Cognitive Abilities of Pre- and Primary School Children with Spina Bifida in Uganda

Femke Bannink, Johnny R. J. Fontaine, Richard Idro, Geert van Hove


This study investigates cognitive abilities of pre/primary school children without and with spina bifida in Uganda. Qualitative semi structured interviews and quantitative functioning scales measurements were combined and conducted with 133 parents, 133 children with spina bifida, and 35 siblings.  ANCOVA was used to test for differences in cognitive scores between children and siblings. Logistic regression analyses were used to study predictive demographic, impairment specific, and environmental factors of cognitive functioning. Children with spina bifida in Uganda had lower cognitive outcomes compared to their siblings. Cognitive outcomes were predicted by age, household income, motor functioning, and schooling. Better motor functioning was predicted by age, the presence of hydrocephalus, and parental support. Continence management was predicted by parental support and household income. Schooling was predicted by age, household income, and motor functioning. Limited access to neurosurgery and rehabilitative care, and schooling had a negative effect on cognitive functioning. Children of parents who have support had better motor functioning, and continence management. A holistic approach for children with spina bifida and their families, including community based rehabilitation; ensuring social support and livelihoods for parents; and access to health and education services can contribute to better cognitive outcomes.


Cognitive abilities, motor function, schooling, spina bifida, Africa

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Abresch, R. T., McDonald, D. A., Widman, L. M., McGinnis, K., & Hickey, K. J. (2007). Impact of spinal cord dysfunction and obesity on the health-related quality of life of children and adolescents. J Spinal Cord Med, 30 Suppl 1, S112-118.

Abubakar, A., Van de Vijver, F., Van Baar, A., Mbonani, L., Kalu, R., Newton, C., & Holding, P. (2008). Socioeconomic status, anthropometric status, and psychomotor development of Kenyan children from resource-limited settings: a path-analytic study. Early human development, 84(9), 613-621.

Alcock, K. J., Holding, P., Mung'ala-Odera, V., & Newton, C. (2008). Constructing tests of cognitive abilities for schooled and unschooled children. Journal of Cross-Cultural Psychology, 39(5), 529-551.

Andren, E., & Grimby, G. (2000). Dependence and perceived difficulty in activities of daily living in adults with cerebral palsy and spina bifida. [Clinical Trial Comparative Study Research Support, Non-U.S. Gov't]. Disabil Rehabil, 22(7), 299-307. doi:

Bangirana, P., Seggane, M., Allebeck, P., Giordani, B., John, C. C., Opoka, O. R., . . . Boivin, M. J. (2009). A preliminary examination of the construct validity of the KABC-II in Ugandan children with a history of cerebral malaria. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't]. Afr Health Sci, 9(3), 186-192.

Bangirana, P., Sikorskii, A., Giordani, B., Nakasujja, N., & Boivin, M. J. (2015). Validation of the CogState battery for rapid neurocognitive assessment in Ugandan school age children. Child Adolesc Psychiatry Ment Health, 9, 38. doi: 10.1186/s13034-015-0063-6

AUTHORS (2016)

AUTHORS (2015)

Beery, K. E., Buktenica, N. A., & Beery, N. A. (1989). The VMI: Administration, Scoring, and Teaching Manual (Developmental Test of Visual-Motor Integration) San Antonio: Pearson.

Boivin, M. J. (2002). Effects of early cerebral malaria on cognitive ability in Senegalese children. Journal of Developmental & Behavioral Pediatrics, 23(5), 353-364.

Chataika, T., McKenzie, J. A., Swart, E., & Lyner-Cleophas, M. (2012). Access to education in Africa: responding to the United Nations Convention on the Rights of Persons with Disabilities. Disability & Society, 27(3), 385-398. doi: 10.1080/09687599.2012.654989

Coomer, R. A. (2013). The experiences of parents of children with mental disability regarding access to mental health care. Afr J Psychiatry (Johannesbg), 16(4), 271-276. doi:

CURE. (2008). Caretaker’s Information Kit. Pennsylvania: CURE Children’s Hospital of Uganda and York College, Department of Nursing.

Danielsson, A. J., Bartonek, A., Levey, E., McHale, K., Sponseller, P., & Saraste, H. (2008). Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele. J Child Orthop, 2(1), 45-54. doi: 10.1007/s11832-007-0069-6

Dennis, M., Jewell, D., Drake, J., Misakyan, T., Spiegler, B., Hetherington, R., . . . Barnes, M. (2007). Prospective, declarative, and nondeclarative memory in young adults with spina bifida. [Research Support, N.I.H., Extramural

Research Support, Non-U.S. Gov't]. J Int Neuropsychol Soc, 13(2), 312-323. doi: 10.1017/S1355617707070336

Dennis, M., Landry, S. H., Barnes, M., & Fletcher, J. M. (2006). A model of neurocognitive function in spina bifida over the life span. Journal of the International Neuropsychological Society, 12(02), 285-296. doi: doi:10.1017/S1355617706060371

Dennis, M. B., M.A. (2010). The cognitive phenotype of spina bifida meningomyelocele. Developmental Disabilities(16), 9. doi: 10.1002/mrdd.89

Ejuu, G. (2016). Moving in Circles along a Straight Path: The Elusiveness of Inclusive Education in Early Childhood Development in Uganda. Journal of Childhood & Developmental Disorders, 2(1).

