# A multi-national cross-sectional exploration of rehabilitation services for children and young people following brain injury in low and middle income countries

## TL;DR

This study explores the availability of rehabilitation services for children with brain injuries in low and middle income countries, finding significant disparities and a need for better funding and prevention.

## Contribution

The study provides the first multi-national assessment of rehabilitation services for children with brain injuries in low and middle income countries.

## Key findings

- Healthcare professionals in least developed countries rely on charities for rehabilitation funding, while upper middle income countries are government-funded.
- Hypoxia is identified as the greatest cause of brain injury in low and middle income countries.
- There are significant differences in access to various rehabilitation services based on a country's development status.

## Abstract

Brain injury (BI) is the largest cause of mortality and morbidity among children and can lead to significant cognitive, social, emotional and behavioural deficits. There has been an absence of research examining the availability of rehabilitation services for affected children and young people in low and middle income countries (LMICs). This study therefore investigated current rehabilitation provision in LMICs for children and young people with BI.

An online survey was developed which collected data on funding support for rehabilitation, causes of BI and access to services. The survey was distributed to healthcare professionals known to members of the research team. Participants were asked to forward the survey to other professionals in their networks. Representation was sought from as many LMICs as possible. Data were analysed using descriptive statistics (e.g. percentages) and the Kruskal Wallis test to explore differences between Official Development Assistance (ODA) status (least developed, lower middle and upper middle) on access to services.

A total of 179 participants from 32 LMICs responded to the survey. Healthcare professionals from the least developed countries reported charities as the main source of funding to support rehabilitation, while those from upper middle income regions were most often funded by governments. According to healthcare professionals, the greatest cause of BI in LMICs was hypoxia. The Kruskal Wallis test comparing ODA status showed statistically significant differences in access to services for occupational (P = .005), speech and language (P = .038) and aquatic therapies (P < .001), cognitive (p < .001) and vocational rehabilitation (P = .008), and community based inclusive development programmes (P = .009).

There is a lack of equity in accessibility of rehabilitation services for children and young people with BI in LMICs, with some services being non-existent in lower income countries. Improvements to obstetric services, screening and management of infectious diseases are needed to reduce rates of hypoxic injuries and injury prevention programmes are needed to reduce traumatic injury. Centralised, government funding is required to develop services to improve life chances for these children.

The online version contains supplementary material available at 10.1186/s12889-025-24933-0.