Kenya. Primary objective: To determine the proportion of children using the appropriate mobility assistive devices (MAD) according to their gross motor function classification score and associated factors among children with CP aged 2-12 years at Kenyatta National Hospital (KNH) Methodology; This was a cross-sectional observational hospital study that recruited children with CP aged 2-12 years attending outpatient clinics. The study population consisted all CP children aged 2-12 years in KNH who have been diagnosed by a peadiatrician or paediatric neurologist. Children presumed to be CP yet have not been diagnosed by a neurologist/paediatrician were screened using 2 screening questions from WHO-formulated ten-question screening (TQS) on CP. Those who screened positive and met the SCPE diagnostic criteria were eligible for inclusion. 92 children enrolled were then subjected to physical examination to find out their GMFCS grading and interviewed through questionnaires to determine the rates of uptake of MAD and factors influencing such uptake. Data analysis: Data was imported into R version 4.1.2 for analysis. Age was summarized using median and inter-quartile range. Categorical variables e.g., sex, GMFCS score and residence were summarized using frequencies and percentage proportions. Categorical data was presented using bar charts and pie charts. The proportion of children using appropriate mobility devices was summarized using percentage proportion. Binary logistic regression was used to assess for factors associated with the utilization of mobility devices (GMFCS score, residence and age). Variable selection was done using Akaike’s Information Criteria (AIC). Tests were interpreted using p-values and odds ratios with their confidence intervals at 5% significance level. P-values less than 0.05 were considered significant. Outcome: Sixteen percent (15 out of 85) of the children in GMFCS 2 and above, were using appropriate MAD. Uptake was low across all gross motor classes. Despite the fact that 62% of caregivers awareness of the need for MAD yet only 16% of them used MAD. In 73% of the children who had MAD, use was initiated more than one 1....................................