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Published on: November 20, 2015
Prenatal and perinatal risk factors for disability in a rural Nepali birth cohort
Edward J N Haworth1, Kirti M Tumbahangphe2, Anthony Costello3,4
1Great Ormond Street UCL Institute for Child Health, University College London, London, UK.
Insights
Maternal underweight, early marriage, and infant diarrhea are linked to childhood disability in rural Nepal. These factors, along with low birth weight, increase disability risks for children in low-income settings.
Area of Science:
- Global Health
- Child Development
- Neurodevelopmental Disorders
Background:
- Improving newborn health is a global priority, yet neurodevelopmental outcomes for survivors of pregnancy, labor, and neonatal complications in low-income countries are poorly understood.
- Existing studies are often small, selective, and facility-based, limiting generalizability to community settings.
Purpose of the Study:
- To identify antenatal, birth, and neonatal factors associated with childhood disability in a large rural community birth cohort in Nepal.
- To investigate the neurodevelopmental consequences for survivors of perinatal complications in a low-income country context.
Main Methods:
- A cohort of 6436 infants was recruited; 6075 survived beyond 28 days.
- Disability screening was conducted at a mean age of 11.5 years using the Washington Group/UNICEF Module on Child Functioning and Disability.
- Multivariable regression modeling was used to analyze hypothesized risk factors for disability.
Main Results:
- The prevalence of disability was 7.4% in the screened population.
- Maternal underweight (OR 1.44), maternal cohabitation under 16 years (OR 1.50), low infant weight at 1 month (OR 0.82), and infant diarrhea/vomiting in the first month (OR 2.48) were significantly associated with disability.
- Most other hypothesized risk factors, including prematurity, were not significant, potentially due to survival bias.
Conclusions:
- Factors such as early marriage, low birth weight proxies, and maternal undernutrition are associated with increased odds of childhood disability.
- The lack of association for other known risk factors may be influenced by survival bias in this cohort.
Background:
Improving newborn health remains a global health priority. Little however is known about the neurodevelopmental consequences for survivors of complications in pregnancy, labour and the neonatal period in in low-income countries outside of small selective and typically urban facility studies. We ask which antenatal, birth and neonatal factors are associated with disability in childhood in a large community birth cohort from rural Nepal.
Methods:
6436 infants were recruited during a cluster randomised control trial (RCT) of participatory women's groups (ISRCTN31137309), of whom 6075 survived beyond 28 days. At mean age of 11∙5 years (range 9.5-13.1), 4219 children (27% lost to follow-up) were available for disability screening which was conducted by face-to-face interview using the Module on Child Functioning and Disability produced by the Washington Group/UNICEF. Hypothesised risk factors for disability underwent multivariable regression modelling.
Findings:
Overall prevalence of disability was 7.4%. Maternal underweight (OR 1.44 (95% CI 1.01-2.08)), maternal cohabitation under 16 years of age (OR 1.50 (1.13-2.00)), standardised infant weight at 1 month (OR 0.82 (0.71-0.95)) and reported infant diarrhoea and vomiting in the first month (OR 2.48 (1.58-3.89)) were significantly associated with disability adjusted for trial allocation. The majority of hypothesised risk factors, including prematurity, were not significant.
Interpretation:
Proxies for early marriage and low birth weight and a measure of maternal undernutrition were associated with increased odds of disability. The lack of association of most other recognised risk factors for adverse outcome and disability may be due to survival bias.
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