{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:23:58Z","timestamp":1790310238963,"version":"4.1.0"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Cerebral palsy is a frequent physical disability of childhood, causing motor impairment, sensory impairment, cognitive and behavioral issues, and secondary musculoskeletal deformities, with a global incidence of 1\u20134 per 1,000 children. It significantly impacts children\u2019s quality of life and imposes an economic burden on families and healthcare systems. There is limited evidence of the risk factors of cerebral palsy in Ethiopia, including in the study setting. We investigated factors associated with cerebral palsy among children attending Hawassa University Comprehensive Specialized Hospital.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>An institution-based, unmatched case-control study was conducted among children who visited Hawassa University Comprehensive Specialized Hospital from January 2019 to December 2023. Consecutive cases were recruited until the required sample size was reached, and controls were randomly selected. Data were extracted from 80 cases and 160 control charts. Binary logistic regression analysis was used to identify risk factors for cerebral palsy. An adjusted odds ratio with a 95% confidence interval was reported to show the strength of the association. The significance of the association was declared at a p-value\u2009&lt;\u20090.05. The goodness-of-fit model was checked by the Hosmer and Lemeshow test.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 240 participants (80 cases and 160 controls) were enrolled in the study. Maternal infection during pregnancy [AOR:4.1; 95%; 1.39, 12.1], low birth weight [AOR:4.1; 95%; 1.49, 11.2], prolonged labor [AOR:3.2; 95%;1.47, 7.00], history of perinatal asphyxia [AOR: 2.65; 95%;1.06, 6.65], and central nervous system infection during infancy [AOR:3.4; 95%; 1.21, 9.64] were risk factors for cerebral palsy.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Perinatal asphyxia, maternal infection, low birth weight, prolonged labor, and CNS infection during infancy are significantly associated with cerebral palsy. Public health education should promote awareness about cerebral palsy, encourage antenatal care, and educate healthcare professionals on emergency obstetrics and newborn care. Appropriate measures should be taken to reduce the incidence of CNS infections during infancy.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0333406","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T17:21:53Z","timestamp":1758907313000},"page":"e0333406","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Factors associated with cerebral palsy among children in Hawassa University comprehensive specialized hospital: Case-control study"],"prefix":"10.1371","volume":"20","author":[{"given":"Bethelhem","family":"Bashe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2006-6368","authenticated-orcid":true,"given":"Desalegn Dawit","family":"Assele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Worku","family":"Ketema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3339-9225","authenticated-orcid":true,"given":"Mulugeta Sitot","family":"Shibeshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"pone.0333406.ref001","first-page":"85","article-title":"Association between risk factors & cerebral palsy and prevalence of its different types","volume":"103","author":"A Ghazal","year":"2019","journal-title":"Hospital"},{"key":"pone.0333406.ref002","first-page":"2020","article-title":"Risk factors for cerebral palsy in Brazilian children: a case-control study","volume":"2020","author":"S Peixoto MV d","year":"2020","journal-title":"medRxiv"},{"key":"pone.0333406.ref003","doi-asserted-by":"crossref","DOI":"10.21037\/tp.2020.01.01","article-title":"Cerebral palsy in children: a clinical overview","volume":"9","author":"DR Patel","year":"2020","journal-title":"Transl Pediatr"},{"key":"pone.0333406.ref004","doi-asserted-by":"crossref","first-page":"2622310","DOI":"10.1155\/2022\/2622310","article-title":"A Review on Recent Advances of Cerebral Palsy","volume":"2022","author":"S Paul","year":"2022","journal-title":"Oxid Med Cell Longev"},{"key":"pone.0333406.ref005","volume-title":"Data and Statistics for Cerebral Palsy: National Center on Birth Defects and Developmental Disabilities","author":"CDC","year":"2022"},{"key":"pone.0333406.ref006","volume-title":"Nelson textbook of pediatrics","author":"MK Robert","year":"2015","edition":"21"},{"issue":"1","key":"pone.0333406.ref007","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.spen.2014.01.001","article-title":"Pediatric cerebral palsy in Africa: a systematic