Hammersmith Infant Neurological Examination for early detection of cerebral palsy in Ethiopia: A feasibility and knowledge translation study

AIM: To implement the Hammersmith Infant Neurological Examination (HINE) in the low-resource setting of Ethiopia using the Knowledge-to-Action Framework, report on the percentage of infants classified as having cerebral palsy (CP) or a high probability of CP, and evaluate age at CP detection and referral. METHOD: Implementation strategies were identified using the Knowledge-to-Action Framework. Paediatric staff and residents received HINE training and administered it in selected clinics. Based on the HINE global score, infants were classified into (1) above the 10th centile score (accepted score), (2) between the 10th centile and a high probability of CP cut-off score, and (3) below the high probability of CP cut-off score. Age at CP detection and referral were assessed. RESULTS: Ninety-eight infants with CP risk factors were classified on clinical reasoning and the HINE global score; 48 (49%) scored above the HINE 10th centile score, 15 (15%) fell into the 'developmental monitoring and coaching' category, and 35 (36%) scored below the high probability of the CP cut-off score. The mean age of children in the third category who received a diagnosis of CP or high probability of CP was 10.6 months (SD = 6.6, range = 3-23 months). All were referred to rehabilitation centres at the time of diagnosis. INTERPRETATION: Implementing the HINE in Ethiopia enabled detection of CP or high probability of CP in children aged under 12 months and timely referral to rehabilitation services.