Trial lecture title: Describe a new vision for CP services in Moldova that builds on what is known about CP and childhood disability in 2021. In particular, how may the concepts presented in the ICF Framework for health and the F-Words contribute to improvements in service systems?
Ordinary opponents:
- First opponent: Professor Peter Rosenbaum, McMaster University, Canada
- Second opponent: Deputy Director, Dr. Solveig Sigurdardottir, State Diagnostic and Counselling Centre, Island
- Leader of the committee: Professor Margreth Grotle, OsloMet
Leader of the public defense is Vice Dean for Innovation and Interdisciplinary Education Programmes Kaare Magne Nielsen, OsloMet.
The main supervisor is Professor Reidun B. Jahnsen, University of Oslo.
The co-supervisors are Associate Professor Guro L. Andersen, Norwegian University of Science and Technology (NTNU) and Professor Larisa Spineu, State Medical and Pharmacy University, Moldova.
Thesis abstract
Cerebral palsy (CP) remains the most common cause of chronic motor disorders in childhood and represents a life-long disability.
This thesis is the first national study of the distribution of subtypes, severity, risk factors and potential influence of early intervention (EI) programmes among children with CP in Moldova.
Aims
The aims of this PhD-project were to:
- identify and describe the prevalence and panorama of CP in Moldova;
- identify risk factors for CP in Moldova and
- investigate associations between early intervention programmes and the prevalence of impairments in children with CP in Moldova.
A population-based study
A population-based study of a cohort of children with CP born in 2009-2010 was conducted in Moldova.
The data for these 396 identified children, 351 with complete data, were extracted from the medical records in the archives of hospitals, rehabilitation centres and orphanages across the country. The CP definition and classification system agreed upon by the Surveillance of Cerebral Palsy in Europe (SCPE) were applied.
Results
The first study showed that the estimated prevalence of CP in Moldova was 3.4 per 1000 live births.
Most children were classified with spastic bilateral CP (61 percent), 20 percent with spastic unilateral CP, 12 percent with dyskinetic, 5 percent with ataxic CP, and 2 percent were unclassified.
The number of children with severe gross motor and associated impairments was higher than shown in comparable studies. The study on risk factors for CP showed that maternal residence in rural areas, low socioeconomic status, chronic diseases and alcohol consumption during pregnancy all increased the risk of CP and had high attributable fraction (AF).
Home birth and breech delivery, hyperbilirubinemia, Apgar score (0–3) at five minutes, and multiple gestation, also had high AF of CP. The third study showed no difference in outcomes of cognition, communication, vision or hearing impairments between those enrolled or not enrolled in early intervention programmes.
However, the subgroup analyses showed that the risk of contractures was 11 times higher among non-walking children who were not enrolled in early intervention programmes.
Based on the findings above, we consider that the most immediate actions are to improve the pregnancy and maternity care; to revise the national clinic protocols and guidelines; to include needed course materials related to CP into the curricula of the medical university and to establish a national CP register in Moldova.
