الفهرس 
Introduction and Aim of the workOnly 14 pages are availabe for public view
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Abstract
Cerebral palsy (CP) is the most frequent cause of motor handicap among children. The present matched case control study was conducted in Assiut University Hospitals and Assiut Health Insurance facilities (Seedi Galal clinic) in Assiut city.
The present study aims to investigate possible risk factors of CP among children under five years in Assiut Governorate, The risk factors include antenatal, perinatal and postnatal. Also, it aims to study sociodemographic characteristics of the cases and the controls and assess the knowledge, attitudes and practices of the parents of CP children in comparison with the parents of the control group.
The analyzed data reveals that:
a) As regards the risk factors for developing cerebral palsy:
• 53.3% of the cases and 60.0% of the controls were males and 46.7% of CP cases and 40.0% of the controls were females. Rural residents represented 77.3% of the cases and 75.3% of the controls while urban residents represented 22.7% of the cases and 24.7% of the controls. The mean age of the cases and the controls was 1.99 ± 1.34 and 1.98 ± 1.33 years respectively.
• There is statistical significant difference between cases and controls as regards handiness as 11.1% of the cases were left handed versus 8.3% of the controls and 25% of the cases could not use any hand versus none of the controls (p = 0.000).
• 19.3% of the cases were of the low socioeconomic level versus 13.3 % of the controls and the mean socioeconomic score of the cases was 113.5 ± 40.9 versus 124.9 ± 48.0 for the controls with statistical significant difference between groups (p = 0.028).
• There is statistical significant difference between cases and controls as regards history of feeding as 86.0% of the controls were breast fed versus 62.0% of the cases (p = 0.000). The mean age of start weaning of the cases and the controls was 8.14 ± 6.84 and 6.08 ± 5.19 months respectively with statistical significant difference (p = 0.005). Mean age of complete weaning showed no statistical significant difference between cases and controls.
• Mothers of 4.0% of the cases had history of premature rupture of membranes versus none of the controls with statistical significant difference (p= 0.024). The fathers of children with CP were older than fathers of the controls and there was statistical significant difference between groups regarding the mean father age at child birth (p = 0.026). On the other hand, many other antenatal risk factors as malpresentations, history of bleeding during last trimester or during labor, history of twins, mother’s history of miscarriage and mother age at childbirth show no statistical significant difference between cases and controls.
• There is no statistical significant difference between the mothers of the cases and the mothers of the controls as regards attendance of antenatal visits. However, the mean number of antenatal visits was 5.75 ± 3.85 and 7.30 ± 4.10 for the mothers of both cases and controls, respectively with statistical significant difference (p = 0.003).
• There are no statistical significant differences between the cases and the controls regarding some mother’s medical problems during pregnancy such as preeclampsia or eclampsia, diabetes mellitus, German measles, cytomegalovirus infection, epilepsy and Toxoplasmosis.
• There are no statistical significant differences between the cases and the controls regarding prematurity, postmaturity, place of delivery, labor attendant, type of labor and meconium staining of amniotic fluid.
• Birth trauma, cyanosis at birth, delayed crying immediately after birth, low birth weight and bleeding from any orifices in the body are significantly higher among the cases than the controls.
• There are statistical significant differences between the cases and the controls regarding history of encephalitis, birth order and head trauma. On the other hand, no statistical significant difference is observed between the cases and the controls regarding history of meningitis.
• Need for incubation, duration of incubation, neonatal jaundice and age at beginning jaundice are significantly higher among the cases than the controls. Also, 22.7% of the cases had history of neonatal convulsions versus none of the controls with statistical significant difference (p = 0.000). On the other hand, no statistical significant differences are found between groups as regards duration of jaundice, need for incubation because of jaundice, duration of incubation because of jaundice and history of blood exchange.
• There are statistical significant differences between the cases and the controls regarding family history of CP (20.7% versus 0.7%, p = 0.000) and family history of mental retardation (4.7% of the cases versus none of the controls, p = 0.022). Consanguinity between parents showed no statistical significant difference between the cases and the controls.
• In the logistic regression model, the odds of developing CP is significantly higher among children with encephalitis (OR= 65.67), birth trauma (OR = 16.76), artificial feeding (OR= 4.91), low birth weight (OR = 2.96) and history of neonatal jaundice (OR = 2.37).
• There were delayed milestones of motor development in children with CP where 92.7% of the cases could not perform the movements that should be done according to their age versus 15.4% of the controls with statistical significant difference (p = 0.000).
• There were delayed milestones of mental development in children with CP where 76.0% of the cases could not perform the action that should be done according to their age versus 6.7% of the controls with statistical significant difference (p = 0.000).
b) As regards children with cerebral palsy:
40.0% of the children with CP experienced seizures. The study revealed that 75% of these children had generalized seizures, while 25% had partial seizures. As regards frequency of seizures, 53.3% of these children had daily-repeated seizures, 11.7% had weekly-repeated seizures, 1.7% had monthly-repeated seizures and another 1.7% had yearly- repeated seizures. On the other hand, there were 31.7% of them who had their seizures in occasional (variant) pattern. Also, 68.3% of these children had their first seizure at the age < 1 year while 31.7% of them had their first seizure at the age ≥ 1 year. Duration of seizures in 48.3% of these children was less than five minutes while duration of seizures in 51.7% of them was more than five minutes and it is significantly ≥ 5 minutes in those with positive family history of CP (81.8% versus 18.2%, p = 0.027).
