BACKGROUND Cerebral palsy is the most common cause of motor dysfunction in children worldwide and is often accompanied by multiple comorbidities. Although cerebral palsy has been studied extensively in high-resource settings, there are few published studies on cerebral palsy etiology, outcomes and comorbidities in low-resource settings. METHODS Children with cerebral palsy were prospectively enrolled from inpatient and outpatient settings at a referral center in Gaborone, Botswana, in a cross-sectional study conducted from 2013 to 2014. Cerebral palsy etiology, outcomes, and comorbidities were determined through caregiver interviews, review of medical records, and direct physical examination. RESULTS Sixty-eight children with cerebral palsy were enrolled. Subjects were 41% male, with a median age of 4 years (interquartile range = 2 to 7). The most common etiologies for cerebral palsy in our cohort were intrapartum hypoxic events (18%), postnatal infections (15%), prematurity (15%), focal ischemic strokes (10%), and prenatal infections (10%). Severe motor impairment was common, with the most severe category present in 41%. The predominant comorbidities were cognitive impairment (84%), epilepsy (77%), and visual impairment (46%). CONCLUSIONS Cerebral palsy in Botswana has different etiologies and is associated with poorer outcomes and higher prevalence of comorbidities than what has been reported in high-resource settings. Further studies are necessary to determine optimal preventative and treatment strategies in this population.

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Background Seizures are common among patients with HIV/AIDS in the developing world and are associated with significant morbidity and mortality. Early treatment with combination antiretroviral therapy (cART) may reduce this risk by decreasing rates of central nervous system infections and HIV encephalopathy. Methods A case-control study of new onset epilepsy among children age 0-18 years with perinatally acquired HIV/AIDS followed in Gaborone, Botswana during the period 2003-2009 was conducted. Children with epilepsy were identified and compared to age-and-sex-matched controls without epilepsy with respect to timing of cART initiation. Early treatment was defined as treatment with cART before the age of twelve months, at a CD4% of greater than 25 in children age 1-5, or at an absolute CD4 count of >350 cell/mm3 in children age 5 and older. Results We identified 29 cases of new onset epilepsy and 58 age and sex-matched controls. The most common identified etiologies for epilepsy were CNS infections and direct HIV neurotoxicity. Only 8 (28%) of the children who developed epilepsy received early treatment compared with 31 (53%) controls (OR 0.36, 95% CI 0.14-0.92, p=0.03). This effect was primarily driven by differences in rates of epilepsy among children who initiated treatment with cART between the ages of 1-5 years (11% vs. 53%, OR 0.11, 95% CI 0.01-1.1, p=0.06). Conclusions Earlier initiation of cART may be protective against epilepsy in children with HIV.