STRUCTURE OF THE PROJECT
BODY OF THE THESIS
List of Figures
List of Tables
Chapter I INTRODUCTION
Chapter II THESIS STATEMENT
Chapter III APPROACH/METHODS
- III.1 Research methodology
III.2 Study area and study population
III.3 Data collection and sources of data
III.4 Ethical considerations
Chapter IV RESEARCH FINDINGS AND DISCUSSION
Chapter V CONCLUSIONS AND RECOMMENDATIONS
Mini – Curriculum Vitae (CV) with list of publications
My sincere thanks to the Academic Department of Atlantic International University (AIU) and my Academic Advisor Dr. Lucia Gorea for her immense academic assistance during the introductory coursework, research and thesis stages. Without her support I would not have achieved this success. My thanks too go to Ms.Nadia Bailey as my student counselor.
Acknowledgements to the Ministry of Health and Social Services - Ohangwena Health Directorate (Namibia) for allowing me to use their health facilities for interviews and research, thanks to Ohangwena Health Director Ms. Kaino Pohamba for technical support, lastly I sincere appreciate the cooperation I received from Cerebral Palsied children of Ohangwena region together with their parents and/or guardians, medical rehabilitation workers of Ohangwena region, my family. If I have forgotten to thank someone this is not intentional.
In terms of neurological disorders, cerebral palsy is one of the most common conditions treated by medical rehabilitation professionals. In Ohangwena region (Namibia) the incidence of cerebral palsy (CP) is surpassed only by cerebral vascular accident (CVA). Cerebral palsy is a major cause of disability in children, affecting child’s movement, posture and muscles tone.
Poor understanding of the etiology of CP, absence of steady decline in the percentage of cerebral palsied and dialogue whether home deliveries area major cause for CP necessitated a study to evaluate the risk factors associated with pathogenesis of cerebral palsy in young children.
A cross-sectional survey on the prevalence of cerebral palsy was conducted in young children aged one to five years in the three districts that formulate the region which is the area of the study. 62 cerebral palsied selected from medical rehabilitation departments patient register and 62 ages and sex matched neighborhood controls, all aged less than five (5) years were study subject matter. Qualitative design, using explorative and descriptive research strategies was the method of choice. Mothers were interviewed and at times additional information about the child was obtained from hospital patient records.
Findings were multi-faced; study revealed that antenatal (gestational) risk factors mainly associated with developed countries, were equally evident in Namibia a developing country, the case in point was maternal high blood pressure, and typical of developing world were factors like poor maternal nutrition (low protein intake during pregnancy) and low educational level of mother to mention the main ones.
In the case of whether home deliveries areas major cause of CP, the study found out incidence was at par between institutional and home deliveries. With regards to absence of steady decline in the percentage of CP, it was evident that modern improved obstetric and advanced perinatal care has resulted in the increased survival of low birth weight babies, which was not the case 20-30 years back.
Bottom-line Prevalence and clinical features of cerebral palsy in Ohangwena is comparable to other developing countries, as well as developed countries spreading in antenatal, perinatal and postnatal categories. Significant risk factors for cerebral palsy identified in the study are potentially modifiable.
Much study need to be done about CP as it is suggested anywhere from 20% - 50% of the real cause are not known. Support is needed to diagnosed children, family and the community in term of finance and social resources. As current there is no antenatal test for CP, no proven preventable measures in late pregnancy, and no known cure. To place more importance in gestational and perinatal care for mothers and babies will definitely reduce occurrence of cerebral palsy in young children population.
List of Figures
Fig. 1: Quarterly recording of CP cases versus CVA
Fig. 2: Comparison of Home deliveries and Hospital deliveries
Fig. 3: Geographical position of Ohangwena Health Region
Fig. 4: Antenatal (Gestational) Risk Factors breakdown
List of Tables
Table 1: Distribution of Cerebral Palsied children per district (2007 – 2009)
Chapter I INTRODUCTION
Cerebral Palsy (CP) is not a new disorder in terms of existence; there have probably been children with cerebral palsy since the beginning of human existence. Naturally a question will follow, if then is such an old disorder and not a disease, but a disability and it is known that in very rare and severe cases people die of overwhelming impact of physical impairment. Do these warrant clinicians, researchers and rehabilitation professionals to study cerebral palsy as a distinct medical condition?
The fact that cerebral palsy causes has been suggested to be anywhere from 20% to 50% unknown I believe more study is still needed. Evaluation of risk factors associated with cerebral palsy in children of Ohangwena Region (Namibia): case control study which is going be the main stay of my research and this thesis paper is an attempt to respond to the question posed in the just above paragraph of the introduction chapter.
Cerebral Palsy (CP) can be defined as a permanent disorder of movement and posture with sensory defects, due to brain damage or developmental abnormality occurring in fetal or early infancy. “Seven children are born with cerebral palsy per 100,000” (Bleck & Nagel, 1975:6)
Study done in Ohangwena Region (Namibia) has suggested that cerebral palsy etiology is poorly understood. Essentials indicators by Ministry Information System (MIS) and Statistics from Regional Medical Rehabilitation Departments indicates Cerebral Palsy as one of the most common neurological conditions treated by medical rehabilitation professionals in the region, surpassed only by Cerebral Vascular Accident (CVA) condition, this alone was a matter of concern that warranted a study to be conducted.
Another purpose of the study is to identify where explanation for the problem lies; whether it is within the health facilities deliveries or is the result of home deliveries facilitated by Traditional Birth Attendants (TBA’s)? The chronic shortage of health professionals’ doctors and nurses especially in the in rural (remote) health facilities does it contribute to the problem? And how this can be compared to the suggestions that perinatal and postnatal factors contributes majorly to cerebral palsy cases in developing countries, whereas in the developed (industrialized) countries cerebral palsy is mainly associated with ante-natal factors.
Though there are many associated markers or conditions associated with cerebral palsy, evidence of those conditions or risk factors don’t guarantee that they are, indeed, the cause. In the 1970s obstetricians suggested that ‘optimal’ care (which they defined as emergency caesarean section for abnormalities on the electronic fetal monitor) then cerebral palsy would be avoided (Quilligan and Paul 1975). The outcome of their suggestion has had no effect on the rates of cerebral palsy (Stanley and Watson 1993, Nelson et al. 1996). Quilligan and Paul suggestion only increased caesarean rates and reduced rate of neonatal seizures. The point I am bringing home here is; that the question of the causes of cerebral palsy can as well be very tricky. Caesarean section may not be ‘optimal’ response. (Stanley, Blair & Alberman, p. 107)
With regards to not been a steady decline in the percentage of cerebral palsied children in the region, there is one important factor that has not clearly come to our recognition; the strides in the ability to keep alive and bring to health extremely premature infants has also increased the number of children who contract if you may allow cerebral palsy, whom 20 – 30 years back would have made it to their first birthday.
To assess, some of the identified risk factors for cerebral palsy, 62 cerebral palsied children were selected from medical rehabilitation department register; all aged less than five (5) years of age, residing in the region of Ohangwena were subject of study, against 62 age peer and sex matched from neighborhood as controls. (Please note; it would have been ideal to have 250-300 children for the study to be standard, but the fact that Namibia being second only to Mongolia as far as the issue of population density is concerned, it was not practical, currently the Population of Namibia is approximately 2 million and is sparsely allocated)*
Information regarding antenatal, perinatal and postnatal was collected through interviewing mothers, wherever available, from hospital records of the study subjects. The impact of cerebral palsy to parents and immediate families, and social-economic issues associated was also another area of the study interest.