Feder, K. P., & Majnemer, A. (2007). Handwriting development, competency, and intervention. Developmental Medicine & Child Neurology, 49(4), 312-317. doi: 10.1111/j.1469-8749.2007.00312.x

Fletcher, J. M. (2014). Alternative Approaches to Outcomes Assessment: Beyond Psychometric Tests. Pediatr Blood Cancer, 61(10), 1734-1738.

Fletcher, J. M., Barnes, M., & Dennis, M. (2002). Language development in children with spina bifida. [Research Support, U.S. Gov't, P.H.S. Review]. Semin Pediatr Neurol, 9(3), 201-208.

Gona, J. K., Mung'ala-Odera, V., Newton, C. R., & Hartley, S. (2011). Caring for children with disabilities in Kilifi, Kenya: what is the carer's experience? [Research Support, Non-U.S. Gov't]. Child Care Health Dev, 37(2), 175-183. doi: 10.1111/j.1365-2214.2010.01124.x

Government of Uganda. (2013). The Education and Sports Sector Annual Performance Report FY 2012/13. Kampala: Ministry of Education and Sports.

Government of Uganda. (2014). National Agricultural Advisory Services Programme (NAADS) Progress Report 2013/14 Retrieved March 8, 2015

Guyer, J. I. (1981). Household and community in African studies. African Studies Review, 87-137. doi:

Halpern, D. F. (2013). Sex differences in cognitive abilities: Psychology press.

Hartley, S., Ojwang, P., Baguwema, A., Ddamulira, M., & Chavuta, A. (2004). How do carers of disabled cope? The ugandan perspective. Child: care, health and development. , 31(2), 14. doi:

Hetherington, R., Dennis, M., Barnes, M., Drake, J., & Gentili, F. (2006). Functional outcome in young adults with spina bifida and hydrocephalus. Child's Nervous System, 22(2), 117-124.

Holding, P. A., Taylor, H. G., Kazungu, S. D., Mkala, T., Gona, J., Mwamuye, B., . . . Stevenson, J. (2004). Assessing cognitive outcomes in a rural African population: development of a neuropsychological battery in Kilifi District, Kenya. Journal of the International Neuropsychological Society, 10(02), 246-260.

Hunt, E. (2010). Human intelligence: Cambridge University Press.

IFSBH (2014). Spina Bifida - Fact Sheet. [Information Material] Retrieved on October 26 2015 from

Jansen, H., Blokland, E., de Jong, C., Greving, J., & Poenaru, D. (2009). Quality of life of African children with spina bifida: results of a validated instrument. Cerebrospinal Fluid Research, 6(Suppl 2), S25. doi: 10.1186/1743-8454-6-s2-s25

Lindquist, B., Persson, E. K., Uvebrant, P., & Carlsson, G. (2008). Learning, memory and executive functions in children with hydrocephalus. [Research Support, Non-U.S. Gov't]. Acta Paediatr, 97(5), 596-601. doi: 10.1111/j.1651-2227.2008.00747.x

Lindsay, S. (2014). A Qualitative Synthesis of Adolescents’ Experiences of Living With Spina Bifida. Qualitative Health Research, 24(9), 1298-1309. doi: 10.1177/1049732314546558

Lyla E. Hampton, Jack M. Fletcher, Paul T. Cirino, Susan Blaser, Larry A. Kramer, James Drake, & Maureen Dennis. (2011). Hydrocephalus status in spina bifida: an evaluation of variations in neuropsychological outcomes. Journal of Neurosurgery: Pediatrics, 8(3), 289-298. doi: doi:10.3171/2011.6.PEDS10584

Mertens, P., & Bannink, F. (2012). Interdisciplinary care for children with spina bifida in east and southern Africa. Journal of Medicine and the Person, 10(3), 129-135. doi: DOI 10.1007/s12682-012-0126-x

Miles, M. (2002). Children with spina bifida and hydrocephalus in East Africa: can family and community resources improve the odds? Disability & Society, 17, 15. doi:

Nampijja, M., Apule, B., Lule, S., Akurut, H., Muhangi, L., Elliott, A. M., & Alcock, K. J. (2010). Adaptation of Western measures of cognition for assessing 5-year-old semi-urban Ugandan children. British Journal of Educational Psychology, 80(1), 15-30. doi: 10.1348/000709909x460600

Northrup, H., & Volcik, K. A. (2000). Spina bifida and other neural tube defects. [Review]. Curr Probl Pediatr, 30(10), 313-332. doi: PMID 11147289

NUDIPU. (2016). National Union of Disabled Persons of Uganda Retrieved December 12, 2015

Nyende, F. (2012). Children with Disabilities in Universal Primary Education in Uganda: A Rights-Based Analysis to Inclusive Education The Hague: Institute of Social Studies.

