Cerebral palsy in Cameroon reflects profound rehabilitation inequities shaped by fragile health systems, stigma, poverty, and limited disability-inclusive services. Delayed diagnosis, fragmented rehabilitation, educational exclusion, and caregiver burden demand integrated systems of care linking prevention, early intervention, rehabilitation, inclusive education, psychosocial support, and disability-inclusive policy implementation.

• Cerebral palsy; Cameroon; Rehabilitation inequities; Disability inclusion; Community-based rehabilitation; Health systems

Lonn H, Cockburn L, Jingkuo G, Nganji J (2026) Cerebral Palsy in Cameroon: Rehabilitation Inequities and the Urgent Need for Integrated Systems of Care. J Neurol Disord Stroke 13(2): 1250.

Cerebral palsy (CP) is the most common cause of childhood disability globally, yet its burden and lived realities remain under-documented in many low- and middle-income countries (LMICs), particularly in sub Saharan Africa. In Cameroon, CP exists at the intersection of fragile health systems, sociocultural beliefs, poverty, educational exclusion, and limited rehabilitation infrastructure [1]. Despite increasing recognition of childhood disability within global health agendas, children with CP in Cameroon continue to experience profound inequities in diagnosis, rehabilitation access, education, and social participation [2].

Emerging evidence suggests that CP prevalence in sub-Saharan Africa may exceed estimates reported in high-income countries (HICs), largely due to preventable perinatal and neonatal complications including birth asphyxia, neonatal infections, jaundice, and untreated seizures [3-6]. However, the true burden of CP in Cameroon remains poorly understood because of fragmented surveillance systems, limited epidemiological research, and the absence of national registries [4]. Existing data are predominantly hospital-based and likely underestimate the number of children living with disability in rural and underserved communities [1,7].

Importantly, CP in Cameroon cannot be understood solely as a biomedical condition. Families often navigate complex sociocultural interpretations of disability that include beliefs related to witchcraft, curses, ancestral displeasure, or maternal wrongdoing during pregnancy [8,9]. These interpretations influence care-seeking behaviours and frequently delay engagement with formal health and rehabilitation systems. At the same time, weak referral systems, shortages of rehabilitation professionals, urban concentration of services, and limited implementation of disability-inclusive policies reinforce systemic exclusion for affected children and their caregivers [2].

This commentary argues that CP in Cameroon reflects broader rehabilitation inequities and structural neglect within paediatric and disability services. Addressing these inequities requires moving beyond fragmented, condition specific responses toward integrated systems of care that link prevention, early detection, rehabilitation, inclusive education, caregiver support, and disability-inclusive policy implementation.

Structural and sociocultural barriers to CP care in Cameroon

The identification and management of CP in Cameroon remain significantly delayed and fragmented. In many settings, diagnosis occurs only after severe developmental delays become visibly apparent, rather than through proactive developmental surveillance or early childhood screening programmes [1-10]. This delay reflects broader systemic weaknesses within maternal, newborn, and child health services, where developmental monitoring is poorly integrated into routine paediatric care.

Healthcare workforce limitations further contribute to delayed identification. Cameroon faces critical shortages of professionals trained in developmental paediatrics, neurology, physical and rehabilitation medicine (PRM), occupational therapy, speech and language therapy, and psychosocial support. Many frontline healthcare providers receive limited training in early detection of neurodevelopmental disorders, functional assessment, or rehabilitation referral pathways. Consequently, opportunities for timely intervention are frequently missed [2].

Sociocultural beliefs surrounding disability further complicate the diagnostic and rehabilitation pathway [9-11]. Across many communities, CP is interpreted through spiritual and supernatural frameworks, including witchcraft, curses, ancestral anger, or violations of cultural taboos during pregnancy [8-12]. Such beliefs are not merely symbolic explanations; they shape health seeking behaviour and influence whether families pursue biomedical care, traditional healing, or faith-based interventions. In many cases, families initially seek help outside formal health systems, delaying rehabilitation and increasing the risk of preventable secondary complications.

Stigma and social exclusion also remain pervasive. Children with CP may be hidden within households because of fear of discrimination, community shame, or social rejection. Caregivers, particularly mothers, often experience blame and isolation associated with assumptions of maternal wrongdoing or spiritual causation [9]. These experiences intensify psychological distress and contribute to reduced participation in education, community life, and healthcare engagement.

The burden of CP in Cameroon is further amplified by structural inequalities between urban and rural settings. Specialized rehabilitation services are concentrated primarily in major urban centres such as Yaoundé and Douala, forcing many families to travel long distances to access care. This phenomenon of “therapeutic migration”imposes substantial financial and emotional burdens on households already experiencing poverty and limited social support. Rural families are disproportionately affected, reinforcing inequities in access to diagnosis, therapy, and follow-up care [2].

Why current systems fail children with CP in Cameroon

Current systems of care in Cameroon remain poorly equipped to respond to the complex and lifelong needs of children with CP. Rehabilitation services are fragmented, underfunded, and insufficiently integrated within pediatric healthcare systems [2]. Although children with CP often present with multiple overlapping impairments including motor dysfunction, epilepsy, feeding difficulties, communication disorders, and cognitive impairments, service delivery remains narrowly biomedical and episodic rather than coordinated and multidisciplinary [7,8].

The absence of a fully institutionalized PRM specialty further limits rehabilitation capacity nationwide. Rehabilitation is frequently perceived as a secondary or optional component of care rather than an essential aspect of child health and development. Undergraduate medical education provides limited exposure to rehabilitation medicine and disability-inclusive care, contributing to poor referral systems and inadequate recognition of functional impairments [2]. As a result, many children are referred late, often after contractures, deformities, malnutrition, and severe functional limitations have already developed.

