Early childhood development strategy for the world's children with disabilities.

Early childhood is foundational for optimal and inclusive lifelong learning, health and well-being. Young children with disabilities face substantial risks of sub-optimal early childhood development (ECD), requiring targeted support to ensure equitable access to lifelong learning opportunities, especially in low- and middle-income countries. Although the Sustainable Development Goals, 2015-2030 (SDGs) emphasise inclusive education for children under 5 years with disabilities, there is no global strategy for achieving this goal since the launch of the SDGs. This paper explores a global ECD framework for children with disabilities based on a review of national ECD programmes from different world regions and relevant global ECD reports published since 2015. Available evidence suggests that any ECD strategy for young children with disabilities should consists of a twin-track approach, strong legislative support, guidelines for early intervention, family involvement, designated coordinating agencies, performance indicators, workforce recruitment and training, as well as explicit funding mechanisms and monitoring systems. This approach reinforces parental rights and liberty to choose appropriate support pathway for their children. We conclude that without a global disability-focussed ECD strategy that incorporates these key features under a dedicated global leadership, the SDGs vision and commitment for the world's children with disabilities are unlikely to be realised.

Cerebral palsy and developmental intellectual disability in children younger than 5 years: Findings from the GBD-WHO Rehabilitation Database 2019.

Objective: Children with developmental disabilities are associated with a high risk of poor school enrollment and educational attainment without timely and appropriate support. Epidemiological data on cerebral palsy and associated comorbidities required for policy intervention in global health are lacking. This paper set out to report the best available evidence on the global and regional prevalence of cerebral palsy (CP) and developmental intellectual disability and the associated "years lived with disability" (YLDs) among children under 5 years of age in 2019. Methods: We analyzed the collaborative 2019 Rehabilitation Database of the Global Burden of Disease (GBD) Study and World Health Organization for neurological and mental disorders available for 204 countries and territories. Point prevalence and YLDs with 95% uncertainty intervals (UI) are presented. Results: Globally, 8.1 million (7.1-9.2) or 1.2% of children under 5 years are estimated to have CP with 16.1 million (11.5-21.0) or 2.4% having intellectual disability. Over 98% resided in low-income and middle-income countries (LMICs). CP and intellectual disability accounted for 6.5% and 4.5% of the aggregate YLDs from all causes of adverse health outcomes respectively. African Region recorded the highest prevalence of CP (1.6%) while South-East Asia Region had the highest prevalence of intellectual disability. The top 10 countries accounted for 57.2% of the global prevalence of CP and 62.0% of the global prevalence of intellectual disability. Conclusion: Based on this Database, CP and intellectual disability are highly prevalent and associated with substantial YLDs among children under 5 years worldwide. Universal early detection and support services are warranted, particularly in LMICs to optimize school readiness for these children toward inclusive education as envisioned by the United Nations' Sustainable Development Goals.

Global Burden of Childhood Epilepsy, Intellectual Disability, and Sensory Impairments.

BACKGROUND: Estimates of children and adolescents with disabilities worldwide are needed to inform global intervention under the disability-inclusive provisions of the Sustainable Development Goals. We sought to update the most widely reported estimate of 93 million children <15 years with disabilities from the Global Burden of Disease Study 2004. METHODS: We analyzed Global Burden of Disease Study 2017 data on the prevalence of childhood epilepsy, intellectual disability, and vision or hearing loss and on years lived with disability (YLD) derived from systematic reviews, health surveys, hospital and claims databases, cohort studies, and disease-specific registries. Point estimates of the prevalence and YLD and the 95% uncertainty intervals (UIs) around the estimates were assessed. RESULTS: Globally, 291.2 million (11.2%) of the 2.6 billion children and adolescents (95% UI: 249.9-335.4 million) were estimated to have 1 of the 4 specified disabilities in 2017. The prevalence of these disabilities increased with age from 6.1% among children aged <1 year to 13.9% among adolescents aged 15 to 19 years. A total of 275.2 million (94.5%) lived in low- and middle-income countries, predominantly in South Asia and sub-Saharan Africa. The top 10 countries accounted for 62.3% of all children and adolescents with disabilities. These disabilities accounted for 28.9 million YLD or 19.9% of the overall 145.3 million (95% UI: 106.9-189.7) YLD from all causes among children and adolescents. CONCLUSIONS: The number of children and adolescents with these 4 disabilities is far higher than the 2004 estimate, increases from infancy to adolescence, and accounts for a substantial proportion of all-cause YLD.

Correction to: Regional prevalence and determinants of exclusive breastfeeding in India.

[This corrects the article DOI: 10.1186/s13006-019-0214-0.].

Regional prevalence and determinants of exclusive breastfeeding in India.

