AVAILABILITY, ACCESSIBILITY AND AFFORDABILITY OF COMPREHENSIVE CARE AMONG CHILDREN WITH CEREBRAL PALSY IN DAR ES SALAAM, TANZANIA: A CROSS SECTIONAL, ANALYTICAL HOSPITAL-BASED STUDY PROTOCOL (CAREGIVERS PERSPECTIVE)

Abstract

EXECUTIVE SUMMARY Background Cerebral palsy is among the major causes of permanent disability in children worldwide. Whereas the overall global incidence rate of CP is 2.11 per 1000 live-births, in Africa incidence rate has been estimated at about 3.34 per 1000 live-births. Many caregivers and families of children with CP in African countries face multiple challenges that limit availability, accessibility and affordability of comprehensive care for children with Cerebral Palsy. Objectives To assess the availability, accessibility and affordability of comprehensive care among children with cerebral palsy attending specialized pediatric neurology clinics in Dar es Salaam, Tanzania. Design & Methods A cross-sectional, analytical hospital-based study will be conducted at two multi-specialty hospitals (Muhimbili National Hospital & CCBRT hospital) in Dar es Salaam, Tanzania from November 2025 – January 2026. Caregiver-child with CP pair will be the target population. Pre-tested questionnaire will be the main tool for data collection. A minimum of 229 children-caregiver pairs will be needed in order to attain a minimum study power of 80% given an α-level of 5%. Descriptive analysis will be conducted to assess the magnitude of availability, accessibility and affordability of care. A binary multivariable logistic regression model will be used to assess factors associated with availability, accessibility and affordability of care. Written informed consent will be obtained from caretakers of all study participants prior to recruitment into the study. Main outcomes measures Proportion of children-caregiver pairs with attained ‘comprehensive care’ for CP. STUDY’S STRENGHTS & LIMITATIONS Strengths Study settings included multi-disciplinary health facilities for pediatric neurology care Inclusivity (i.e. caregiver-child pairs) Findings will be generalizable to the entire country since the 2 study settings receive patients from throughout the nation. Limitations Since the study is cross-sectional by design, temporal association (i.e. between exposure and outcomes) cannot be proven. Possibilities of recall biases from caregivers’ responses cannot be ruled-out.