Children with CP in Cameroon also face profound educational exclusion. Despite national commitments to inclusive education, implementation remains weak. Many schools lack accessible infrastructure, adapted learning materials, assistive technologies, and trained personnel capable of supporting children with physical, cognitive, and communication impairments. Teachers often receive little preparation in inclusive pedagogy or disability-responsive classroom practices. Consequently, school enrolment among children with disabilities remains extremely low, while academic failure and early dropout are common among those who gain access to formal education [13,14].

The social and economic burden placed on caregivers is equally significant. Families often incur catastrophic out-of pocket expenses related to transport, therapy, medications, and assistive devices. Caregiving responsibilities frequently limit parental employment opportunities and contribute to chronic financial insecurity. In addition, caregivers experience substantial emotional and psychological strain arising from stigma, isolation, uncertainty about the future, and the long-term demands of care provision.The social and economic burden placed on caregivers is equally significant. Families often incur catastrophic out-of pocket expenses related to transport, therapy, medications, and assistive devices. Caregiving responsibilities frequently limit parental employment opportunities and contribute to chronic financial insecurity. In addition, caregivers experience substantial emotional and psychological strain arising from stigma, isolation, uncertainty about the future, and the long-term demands of care provision.

Importantly, these challenges are not isolated clinical problems; they reflect systemic failures in disability inclusion, rehabilitation planning, and equitable health service delivery. Without coordinated investments in rehabilitation systems, workforce development, inclusive education, and social protection, children with CP will continue to experience preventable disability and exclusion across the life course.

Strategic priorities for transforming CP care in Cameroon

Addressing CP in Cameroon requires an integrated systems approach that strengthens prevention, early identification, rehabilitation, education, and community inclusion simultaneously.

First, strengthening maternal and newborn healthcare services is essential for reducing preventable causes of CP. Existing evidence suggests that many cases in Cameroon are associated with birth asphyxia, neonatal infections, severe jaundice, and poorly managed neonatal complications. Expanding access to skilled birth attendance, emergency obstetric care, neonatal resuscitation, and infection prevention strategies could substantially reduce early brain injury and long-term neurodevelopmental impairment.

Second, early detection and intervention systems must become a national priority. Developmental surveillance should be integrated into routine maternal and child healthcare platforms, including immunization clinics and primary healthcare services. Frontline healthcare workers require training in recognizing early motor abnormalities, developmental delays, feeding difficulties, and associated impairments. Earlier diagnosis would allow timely rehabilitation interventions and reduce the progression of secondary complications.

Third, rehabilitation services must be decentralized and integrated into primary healthcare systems. Expanding PRM training programmes at undergraduate and postgraduate levels would help address critical workforce shortages. Equally important is the development of multidisciplinary rehabilitation models that incorporate physiotherapy, occupational therapy, speech and language therapy, nutrition, orthopaedics, epilepsy management, and psychosocial support. Rehabilitation should not remain confined to tertiary urban hospitals but should be available closer to where families live.

Community-based rehabilitation (CBR) offers a particularly promising strategy within low-resource settings. CBR approaches aligned with World Health Organization (WHO) guidelines can improve service access, empower caregivers, and strengthen continuity of care within homes and communities. Task-sharing models involving community health workers and trained caregivers may help bridge workforce shortages while promoting culturally responsive support systems.

Inclusive education must also move beyond policy rhetoric toward practical implementation. This requires investment in accessible school infrastructure, adapted curricula, teacher training, assistive technologies, and individualized educational support systems. Educational inclusion is critical not only for academic achievement but also for social participation and long-term economic opportunities for children with CP.

Supporting caregivers should form a central component of national CP strategies. Psychosocial/mental health counselling through structured and unstructured peer support programmes including parent support groups, and financial protection mechanisms are urgently needed to reduce caregiver burden and improve family wellbeing. Integrating disability-related services within universal health coverage frameworks could further reduce catastrophic out-of-pocket expenditures and improve continuity of care.

Finally, strengthening disability governance and data systems is essential for sustainable progress. Cameroon currently lacks a national CP registry and comprehensive disability surveillance systems. Developing robust epidemiological data systems would improve understanding of disease burden, guide resource allocation, and inform evidence-based policy development. Aligning national rehabilitation priorities with global frameworks such as WHO Rehabilitation 2030 could further support the integration of rehabilitation into universal health coverage and paediatric healthcare planning.

The World Health Organization “Rehabilitation 2030 – A call for action” 2017.

Cerebral palsy in Cameroon reflects more than a childhood neurological condition; it exposes broader inequities in rehabilitation access, disability inclusion, and health system organization. Children with CP and their families continue to face delayed diagnosis, fragmented rehabilitation services, educational exclusion, stigma, and substantial financial and psychosocial burdens. These challenges are intensified by workforce shortages, weak referral systems, and limited implementation of disability inclusive policies.

Improving outcomes for children with CP therefore requires moving beyond fragmented and condition specific interventions toward integrated systems of care that address prevention, early identification, rehabilitation, education, caregiver support, and social inclusion simultaneously. Strengthening rehabilitation systems and embedding disability-inclusive approaches within pediatric and public health policy are essential for reducing avoidable disability and improving quality of life for affected children and their families.

Without sustained investment in equitable rehabilitation and inclusive systems of care, children with CP in Cameroon will continue to experience preventable exclusion across the life course. Conversely, integrated and rights-based approaches offer an important opportunity to advance health equity, disability inclusion, and child wellbeing within Cameroon and across similar low resource settings.

Authors’ contributions

Helen and Lynn contributed to the conception and drafting of the manuscript, acquisition, analysis, and interpretation of evidence. Golda and Julius revised the article critically for intellectual content, refining interpretations and comparing contextual findings with broader literature, and ensuring clarity and scholarly rigor. All authors provided final approval of the final version.

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