Researching Links between Birth Asphyxia, Infections and Cerebral Palsy in Africa
Each year new born brain injury (birth asphyxia) causes up to 700,000 new born deaths and 1 million stillbirths. A further 400,000 infants survivors develop seizures or cerebral palsy. The majority of those affected by cerebral palsy after newborn brain injury live in the lowest income countries.
Since 2010 Dr Cally Tann and her team have been recruiting mothers and their newborns to a research project at Mulago Hospital in Kampala, Uganda, called the “ABAaNA’ study (abaana means ‘young children’ in the local language).
Dr Cally Tann has received two grants from the Research Foundation of Cerebral Palsy Alliance to support her work – an Innovation grant of $35,513 in 2012 and a Career Development grant of $25,000 in 2013.
Her study has been investigating the causes, timing, outcomes and possible strategies to prevent brain-injury related cerebral palsy resulting from neonatal encephalopathy – NE (lack of oxygen to the brain) in newborns in Uganda; a country where there is limited access to skilled health professionals and newborn intensive care facilities.
Mulago Hospital has 33,000 deliveries per year and more than 70 babies admitted to the Special Care Baby Unit at any one time.
This was the first research study of this size to be conducted at Mulago Special Care Unit where a team of 19 local clinical staff (5 doctors, 5 midwives, 9 neonatal nurses) were trained and managed during recruitment, data collection and clinical care of the newborns.in the study.
For the past 4 years, the team has been examining the early development of this group of Ugandan infants using information collected on important events from their pregnancy and birth.
This group of newborn participants are now aged between 2 and 2 ½ years and together with their families are currently involved in phase 2 of the study – ‘ABAaNA at Two’ which has been funded by a Career Development Award of $25,000 awarded to Dr Tann in 2013.
In this study Dr Tann and her team are comparing their development with a group of well term newborns (the controls) to assess the outcomes of babies who survived NE and the interventions that may improve the quality of life for affected infants and their families.
Through an improved understanding of the difficulties faced by affected children and their carers, the study aims to help identify appropriate intervention strategies for low income settings.
‘Our ultimate aim is to identify interventions that can substantially reduce poor outcomes from NE and improve the life chances of children affected by cerebral palsy,’ said Dr Tann.
Early findings show that 42% of the NE survivors had died by the age of one year and 27% of survivors have significant impairment/early cerebral palsy and a quarter of these are complicated by malnutrition.
- A number of Ugandan paediatricians have been successfully trained to perform early cranial ultrasound scanning using a small portable machine to assess the pattern, timing and severity of brain injury.
- Mulago Hospital staff have been trained and certified in neurodevelopmental assessment (Griffiths) and management of children with impairments. This training is currently otherwise unavailable in Uganda.
- Investigate the role of the placenta in poor outcomes from NE
- Conduct studies focusing on the associations between placental infection/inflammation and NE amongst UK-born infants to confirm if ABAaNA findings are also applicable in high income settings.
- Evaluate a community participatory CP Rehabilitation programme to support families and carers.