review","volume":"21","author":"KA Donald","year":"2014","journal-title":"Semin Pediatr Neurol"},{"issue":"15","key":"pone.0333406.ref008","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000033479","article-title":"Etiological risk factors in children with cerebral palsy","volume":"102","author":"A Ba\u015faran","year":"2023","journal-title":"Medicine (Baltimore)"},{"issue":"1","key":"pone.0333406.ref009","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1186\/s12887-024-05156-5","article-title":"Associations of risk factors and the number of risk factors with the classification, GMFCS level and comorbidities with cerebral palsy: a retrospective study","volume":"24","author":"C Gong","year":"2024","journal-title":"BMC Pediatr"},{"issue":"1","key":"pone.0333406.ref010","doi-asserted-by":"crossref","first-page":"47","DOI":"10.2340\/16501977-2486","article-title":"Paediatric cerebral palsy prevalence and high-risk factors in Henan province, Central China","volume":"51","author":"J Yuan","year":"2019","journal-title":"J Rehabil Med"},{"issue":"7","key":"pone.0333406.ref011","first-page":"1315","article-title":"Risk factors evaluation of cerebral palsy in Hazara division Khyber Pakhtunkhwa Pakistan: A cross-sectional survey","volume":"72","author":"KU Keramat","year":"2022","journal-title":"J Pak Med Assoc"},{"issue":"2","key":"pone.0333406.ref012","doi-asserted-by":"crossref","first-page":"179","DOI":"10.3233\/NPM-1759","article-title":"Perinatal asphyxia in a rural Nigerian hospital: Incidence and determinants of early outcome","volume":"11","author":"OI Egharevba","year":"2018","journal-title":"J Neonatal Perinatal Med"},{"issue":"4","key":"pone.0333406.ref013","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2016-0874","article-title":"Maternal Prepregnancy BMI and Risk of Cerebral Palsy in Offspring","volume":"138","author":"I Forthun","year":"2016","journal-title":"Pediatrics"},{"key":"pone.0333406.ref014","first-page":"705","article-title":"Cerebral palsy in Pakistani children: a hospital based survey","volume":"39","author":"P\u00c7S Palsi","year":"2014","journal-title":"Cukurova Med J"},{"issue":"3","key":"pone.0333406.ref015","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1159\/000314345","article-title":"Door-to-door survey of major neurological disorders in Al Kharga District, New Valley, Egypt: methodological aspects","volume":"35","author":"HNA El Tallawy","year":"2010","journal-title":"Neuroepidemiology"},{"issue":"2","key":"pone.0333406.ref016","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.ncl.2020.01.009","article-title":"Principles of Medical and Surgical Treatment of Cerebral Palsy","volume":"38","author":"EM Chin","year":"2020","journal-title":"Neurol Clin"},{"issue":"1","key":"pone.0333406.ref017","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1186\/s13052-024-01715-9","article-title":"Effects of hippotherapy on motor function of children with cerebral palsy: a systematic review study","volume":"50","author":"P Plotas","year":"2024","journal-title":"Ital J Pediatr"},{"key":"pone.0333406.ref018","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.ridd.2018.06.012","article-title":"Systematic review of the economic impact of cerebral palsy","volume":"80","author":"U Tonmukayakul","year":"2018","journal-title":"Res Dev Disabil"},{"issue":"2","key":"pone.0333406.ref019","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.healthpol.2008.01.001","article-title":"A preliminary study into the economic burden of cerebral palsy in China","volume":"87","author":"B Wang","year":"2008","journal-title":"Health Policy"},{"issue":"8","key":"pone.0333406.ref020","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-038453","article-title":"Associations between antenatal and perinatal risk factors and cerebral palsy: a Swedish cohort study","volume":"10","author":"A J\u00f6ud","year":"2020","journal-title":"BMJ Open"},{"key":"pone.0333406.ref021","doi-asserted-by":"crossref","first-page":"9993912","DOI":"10.1155\/2021\/9993912","article-title":"Determinants of Cerebral Palsy in Pediatric Patients in Northern Ethiopia: A Hospital-Based Study","volume":"2021","author":"PE Ekanem","year":"2021","journal-title":"Neurol Res Int"},{"key":"pone.0333406.ref022","unstructured":"WHO. Perinatal asphyxia. https:\/\/www.who.int\/teams\/maternal-newborn-child-adolescent-health-and-ageing\/newborn-health\/perinatal-asphyxia. 2023."