ABSTRACT
BACKGROUND: One of the main objectives of studying intellectual disability (ID) in children is to explore its causes. A specific aetiological diagnosis is important in determining the prognosis, nature and extent of services needed to support affected children. METHODS: Aetiology and risk factors in mild ID were studied in a cohort of longitudinally followed children (6-10 years of age, n = 40) in four population groups in and around Lahore, Pakistan. RESULTS: The overall prevalence of mild ID was 6.2%. In 22% of the cases the onset of mild ID was prenatal with small for gestational age and multifactorial inheritance as the main underlying factors. During the postnatal period (28% of the cases), social deprivation and malnutrition were the major causes of ID. In a substantial proportion of the cases (50%), the cause of ID could not be traced. CONCLUSION: The present study indicates a clear relationship of mild ID with prenatal and postnatal malnutrition and social deprivation. Two independent variables, maternal illiteracy and small head circumference at birth, showed a clear association with the development of mild mental disability among children in the study population.
Subject(s)
Intellectual Disability/epidemiology , Intellectual Disability/etiology , Catchment Area, Health , Child , Female , Humans , Intellectual Disability/metabolism , Male , Malnutrition/epidemiology , Maternal Age , Pakistan/epidemiology , Parenting , Prevalence , Risk Factors , Severity of Illness Index , Socioeconomic Factors , Urban Population/statistics & numerical dataABSTRACT
UNLABELLED: The aim of this study was to find the prevalence of mild mental retardation (MMR) in 6-10-y-old children in a prospectively followed cohort in Pakistan from four areas with different socioeconomic conditions. Retarded children were identified by a two-step method, comprising a household screening with the Ten Questions Screening in 649 families followed by clinical investigation and psychometric testing (WISC-R and Griffiths) of the 132 children found by the screening. The overall prevalence of MMR among 6-10-y-old children was 6.2%. The distribution of MMR was uneven, with 1.2% among children from the upper-middle class, 4.8% in the village, 6.1% in the urban slum and 10.5% in the poor periurban slum area. Additional impairments were found in 75% of the children with MMR, of which speech impairment was the most common. CONCLUSION: The prevalence of MMR was found to be higher in a developing country than in developed countries. It also seemed to be related to poor socioeconomic conditions, as the prevalence in the upper-middle class was comparable to figures from developed countries, while the prevalence in children from poor population groups was much higher.
Subject(s)
Intellectual Disability/epidemiology , Child , Comorbidity , Humans , Intellectual Disability/etiology , Pakistan/epidemiology , Prevalence , Prospective Studies , Socioeconomic FactorsSubject(s)
Disabled Persons/rehabilitation , Medical Laboratory Science , Adolescent , Brain Diseases/mortality , Brain Diseases/rehabilitation , Brain Diseases/therapy , Child , Child, Preschool , Congenital Abnormalities/mortality , Congenital Abnormalities/rehabilitation , Congenital Abnormalities/therapy , Female , Genetic Diseases, Inborn/mortality , Genetic Diseases, Inborn/rehabilitation , Genetic Diseases, Inborn/therapy , Humans , Infant , Infant, Newborn , Intensive Care Units, Neonatal , Intensive Care Units, Pediatric , Length of Stay , Male , SwedenSubject(s)
Child Care , Disabled Persons , Home Care Services , Home Nursing , Infant Care , Medical Laboratory Science , Parents/psychology , Adolescent , Adult , Child , Child, Preschool , Disabled Persons/rehabilitation , Home Care Services/organization & administration , Home Nursing/organization & administration , Humans , Infant , Infant, Newborn , Patient Education as Topic , Social Support , Stress, Psychological , Surveys and QuestionnairesABSTRACT
Severe mental retardation (developmental quotient (DQ) < 50) was investigated in 1303 children from 2 to 24 months of age, born during 1984-87 in four population groups representing different socio-economic levels in and around Lahore, Pakistan. The incidence per 1000 live births was 22 in the periurban slum, 9 in the urban slum, 7 in the village and 4 in the upper middle class group. The aetiology was prenatal in 79%, perinatal in 14% and untraceable in 7% of cases. Down's syndrome was the most common cause of severe mental retardation (36%). Impairments were studied at 2 years of age. Impairment of language was present in all, while locomotor dysfunction was seen in 89% of cases. Epilepsy and cerebral palsy were each present in 22% of cases. Mortality among these severely mentally retarded children was 36%.
Subject(s)
Intellectual Disability/epidemiology , Asphyxia Neonatorum/complications , Cerebral Palsy/complications , Chromosome Aberrations , Chromosome Disorders , Cohort Studies , Down Syndrome/complications , Epilepsy/complications , Female , Humans , Infant , Infant, Newborn , Intellectual Disability/etiology , Intellectual Disability/mortality , Male , Maternal Age , Pakistan/epidemiology , Poverty Areas , Social ClassABSTRACT
Psychomotor development was assessed in 1476 infants from four different levels of urbanization in and around Lahore, Pakistan. Development was assessed monthly at birth to 24 months of age by using a set of 10 milestones selected from the Denver Developmental Screening Test and the Developmental Screening Inventory. The psychomotor development of children in the upper middle (Um) class was consistent with reference population groups in Europe and North America, hence this group was used as control. There was significant delay in the psychomotor development of infants belonging to the poorer areas compared to the Um class. There was no sex difference in the development of the milestones in any study area, except for girls in the Um class who were earlier for about one month than boys in talking. Infants in the poorer areas were, on average about 3 months, delayed in their walking and fine motor activity (building a tower of 3 cubes) in comparison with the Um class. Observed disturbance in psychomotor development at an early age may affect the abilities and achievements in later life.
