Cognitive Abilities of Pre- and Primary School Children with Spina Bifida in Uganda

Abstract

This study investigates cognitive abilities of pre/primary school children without and with spina bifida in Uganda. Qualitative semi structured interviews and quantitative functioning scales measurements were combined and conducted with 133 parents, 133 children with spina bifida, and 35 siblings. ANCOVA was used to test for differences in cognitive scores between children and siblings. Logistic regression analyses were used to study predictive demographic, impairment specific, and environmental factors of cognitive functioning. Children with spina bifida in Uganda had lower cognitive outcomes compared to their siblings. Cognitive outcomes were predicted by age, household income, motor functioning, and schooling. Better motor functioning was predicted by age, the presence of hydrocephalus, and parental support. Continence management was predicted by parental support and household income. Schooling was predicted by age, household income, and motor functioning. Limited access to neurosurgery and rehabilitative care, and schooling had a negative effect on cognitive functioning. Children of parents who have support had better motor functioning, and continence management. A holistic approach for children with spina bifida and their families, including community based rehabilitation; ensuring social support and livelihoods for parents; and access to health and education services can contribute to better cognitive outcomes.

Teachers’ and Parents’ Perspectives on Inclusive Education for Children with Spina Bifida in Uganda

“…Bangirana et al [36] have created a Ugandan validated test battery which is used to assess neuropsychological functioning in the national referral hospital Mulago in Kampala, the capital city. Earlier we noted children were unable to understand or complete a number of subtests from this battery due to their physical impairment [21]. We argue for awareness rising on the cognitive profiles of children with spina bifida and strategies to help them in learning in schools rather than individual testing of the child as a strategy to address their 'slow learning'.…”

“…Parents in our study had to pay tuition fee for their child in the private schools, and a child had to often do an entrance examination. Earlier we found parents household income affected schooling [21] and parents would not prioritize sending their child with spina bifida to a private school if they did not have sufficient funds to send all children to school [16]. As schooling in turn will affect cognitive outcomes positively [21,33], the chances to enrol into school later, e.g.…”

“…Earlier we found parents household income affected schooling [21] and parents would not prioritize sending their child with spina bifida to a private school if they did not have sufficient funds to send all children to school [16]. As schooling in turn will affect cognitive outcomes positively [21,33], the chances to enrol into school later, e.g. when funds are available, may decrease even further as the gap between the child's development and those of their school going peers will enlarge, and the chance to pass the examination test reduces.…”

“…In Uganda infants not requiring treatment for hydrocephalus had significantly better neurocognitive outcomes than those who did require treatment [20]. In Uganda children with spina with better motor function outcomes have better cognitive outcomes and are more likely to be in school [21].…”

Social inclusion, care and belonging of children with spina bifida: perspectives from Uganda

“…Reports -Rapports ally schooling and cognitive outcomes (Bannink, Idro, & van Hove, 2016b). The lack of an enabling environment hindered children from participation, e.g.…”