},{"issue":"4","key":"pone.0333406.ref023","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1111\/ped.12420","article-title":"Biochemical and clinical features of hereditary hyperprolinemia","volume":"56","author":"H Mitsubuchi","year":"2014","journal-title":"Pediatr Int"},{"key":"pone.0333406.ref024","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.pediatrneurol.2015.12.018","article-title":"Maternal Infections During Pregnancy and Cerebral Palsy in the Child","volume":"57","author":"JJ Bear","year":"2016","journal-title":"Pediatr Neurol"},{"issue":"1","key":"pone.0333406.ref025","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0281066","article-title":"Prevalence of birth injuries and associated factors among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021. Crossectional study","volume":"18","author":"EA Tibebu","year":"2023","journal-title":"PLoS One"},{"key":"pone.0333406.ref026","doi-asserted-by":"crossref","unstructured":"LK A, RG Q. Central Nervous System Infections. Textbook of Neurointensive Care 2013 May 7:427\u2013517 doi:.","DOI":"10.1007\/978-1-4471-5226-2_22"},{"issue":"7","key":"pone.0333406.ref027","doi-asserted-by":"crossref","first-page":"859","DOI":"10.3390\/brainsci12070859","article-title":"Epidemiology of Cerebral Palsy among Children and Adolescents in Arabic-Speaking Countries: A Systematic Review and Meta-Analysis","volume":"12","author":"SM Mushta","year":"2022","journal-title":"Brain Sci"},{"issue":"3","key":"pone.0333406.ref028","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1111\/apa.14147","article-title":"The panorama of cerebral palsy in Sweden part XII shows that patterns changed in the birth years 2007-2010","volume":"107","author":"K Himmelmann","year":"2018","journal-title":"Acta Paediatr"},{"issue":"3","key":"pone.0333406.ref029","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/s00401-017-1718-6","article-title":"White matter injury in the preterm infant: pathology and mechanisms","volume":"134","author":"SA Back","year":"2017","journal-title":"Acta Neuropathol"},{"issue":"3","key":"pone.0333406.ref030","first-page":"215","article-title":"Intraventricular hemorrhage in preterm babies","volume":"55","author":"E \u00d6zek","year":"2020","journal-title":"Turk Pediatri Ars"},{"key":"pone.0333406.ref031","article-title":"Periventricular and intraventricular hemorrhage","volume-title":"StatPearls","author":"R Starr","year":"2025"},{"issue":"4","key":"pone.0333406.ref032","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1113\/JP271402","article-title":"The consequences of fetal growth restriction on brain structure and neurodevelopmental outcome","volume":"594","author":"SL Miller","year":"2016","journal-title":"J Physiol"},{"issue":"6","key":"pone.0333406.ref033","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1093\/tropej\/fmz006","article-title":"Neurodevelopmental Outcomes of Very Low Birth Weight Infants at 18-24 Months, Corrected Gestational Age in a Tertiary Health Centre: A Prospective Cohort Study","volume":"65","author":"SP Oommen","year":"2019","journal-title":"J Trop Pediatr"},{"key":"pone.0333406.ref034","article-title":"Congenital and maternal syphilis","volume-title":"StatPearls","author":"S Leslie","year":"2025"},{"key":"pone.0333406.ref035","doi-asserted-by":"crossref","first-page":"704","DOI":"10.3389\/fneur.2020.00704","article-title":"Birth Asphyxia Is Associated With Increased Risk of Cerebral Palsy: A Meta-Analysis","volume":"11","author":"S Zhang","year":"2020","journal-title":"Front Neurol"},{"key":"pone.0333406.ref036","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.eclinm.2018.12.001","article-title":"Early Childhood Outcomes After Neonatal Encephalopathy in Uganda: A Cohort Study","volume":"6","author":"CJ Tann","year":"2018","journal-title":"EClinicalMedicine"},{"issue":"3","key":"pone.0333406.ref037","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1111\/dmcn.12228","article-title":"Population-based studies of brain imaging patterns in cerebral palsy","volume":"56","author":"SM Reid","year":"2014","journal-title":"Dev Med Child Neurol"},{"issue":"1","key":"pone.0333406.ref038","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1186\/s12887-020-02449-3","article-title":"Intrauterine cytomegalovirus infection: a possible risk for cerebral palsy and related to its clinical features, neuroimaging findings: a retrospective study","volume":"20","author":"H Xu","year":"2020","journal-title":"BMC Pediatr"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333406","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T17:21:59Z","timestamp":1758907319000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333406"}},"subtitle":[],"editor":[{"given":"Efrem","family":"Kentiba","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,9,26]]},"references-count":38,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,26]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0333406","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,26]]}}}