Background: Exclusive breastfeeding (EBF) has important benefits for both the mother and child. In India, no nationwide studies have examined patterns of EBF in the past decade to inform national and subnational breastfeeding programmes. The present study aimed to investigate the regional prevalence and determinants of EBF in India. Methods: This study used a total weighted sample of 21,352 from the 2015-2016 India National Family Health Survey. EBF was measured as the proportion of infants 0-5 months of age who received breast milk as the only source of nourishment, based on mother's recall on feeds given to the infant 24 h before the survey. The prevalence of EBF and other breastfeeding patterns were estimated by region, and multivariable logistic regression that adjusted for clustering and sampling weights was used to investigate the association between the study factors (child, maternal, household, health service and community factors) and EBF by regional areas in India. Results: This study indicated that wide differences in the prevalence of EBF and other childhood feeding practices exist across regions of India, where Southern India had the highest EBF prevalence (79.2%) and the North-East reported the lowest (68.0%). EBF prevalence decreased with infant age, dropping faster in the South (43.7% at 5 months) compared to the North-East region (54.0% at 5 months). Similarly, substantial variations in key determinants of EBF were evident by region, where higher birth order was the only common factor associated with non-EBF across all regions. Key modifiable determinants of non-EBF included higher maternal education in the South and belonging to rich households in Central India, while those for EBF were higher maternal education in the Central region and frequent antenatal care (≥ 4) visits in Northern India. Conclusion: This study demonstrates wide variations in regional prevalence and determinants of EBF in India. Improving EBF participation in India would require multifaceted national and subnational efforts that include dedicated funds and the establishment of appropriate policy and interventions that are consistently monitored and evaluated.

Diarrhoea deaths and disability-adjusted life years attributable to suboptimal breastfeeding practices in Nigeria: findings from the global burden of disease study 2016.

Background: In Nigeria, diarrhoea contributes significantly to childhood morbidity and mortality, with suboptimal breastfeeding practices playing a key role. The present study aimed to report on diarrhoea deaths and disability-adjusted life years (DALYs) among children aged under five years attributable to suboptimal breastfeeding practices in Nigeria. Methods: This study used data from the Global Burden of Disease study 2016, which estimated mortality from diarrhoea in the Cause of Death Ensemble model. Suboptimal breastfeeding was assessed as a combination of non-exclusive breastfeeding and discontinued breastfeeding. The comparative risk assessment approach was used to estimate the attributable burden of diarrhoea deaths and DALYs due to suboptimal breastfeeding practices in the spatial-temporal Gaussian Process Regression tool. Results: In 2016, suboptimal breastfeeding practices accounted for an estimated 56.5% (95% uncertainty intervals [UI]: 47.5, 68.3) of diarrhoea deaths in the late neonatal period, 39.0% (31.0, 46.3) in post-neonatal period, 39.0% (31.3, 46.20) in infancy period and 22.8% (16.9, 29.9) in children aged under five years in Nigeria. In the same year, 22,371 (14,259, 32,746) total diarrhoea deaths in children under five years could be attributed to suboptimal breastfeeding practices. DALYs from diarrhoea attributable to suboptimal breastfeeding practices was 1.9 million (1.2, 2.8 million) among children under five years in 2016. Between 1990 and 2016, the proportion of children who died from diarrhoea due to suboptimal breastfeeding did not change substantially across all age groups in Nigeria. Conclusions: Suboptimal breastfeeding practices remain a significant contributor to diarrhoea mortality and disability among children under five years in Nigeria. The study builds on previously published works on breastfeeding practices in Nigeria and provides evidence to support calls for the scale-up of efforts to improve infant feeding outcomes and reduce diarrhoea burden in Nigeria.

Tuberculosis disease burden and attributable risk factors in Nigeria, 1990-2016.

BACKGROUND: According to the World Health Organization, Nigeria is one of the countries with a high burden of tuberculosis (TB) worldwide. Improving the burden of TB among HIV-negative people would require comprehensive and up-to-date data to inform targeted policy actions in Nigeria. The study aimed to describe the incidence, prevalence, mortality, disability-adjusted life years (DALYs) and risk factors of tuberculosis in Nigeria between 1990 and 2016. METHODS: This study used the most recent data from the global burden of disease study 2016. TB deaths were estimated using the Cause of Death Ensemble model, while TB incidence, prevalence and DALYs, as well as years of life lost and years of life lived with disability were calculated in the DisMod-MR 2.1, a Bayesian meta-regression tool. Using a comparative risk assessment approach, TB burden attributable to risk factors was estimated in a spatial-temporal Gaussian Process Regression tool. RESULTS: In 2016, the prevalence of TB among HIV-negative people was 27% (95% uncertainty interval [95% UI] 23-31%) in Nigeria. TB incidence rate (new and relapse cases) was 158 per 100,000 people (95% UI; 128-193), while the total number of TB mortality was 39,933 deaths (95% UI; 30,488-55,039) in 2016. Between 2000 and 2016, the age-standardised prevalence and incidence rates of TB-HIV negative decreased by 20.0 and 87.6%, respectively. The age-standardised mortality rate also dropped by 191.6% over the same period. DALYs due to TB among HIV-negative Nigerians was high but varied across the age groups. Of the risk factors studied, alcohol use accounted for the highest number of TB deaths and DALYs, followed by diabetes and smoking in 2016. CONCLUSION: The study shows an improving trend in TB disease burden among HIV-negative individuals in Nigeria from 1990 to 2016. Despite this progress, this study suggests that additional efforts are still needed to ensure that Nigeria is not left behind in the current global strategy to end TB disease. Reducing TB disease burden in the country will require a multipronged approach that includes increased funding, health system strengthening and improved TB surveillance, as well as preventive efforts for alcohol use, smoking and diabetes.