• As regards the sequences of CP on diseased children, 9.3% of the cases experienced vision troubles while 5.6% experienced hearing troubles. Speech troubles occurred in 75.9% of the cases while learning difficulties occurred in 66.7%. Teething troubles occurred in 5.6% of the cases. Swallowing troubles, feeding troubles and repeated vomiting occurred in 31.3%, 8.0% and 12.7% of the cases respectively. Respiratory system troubles occurred in 20.0% of the cases. Urinary incontinence occurred in 86.5% of the cases while Fecal incontinence occurred in 76.2%.
• 92.0 % of the cases had spastic CP. Atonic and athetoid CP occurred in 7.3% and 0.7% of the cases respectively. Among spastic CP, quadriplegic CP was the most frequent one (66.0%) followed by hemiplegic CP (8.7%), diplegic CP (8%) , paraplegic CP (7.3%) and monoplegic CP (2%).
• Doctors at private clinics diagnosed 47.3% of the cases while diagnosis at health insurance clinics and university hospitals were in 28.7% and 24.0% of the cases respectively.
• Diagnosis of CP was made on the clinical basis only in 6.0% of the cases while, it was done on CT scan basis together with the clinical picture in 94.0% of the cases. The most frequent investigations done were CT, EEG and X-ray. Also, 91.3% of the cases had treatment compliance while 8.7% had no treatment compliance. Only 18% of the cases who were under treatment needed to change the drugs.
• Most children with CP (88.0% of cases) who were under treatment used to go to follow up visits. Health insurance clinic was most frequent place of follow up in 71.2% of the cases followed by private clinic (34.1%) and lastly university hospitals (14.4%). As regards patient satisfaction with provided care, 11.4% of the cases were unsatisfied with the provided services and the most common cause of dissatisfaction was overcrowdness and prolonged waiting time.
• Negative effect on family of children with CP occurred among 88.7% of the parents. Psychological upset was reported by 99.2% of the parents followed by economic burden (43.6%) and lastly social isolation (6.8%). Exposure to annoyment from the surrounding occurred in 17.9% of the cases. Effect on child personality occurred in 71.6% of the cases. This effect on child personality was in the form of being moody (60.4%), feel lonely (39.6%), nervous (37.5%) or feeling of shyness (20.8%).
c) KAP assessment of parents about CP:
• There are statistical significant differences between the cases and the controls regarding father’s education and father’s job (p = 0.014 and 0.006 respectively). While, no statistical significant differences are found between the cases and the controls regarding mother’s education and mother’s job.
• Previous hearing about CP was present among 33.3% of the parents of the controls.
• As regards time of gaining information about CP among the parents of the cases, 31.3% of the parents gained information before child illness whereas 68.7% of the parents gained information after child illness.
• There are statistical significant differences between two groups regarding sources of information about CP as 77.3% of the parents of the cases gained information about CP from family members versus 8.0% of the parents of the controls (p = 0.000) while mass media (p = 0.000), neighbors (p = 0.000) and health team (p = 0.049) were the sources of information which common among the parents of the controls than the parents of the cases.
• 81.3% of the parents of the cases reported their need for additional information about CP versus 66.0% of the parents of the controls with statistical significant difference (p = 0.025). There is statistical significant difference between two groups regarding awareness of side effects of drugs as 13.3% of the parents of the cases knew about side effects of drugs versus none of the parents of the controls (p = 0.000). There is statistical significant difference between two groups regarding experience with treatment provided where 82.7% of the parents of the cases versus 60% the parents of the controls thought improvement with treatment (p= 0.001). There is statistical significant difference between two groups regarding possibility of complete recovery from CP as 34.7% of the parents of the cases versus 8.0% of the parents of the controls thought complete recovery (p = 0.001) . There is statistical significant difference between groups regarding awareness of course of disease where 22.7% of the parents of the cases reported that CP is a progressive disease versus 92.0% of the parents of the controls (p = 0.000).
• There are statistical significant differences between two groups as regards knowledge of the causes of CP being birth trauma (p = 0.009) or genetic disease (p = 0.000) where 19.3% of the parents of the cases versus 4.0% of the parents of the controls reported that CP caused by birth trauma. Also 10.0% of the parents of the cases versus 46.0% of the parents of the controls reported that CP was a genetic disease. There are statistical insignificant differences between two groups as regards knowledge of the rest of the causes of CP.
• Impression about child with CP being weak or handicapped revealed statistical significant difference between two groups where 64.7% of the parents of the cases versus 30.0% of the parents of the controls considered him/ her as weak (p = 0.000). Also, 42.7% of the parents of the cases versus 74.0% of the parents of the controls considered him/ her as handicapped (p= 0.000). There is statistical significant difference between two groups regarding their feeling of trust to deal with child with CP where 88.0% of the parents of the cases versus 46.0% of the parents of the controls reported their ability to deal with child with CP (p = 0.000). There are statistical insignificant differences between two groups regarding their attitudes towards practicing the usual activities by children with CP such as practicing school activities, social activities and daily home activities.
• 5.3% of the parents of the cases had tried alternative medicine in the treatment of CP. Visiting religious men was the most common method used.
• 62.7% of the parents spoke with others as regards their child illness. Relatives were the most frequent persons preferred followed by neighbors and lastly friends. Also, 69.3% of the parents reported that their children need special care and they cannot deal with them as the rest of normal children.
• Some parents commonly practiced many of unnecessary and sometimes potentially harmful practices at the time of fit occurrence to the child.