Cerebral palsy (CP) is the most common cause of childhood motor disability, with a global prevalence of 1.5-3 per 1000 live births.1 CP is a neurodevelopmental disorder caused by non-progressive damage to the developing brain, which can affect movement and posture, with variable degrees of activity limitation.2 The primary motor disability in CP may be accompanied by comorbidities of impaired sensation or perception, intellectual disability, communication and behavioural difficulties, seizures, and musculoskeletal complications. With improvements in public health, maternal and perinatal care, the birth prevalence of CP has been declining in high-income countries (HIC).3, 4, 5, 6 In contrast, higher rates of CP are now being reported from low- and middle-income countries (LMICs) where the majority of births occur and perinatal care is suboptimal in the background of economic vulnerability.7, 8, 9, 10 A recent systematic analysis of the global prevalence of CP concluded that the overall CP (including pre-/peri- and postnatal) birth prevalence is 1.6 per 1000 (95% CI 1.5-1.7) live births in the HICs, and ranged between 2.3 to 3.7 per 1000 children in LMICs, which is markedly higher than in HICs.11 Population-based data on children below 18 years of age from the Global Low- and Middle-Income Country CP register (GLM-CPR) showed that the majority (87%) of children acquired CP pre- and perinatally. The GLM-CPR also highlighted that the proportion of severe cases of CP was markedly high in the LMICs, and nearly half of patients lacked access to rehabilitation.12 The severity of CP as well as the risk factors for CP differ in high resource versus low resource countries.13,14 Emerging studies from LMICs indicate the rarity of CP related to preterm births is related to the high mortality of the severely ill infants in regions with poor access to neonatal intensive care.15,16 Several of the risk factors prevalent in LMICs are preventable and potentially amenable to public health measures.

Early diagnosis of CP is crucial for timely intervention, which can significantly improve motor and cognitive outcomes. However, in low-resource settings, several barriers hinder early identification, and hence early intervention. The current article focuses on the etiology and risk factors of CP in resource-limited regions. as well as the challenges and solutions for early diagnosis and intervention.