Patterns and Correlates of Health Care Utilization Among Children With Cerebral Palsy Attending a Tertiary Care Setting: Implications for Long Term Care

Abstract

Introduction: Cerebral palsy is the commonest cause of physical disability in children worldwide, including Sri Lanka. Use of health services by children with disabilities can be far from optimal, specially among disadvantaged groups. Many factors affect use ok health care by these children, influencing their long term health. Objectives: To describe patterns and correlates of health care utilization by children with cerebral palsy attending a tertiary care setting. Materials and methods: This study was conducted among 375 children with a diagnosis of cerebral palsy, attending Teaching Hospital, Karapitiya, Galle. An interviewer-administered questionnaire was used to collect data from their principal caregivers. Univariate analysis was used to assess the correlates of health care utilization, followed by logistic regression analysis. Results: Of the 375 children, 89.9% received some form of regular health care, 8.0% received care irregularly, while 2.1% never received any formal therapy. Commonest type of care received was physiotherapy (97.9%), followed by drug therapy (53.3%), speech therapy (48.3%) and occupational therapy (9.9%). In addition, approximately 11% used alternative therapy such as Ayurveda or Acupuncture. Poor health care utilization was associated with older age of child (pco.ooi), younger age of caregiver (p<0.05), low education of caregiver (p<o.oi), high family income (pco.os), nuclear family type (pco.oi), longer distance to treatment facility (p<o.ooi) and longer duration of treatment (p<0.001). All above variables except caregiver age and duration of treatment were predictive of health service use in multivariate analysis. Conclusions: Use of health services is inadequate among children with cerebral palsy in areas such as speech and occupational therapy; probably due to lack of trained therapists and/or poor parental awareness. Organizing community-based rehabilitation services and building parental awareness may ensure a wider and regular use of services, while training/ recruitment of more therapists in required fields will further enhance optimal care.