Rehabilitation of Obstetric Brachial Plexus Palsy at the National Orthopedic Rehabilitation Center of Mali: A Longitudinal Study of 150 Children Followed between 2020 and 2023

Background: Obstetric brachial plexus palsy (OBPP) remains a neonatal neurological complication associated with dystocic deliveries despite recent advances in obstetric practice. African and Malian data regarding prognostic factors and responses to rehabilitation remain scarce. Objective: To investigate the epidemiological, clinical, and prognostic characteristics of children with OBPP managed at the National Orthopaedic Rehabilitation Center of Mali (CNAOM). Methods: We conducted a prospective longitudinal study at the CNAOM between October 2020 and December 2023. Children aged 0 - 5 years with clinically confirmed OBPP according to the Narakas classification and who underwent standardized rehabilitation follow-up were included. Patients were assessed at admission and subsequently at 3, 6, and 18 months. The primary outcome was the evolution of the global active movement score of the affected upper limb. Statistical analyses included descriptive methods, bivariate analyses, and multivariable logistic regression using generalized estimating equations (GEE). Results: Among 28,939 admissions to the CNAOM, 1,123 cases of OBPP were identified, corresponding to a hospital frequency of 3.8%. A total of 150 children were included in the final analysis. The median age at diagnosis was four months. The male-to-female ratio was 1.34. Partial Narakas forms (types I - II) accounted for 56.7% of cases, whereas complete forms (types III - IV) represented 43.3%. Complete recovery was observed in 78% of children after follow-up. Independent predictors of favorable outcomes included partial OBPP (adjusted OR = 3.86; 95% CI: 2.78 - 5.36; p < 0.001), maternal age below 35 years (adjusted OR = 2.30; 95% CI: 1.45 - 3.67; p < 0.001), primiparity (adjusted OR = 1.55; 95% CI: 1.08 - 2.21; p = 0.017), and normal or low birth weight (adjusted OR = 1.75; 95% CI: 1.16 - 2.63; p = 0.007). Conclusion: OBPP is a common condition encountered in pediatric rehabilitation services in Mali. Early functional rehabilitation significantly improves motor outcomes, particularly in children presenting with partial lesions. Delayed diagnosis and complete lesions remain associated with an increased risk of long-term disability.