Subject(s)
Child Development , Psychomotor Performance , Female , Humans , Infant , Infant, Newborn , Language Development , Longitudinal Studies , Male , Pakistan , Socioeconomic Factors , UrbanizationABSTRACT
Nine severely mentally retarded patients with severe epilepsy who were living in an institution were studied during a three-year period by a multi-disciplinary team. A seizure rate serum level chart was made for each patient. It served as the basis for monthly discussions in the team about medication changes. Drug plasma concentrations were monitored monthly. Statistical comparisons between seizure frequency on different drug regimens were made by chi 2 test. Withdrawal of all medication was possible in one case and reduction to monotherapy in two cases. In the remainder of the patients a combination of two or three anticonvulsants gave the best clinical effect. We thus found polypharmacotherapy necessary for some severely retarded patients with epilepsy. Our multidisciplinary approach and chart monitoring system has many advantages and is valuable for the medical care and drug treatment of this patient category.
Subject(s)
Anticonvulsants/administration & dosage , Epilepsy/drug therapy , Institutionalization , Intellectual Disability/complications , Adolescent , Anticonvulsants/blood , Child , Drug Therapy, Combination , Epilepsy/blood , Epilepsy/complications , Evaluation Studies as Topic , Female , Humans , Male , Patient Care Team , Phenobarbital/administration & dosage , SwedenABSTRACT
The handicap section of the ICIDH was developed with the experience of adults in mind. In its original form the H Code is not immediately applicable to young children with disabilities. The Classification Group of the Nordic Neuropediatric Association has developed an adaptation of the H Code for use in children aged 6-7 years, and the adaptation is presented in this paper.
Subject(s)
Activities of Daily Living , Disabled Persons/classification , Child , Humans , Income , Interpersonal Relations , Neurology , Occupations , Orientation , Pediatrics , Scandinavian and Nordic Countries , Societies, Medical , WalkingABSTRACT
This paper reports on the clinical use of a classification of handicaps in 6-7-year-old mentally retarded children. A child-adapted handicap code of WHO's ICIDH was used. It was easy to manage and added valuable information to the child's medical status and psychosocial evaluation. The inter-observer agreement was most satisfactory. The handicap dimension of 'social integration' ought to be regarded as 'social interaction' and needs to be specified further.
Subject(s)
Disabled Persons/classification , Intellectual Disability/rehabilitation , Child , Disability Evaluation , Female , Humans , Intellectual Disability/physiopathology , Male , SwedenABSTRACT
The level of antitoxin i.e. neutralizing antibodies to pertussis toxin, or lymphocytosis promoting factor, was determined in six pertussis immune globulin preparations from different manufactures. A comparison with antitoxin levels after natural pertussis disease in adults showed that pertussis immune globulins did not contain more antitoxin than convalescent phase sera, i.e. they had very low antitoxin content for specific immune globulins. Agglutinin and anti-FHA titres were relatively higher in immune globulins, probably reflecting a difference between the antibody response elicited by whole cell vaccines used for hyperimmunization in immune globulin production and by natural disease. The low antitoxin content of currently available pertussis immune globulin preparations could explain the inefficacy or conflicting results obtained with these products in prophylaxis and therapy of whooping cough.
Subject(s)
Antibodies, Bacterial/analysis , Antitoxins/analysis , Bordetella pertussis/immunology , Immune Sera/analysis , Whooping Cough/immunology , Agglutination Tests , Enzyme-Linked Immunosorbent Assay , Humans , Immune Sera/immunology , Immunization , Immunization, Passive , Neutralization Tests , Quality ControlSubject(s)
Benzodiazepinones/therapeutic use , Clonazepam/therapeutic use , Epilepsy/drug therapy , Adolescent , Child , Child, Preschool , Clinical Trials as Topic , Clonazepam/administration & dosage , Clonazepam/adverse effects , Drug Evaluation , Drug Resistance , Drug Therapy, Combination , Epilepsy, Absence/drug therapy , Epilepsy, Temporal Lobe/drug therapy , Female , Humans , Male , PlacebosSubject(s)
Diazepam/therapeutic use , Seizures, Febrile/drug therapy , Seizures/drug therapy , Child , Child, Preschool , Diazepam/blood , HumansABSTRACT
Plasma levels of diazepam and N-desmethyldiazepam were investigated in 19 children by a gas chromatographic method permitting the use of capillary sample. Intravenous administration was studied in 3 children and the plasma level curves showed a rapid decline during the first hour. Absorption and elimination after rectal administration of a solution in 16 children were similar to those after intramuscular administration. Diazepam given by suppository to 5 children gave much lower plasma levels and delayed time to peak levels. Recurrence of seizures in 2 children indicated that the anticonvulsants plasma level was of the order of 150 to 200 mug/liter. No significant side effects were observed. Thus rectal administration of a solution of diazepam is a practical method to arrest convulsions in children.
