Socioeconomic and education-based inequality in suspected developmental delays among Nepalese children: a subnational level assessment.

Failure to meet early childhood developmental milestones leads to difficulty in schooling and social functioning. Evidence on the inequality in the burden of developmental delays across population groups, and identification of potential risk factors for suspected developmental delays (SDD) among younger children, are essential for designing appropriate policies and programs. This study explored the level of socioeconomic and maternal education-based inequality in the prevalence of SDD among Nepalese children at subnational level and identified potential risk factors. Individual-level data from the 2019 Nepal Multiple Indicator Cluster Survey was used to estimate the prevalence of SDD among children aged 3-4 years. Regression-based slope index of inequality (SII) and relative index of inequality were used to measure the magnitude of inequality, in terms of household socioeconomic status (SES) and mother's education, in the prevalence of SDD. In addition, a multilevel logistic regression model was used to identify potential risk factors for SDD. The national prevalence of SDD was found to be 34.8%, with relatively higher prevalence among children from rural areas (40.0%) and those from Karnali Province (45.0%) followed by Madhesh province (44.2%), and Sudhurpashchim Province (40.1%). The prevalence of SDD was 32 percentage points higher (SII: -0.32) among children from the poorest households compared to their rich counterparts at the national level. At the subnational level, such inequality was found to be highest in Lumbini Province (SII = -0.47) followed by Karnali Province (SII = -0.37), and Bagmati Province (SII = -0.37). The prevalence of SDD was 36 percentage points higher (SII: -0.36) among children whose mother had no formal education compared to children of higher educated mothers. The magnitude of education-based absolute inequality in SDD was highest in Lumbini Province (SII = -0.44). Multilevel logistic regression model identified lower levels of mother's education, disadvantaged SES and childhood stunting as significant risk factors for SDD. One in each three children in Nepal may experience SDD, with relatively higher prevalence among children from rural areas. Subnational level variation in prevalence, and socioeconomic and education-based inequality in SDD highlight the urgent need for province-specific tailored interventions to promote early childhood development in Nepal.

Home environment and prenatal exposure to lead, arsenic and zinc on the neurodevelopment of six-month-old infants living in Chitwan Valley, Nepal.

BACKGROUND: We have previously reported the inverse associations between in utero levels of lead (Pb), arsenic (As) (i.e., toxic elements), and neurodevelopmental indicators (i.e., motor and state regulation cluster score) measured by the Brazelton Neonatal Behavioral Assessment Scale, third edition (NBAS III) in this cohort at birth. Using additional follow-up, this study investigated the effects of cord blood levels of Pb, As, and zinc (Zn) (an essential element) and the postnatal environment on the neurodevelopment of 6-month-old infants in Chitwan Valley, Nepal. METHODS: In total, 100 mother-infant pairs were recruited from Chitwan District, Nepal. Pb, As, and Zn concentrations in cord blood were measured. Postnatal raising environment (i.e., HOME score or home environment hereafter) was evaluated using the Home Observation for Measurement of Environment (HOME) scale. Neurodevelopment of infants at 6 months (n=94) was assessed according to the Bayley Scale of Infant Development, second edition (BSID II). Multivariable regression adjusting for covariates was performed to determine the associations of in utero levels of toxic and essential elements and the home environment with neurodevelopment scores. RESULTS: Cord blood levels of Pb, As, and Zn were not associated with any BSID II cluster scores in 6-month-old infants. The total HOME score was positively associated with the Psychomotor Development Index (PDI) score (coefficient=0.59, 95% confidence interval [CI]=0.04 to 1.13). CONCLUSION: In this cohort, detrimental effects of in utero Pb and As on neurodevelopmental indicators observed at birth did not persist at 6 months of age, while it showed an association between the neurodevelopment and home environment.

Diet among people in the Terai region of Nepal, an area of micronutrient deficiency.

In the Terai region, despite its ecological richness, the people have long suffered from a deficiency of micronutrients such as vitamin A, iron and zinc. The aim of this study was to investigate dietary and nutritional intakes among people in the Terai region of Nepal. The results were compared by sex and ethnicity. Food consumption surveys (one-day weighed records) were conducted among 114 people (55 Mushar and 59 Tharu). Nutritional intakes were calculated using Nepali food composition and other tables. The diet in the Terai region was characterized by a large amount of rice consumed with a tiny amount of curry or dal as a side dish. Intakes of vitamin A, iron, riboflavin and selenium were less than 50% of the recommended daily allowance irrespective of ethnicity or sex (with the exception of iron intake among Tharu males). Intakes of thiamine, riboflavin, niacin, phosphorus and zinc were higher among the Tharu than the Mushar, while intakes of selenium and iodine were higher among the Mushar than the Tharu. The nutritional significance of these differences was slight. Protein intake (per kg body weight) was lower in females than in males, while the energy-adjusted micronutrient intakes did not differ by sex. Intakes of vitamin A, iron, riboflavin and selenium were deficient among the participants. Intervention projects such as the introduction of kitchen gardens or fish farming may be effective, but will increase the degree of inequality between the two ethnic groups.