Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BACKGROUND: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions.

Factors determining noncompliance to mass drug administration for lymphatic filariasis elimination.

Mass Drug Administration (MDA) for Lymphatic Filariasis (LF) elimination has been implemented worldwide and in India with a goal of eliminating the disease by 2020 and 2015 respectively. Compliance to MDA is less than adequate to achieve the goal in the desired time. This study aims to identify the factors related to awareness, acceptability and attitude and the role of certain theoretical constructs of health belief model in determining the compliant behavior to MDA. Within a cross-sectional study done in Thiruvananthapuram district of Kerala, India, undertaken to determine coverage, a comparison was done between compliant and noncompliant individuals. 300 households were selected using cluster sampling technique, for estimation of coverage of MDA. From these households, 99 noncompliant and 70 compliant individuals were selected as cases and controls. The independent factors determining noncompliance were client attitude of not perceiving the need with an adjusted odds ratio (OR) of 2.52 (1.29-4.92), an unfavorable provider attitude with an adjusted OR of 2.14 (1.05-4.35) and low drug administrator acceptability with an adjusted OR of 2.01 (1.01-3.99). In MDA, the person giving the drug to the beneficiary is the most important person, whose attitude and acceptability determines compliance. More rigorous selection and training for capacity building of drug administrators are essential to enhance the compliance level. Alternate drug delivery strategies, besides house to house campaign by voluntary drug administers also needs to be implemented.

Development and validation of the Domestic Violence Questionnaire in married women aged 18-55 years.

BACKGROUND: Intimate partner violence against women is seen in all cultures. It has wide-ranging effects on the physical and psychological health of women. In the local language, available questionnaires are either too exhaustive or inadequate to assess domestic violence comprehensively. OBJECTIVE: To develop a Domestic Violence Questionnaire in Malayalam and validate it for married women aged 18-55 years in the local population. STUDY DESIGN: Descriptive study - Validation of questionnaire. MATERIALS AND METHODS: A 29-item questionnaire, to identify domestic violence over the past 1 year, was developed in the local language, by selecting items from two other questionnaires and based on expert opinion. Item reduction was done after pilot testing. Then, this 25-item questionnaire was administered to 276 married women aged 18-55 years. Reliability and validity were estimated. Factor analysis was done for item reduction. Poor-loading, wrong-loading and cross-loading items were removed from the questionnaire. Taking the subjective perception of the participants regarding themselves experiencing domestic violence as the gold standard, a Receiver Operator Characteristic curve was drawn to decide the cut-off score with optimum sensitivity and specificity. RESULTS: The final questionnaire had 20 items - 13 items for psychological and 7 items for physical violence. Internal consistency reliability was 0.92. At a cut-off score of 5, sensitivity was 89.5% and specificity 87.2%. CONCLUSIONS: The Domestic Violence Questionnaire in Malayalam has adequate psychometric properties to identify intimate partner violence against women in the local population.

Child disciplining practices in Kerala.

This study was done to examine the type and severity of disciplinary practices adopted by parents in Kerala. 1668 mothers, aged 18-49, participated in face-to-face interviews as part of a cross-sectional, population-based survey covering rural, urban and coastal areas. One child from each family was randomly selected as the index child. The interview focused primarily on disciplinary practices. 62% of the mothers reported using severe verbal discipline and 50% of mothers reported using severe physical abuse. Results suggest a high prevalence of normative and abusive practices in the community with mothers playing a prime role in disciplining the child.

Intestinal helminthic infestations among tribal populations of Kottoor and Achankovil areas in Kerala (India).

The present study was undertaken among 258 subjects belonging to 152 houses of two tribal communities (Kani and Malampandaram) settled in Kottoor and Achankovil areas, respectively of Thiruvananthapuram and Kollam districts in Kerala, South India. The survey covered people of all age groups and both the sexes from the study population. Out of the total 258 stool samples examined, 60 showed ova of one or more intestinal helminthes, showing the overall prevalence of 23.3% with a confidence interval of 18.5-28.45. Among the tribal populations of two areas studied, Achankovil area showed an increased overall prevalence rate (26.15%) as compared to Kottoor area (22.27%). The difference in prevalence rates of the two areas is found to be statistically significant (p-value 0.01). Hookworm infestation was found to be predominant (58.82%) in Achankovil and the remaining (41.1%) was due to only roundworm. Whereas in Kottoor area, roundworm infestation predominated (74.41%) followed by hookworm (18.6%) and other types (6.97%). Analysis of haemoglobin (Hb) level of the 190 study population showed that 66.32% were anaemic (<11 gm/dl) from both the areas. The proportions of subjects either moderately anaemic (7 gm/dl-11 gm/dl) or severely anaemic (<7 gm/dl) were almost same in the two study groups, showing a similar pattern in both the areas with no statistically significant difference. Haemoglobin level in relation to helminthic infestation revealed that in the worm infested group, 81.1% (43/53) was anaemic, as compared to only 60% (83/137) of non-worm infested group, showing significant difference (p value=0.01). Hb level in relation to helminthic infestation also seemed to differ in both the areas. Among the environmental factors studied in relation to helminthic infestation, the practice of hand wash alone was found out to be statistically significant, showing that habit of proper hand wash considerably reduces the risk of helminthic infestation.