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Children with Cerebral Palsy: Current needs and challenges in the Western Cape
Thesis (PhD)--Stellenbosch University, 2026.
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| Format: | Thesis |
| Language: | English |
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Stellenbosch : Stellenbosch University
2026
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| _version_ | 1867614023500955648 |
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| access_status_str | Open Access |
| author | Katangwe-Chirwa, Thembi Janis |
| author2 | Kruger, Mariana |
| author_browse | Katangwe-Chirwa, Thembi Janis Kruger, Mariana |
| author_facet | Kruger, Mariana Katangwe-Chirwa, Thembi Janis |
| author_sort | Katangwe-Chirwa, Thembi Janis |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (PhD)--Stellenbosch University, 2026. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/136162 |
| institution | Stellenbosch University (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:45:26.037Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2026 |
| publishDateRange | 2026 |
| publishDateSort | 2026 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/136162 Children with Cerebral Palsy: Current needs and challenges in the Western Cape Katangwe-Chirwa, Thembi Janis Kruger, Mariana Donald, Kirsten A. Van Toorn, Ronald Solomons, Regan Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics & Child Health. Thesis (PhD)--Stellenbosch University, 2026. Katangwe-Chirwa, T. J. 2026. Children with Cerebral Palsy: Current needs and challenges in the Western Cape. Unpublished doctoral dissertation. Stellenbosch: Stellenbosch University [online]. Available: https://scholar.sun.ac.za/items/b80ced9c-e1c0-43d1-848f-c39715a60c0c There is a growing interest in understanding the global epidemiology of Cerebral Palsy (CP). CP remains one of the most important causes of motor disability in children, with the most significant burden of this disease in low- and middle-income countries (LMICs). CP risk factors in resource-constrained countries such as South Africa are different from those of the rest of the world. Causal contributors to CP in South Africa are still unclear and require further investigation. This study documents the spectrum of clinical manifestations and causes of CP in two tertiary hospitals in the Western Cape. The study should lead to the establishment of a hospital-based paediatric CP registry. Although this PhD did not objectively review current management protocols to identify gaps, by examining the profiles of children accessing CP-related services at the two tertiary centres in the province, gaps and challenges in the care provided are highlighted. Recommendations for implementing evidence-based management and preventing CP within the region have been made. The overall aim of this study is to identify and describe the cohort of children with CP who access CP-related services at Tygerberg Hospital and Red Cross War Memorial Children’s Hospital (RCWMCH), two tertiary hospitals in the Western Cape, and to identify gaps in the current service delivery and management of CP in these settings, with a view to inform improvements in care in the Western Cape Province, South Africa. There are four studies completed. The scoping review comprehensively identified and mapped variables across global CP registries to facilitate the establishment of a regional CP registry for Africa. The second study of this PhD described the clinical and demographic characteristics of children who access CP-related services at Tygerberg Hospital. Study three investigated the accessibility and utilisation of CP rehabilitation services by children accessing CP-related services both at Tygerberg Hospital and RCWMCH in Cape Town, South Africa. The final study described the lifetime inpatient hospitalisation care offered to children with CP who accessed the RCWMCH CP clinic in 2021. The findings from the scoping review were key in mapping out the focus areas of the subsequent studies for this PhD. The main conclusion of this review was that CP registries are currently more widely available in HICs than in LMICs. Differences in CP risk factors account for most of the differences in variables included in HICs and LMICs. Comparing variables used by global CP registries improves understanding of context-specific factors that may be key to designing regional registries. Following the scoping review, the second study gave insight into the profile of children with CP who access tertiary hospital services in South Africa, as well as the most common CP risk factors and comorbidities. The study revealed that most of the brain insults that resulted in CP occurred during the perinatal period, with perinatal asphyxia and preterm birth as essential causes. Postnatally, tuberculous meningitis and bacterial meningitis were the most significant causes. The most prevalent comorbidities included: intellectual impairment, epilepsy, and visual impairment. Notably, a substantial proportion of this cohort had severe CP, classified as Gross Motor Function Classification System IV and V. This was a very minimal improvement compared with the previous study, probably due to a lack of CP surveillance data at the facility through a registry. With several co-morbidities identified for the children living with CP in the Western Cape Province of South Africa, study three explored the access to rehabilitation services for these children. This study found that older children living with CP had greater access to CP-related services than younger children in this cohort. These older children had severe CP (Gross Motor Function Classification System [GMFCS] IV and V and resided within 30 km of their respective hospitals. Overall, occupational therapy was the most accessed rehabilitation service by all the children, followed by physiotherapy. However, the younger children, under five years old, had more referrals for dietetic support. Having obtained an overview of tertiary hospital utilisation of rehabilitation services in the Western Cape Province, study four focused on describing the access to in-hospital services by children with CP at a tertiary hospital in the Western Cape Province. A total of 877 children and young adults with CP, aged one to 23 years, who attended a dedicated clinic at Red Cross War Memorial Children’s Hospital in 2021, were included. Most were non-ambulatory (GMFCS IV-V). Over two-thirds of the cohort were admitted to hospital at least once per year, primarily the non-ambulatory children. Emergency admissions rates were higher in the non-ambulatory group compared to the ambulatory group. The top emergency admission diagnoses were seizures, respiratory-related illnesses and gastrointestinal disorders. Orthopaedic procedures were the most frequently documented cause for elective admissions. Notably, there was an association between orthopaedic procedures and the first elective admission among ambulatory children. This thesis highlights the need for standardised CP registries in LMICs, particularly in Africa, to understand region-specific risk factors better and improve healthcare outcomes. The critical findings that this work highlights include a high proportion of children with severe CP, who had preventable perinatal causes such as perinatal asphyxia and preterm birth as the two very important aetiological factors. The study emphasises the importance of implementing healthcare prevention strategies, including early identification and intervention programmes, to mitigate the impact of CP. Recommendations include developing a standardised CP registry with an ongoing surveillance programme that addresses disparities in healthcare utilisation and service priorities, incorporates family perspectives on barriers to care, and provides efficient in-hospital services for children with CP, especially non-ambulatory children. Through a CP registry, collaborative efforts, and coordinated approaches, improvements in CP care and outcomes can be achieved in the region. Doctoral 2026-04-23T13:46:15Z 2026-04-23T13:46:15Z 2026-03 Thesis https://scholar.sun.ac.za/handle/10019.1/136162 en Stellenbosch University 169 pages : ill. application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Katangwe-Chirwa, Thembi Janis Children with Cerebral Palsy: Current needs and challenges in the Western Cape |
| title | Children with Cerebral Palsy: Current needs and challenges in the Western Cape |
| title_full | Children with Cerebral Palsy: Current needs and challenges in the Western Cape |
| title_fullStr | Children with Cerebral Palsy: Current needs and challenges in the Western Cape |
| title_full_unstemmed | Children with Cerebral Palsy: Current needs and challenges in the Western Cape |
| title_short | Children with Cerebral Palsy: Current needs and challenges in the Western Cape |
| title_sort | children with cerebral palsy current needs and challenges in the western cape |
| url | https://scholar.sun.ac.za/handle/10019.1/136162 |
| work_keys_str_mv | AT katangwechirwathembijanis childrenwithcerebralpalsycurrentneedsandchallengesinthewesterncape |