Paget, A., Mallewa, M., Chinguo, D., Mahebere-Chirambo, C., & Gladstone, M. (2015). "It means you are grounded" - caregivers' perspectives on the rehabilitation of children with neurodisability in Malawi. Disabil Rehabil, 1-12. doi: 10.3109/09638288.2015.1035458

Pike, M., Swank, P., Taylor, H., Landry, S., & Barnes, M. A. (2013). Effect of Preschool Working Memory, Language, and Narrative Abilities on Inferential Comprehension at School-Age in Children with Spina Bifida Myelomeningocele and Typically Developing Children. Journal of the International Neuropsychological Society, 19(04), 390-399. doi: doi:10.1017/S1355617712001579

Raghubar, K. P., Barnes, M. A., Dennis, M., Cirino, P. T., Taylor, H., & Landry, S. (2015). Neurocognitive predictors of mathematical processing in school-aged children with spina bifida and their typically developing peers: Attention, working memory, and fine motor skills. Neuropsychology, 29(6), 861-873. doi: 10.1037/neu0000196

Reitan, R. (1985). Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation. Tucson, Arizona: Reitan Neuropsychology.

Rose, B. M., & Holmbeck, G. N. (2007). Attention and executive functions in adolescents with spina bifida. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't]. J Pediatr Psychol, 32(8), 983-994. doi: 10.1093/jpepsy/jsm042

Schechter, M. S., Liu, T., Swanson, M., Ward, E., & Thibadeau, J. (2015). Sociodemographic Attributes and Spina Bifida Outcomes. Pediatrics, 135(4), e957-e964.

Strand, S., Deary, I. J., & Smith, P. (2006). Sex differences in cognitive abilities test scores: A UK national picture. British Journal of Educational Psychology, 76(3), 463-480.

Sylva, K. (1994). School influences on children's development. [Review]. J Child Psychol Psychiatry, 35(1), 135-170.

Tarazi, R. A., Zabel, T. A., & Mahone, E. M. (2008). Age-related differences in executive function among children with spina bifida/hydrocephalus based on parent behavior ratings. [Research Support, N.I.H., Extramural]. Clin Neuropsychol, 22(4), 585-602. doi: 10.1080/13854040701425940

UNICEF. (2014). Situational Analysis on the Rights of Children with Disabilities in Uganda. Kampala: UNICEF.

USAID, & AVSI. (2016). Sustainable Comprehensive REsponses (SCORE) for Vulnerable Children and their Families Retrieved March 8, 2016

van't Veer, T., Meester, H., Poenaru, D., Kogei, A., Augenstein, K., & Bransford, R. (2008). Quality of life for families with spina bifida in Kenya. Trop Doct, 38(3), 160-162. doi: 10.1258/td.2007.070053

Verpoorten, C., & Buyse, G. M. (2008). The neurogenic bladder: medical treatment. [Review]. Pediatr Nephrol, 23(5), 717-725. doi: 10.1007/s00467-007-0691-z

Vinck, A., Nijhuis-van der Sanden, M. W. G., Roeleveld, N. J. A., Mullaart, R. A., Rotteveel, J. J., & Maassen, B. A. M. (2010). Motor profile and cognitive functioning in children with spina bifida. European Journal of Paediatric Neurology, 14(1), 86-92. doi: 10.1016/j.ejpn.2009.01.003

Warf, B. C., & Campbell, J. W. (2008). Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment of hydrocephalus for infants with myelomeningocele: long-term results of a prospective intent-to-treat study in 115 East African infants. J Neurosurg Pediatr, 2(5), 310-316. doi: 10.3171/PED.2008.2.11.310

Warf, B. C., Ondoma, S., Kulkarni, A., Donnelly, R., Ampeire, M., Akona, J., . . . Nsubuga, B. K. (2009). Neurocognitive outcome and ventricular volume in children with myelomeningocele treated for hydrocephalus in Uganda. J Neurosurg Pediatr, 4(6), 564-570. doi: 10.3171/2009.7.PEDS09136

Warf, B. C., Wright, E. J., & Kulkarni, A. V. (2011). Factors affecting survival of infants with myelomeningocele in southeastern Uganda. J Neurosurg Pediatr, 7(2), 127-133. doi: 10.3171/2010.11.PEDS10428

Wechsler, D. (2003). Manual for the Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV). San Antorio: TX: The Psychological Cooperation.


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