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Prevalence and correlates of mental retardation among children in Karachi, Pakistan
M S Durkin1, Z M Hasan, K Z Hasan
1Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Insights
Prevalence of mental retardation in Karachi children is high, with lack of maternal education a key risk factor. Other factors include perinatal issues, infections, and malnutrition, requiring further research.
Area of Science:
- Epidemiology
- Child Health
- Global Health
Background:
- Mental retardation prevalence varies globally.
- Understanding local factors is crucial for targeted interventions.
Purpose of the Study:
- Estimate mental retardation prevalence in Karachi children (2-9 years).
- Identify associated risk factors in this population.
Main Methods:
- A two-phase population survey in Greater Karachi (1988-1989).
- Screening using the Ten Questions instrument followed by medical/psychological assessments.
- Cluster sampling of 6,365 children.
Main Results:
- Prevalence: 19.0/1,000 (serious) and 65.3/1,000 (mild) mental retardation.
- Higher than in industrialized and some developing countries.
- Maternal education, perinatal/neonatal/postnatal factors, brain injury, and malnutrition were associated.
Conclusions:
- Karachi shows high mental retardation rates compared to global estimates.
- Maternal education is a significant protective factor.
- Further research on consanguinity and child survival is warranted.
Abstract:
This paper reports estimates of the prevalence of mental retardation and associated factors based on a population survey of 2- to 9-year-old children in Greater Karachi, Pakistan. A two-phase survey was implemented during the years 1988-1989. In the first phase, a cluster sample of 6,365 children (5,748 from urban areas and 617 from rural areas) was screened for disabilities using a parental report known as the Ten Questions instrument. In the second phase, all children with positive screening results and a 10% sample of those with negative results were referred for structured medical and psychological assessments. Estimates of the prevalence of mental retardation were 19.0/1,000 children (95% confidence interval (CI) 13.5-24.4) for serious retardation and 65.3/1,000 children (95% CI 48.9-81.8) for mild retardation. Both estimates were considerably higher than respective prevalence estimates obtained in industrialized countries and in selected less developed countries. In this population, lack of maternal education was strongly associated with the prevalence of both serious (odds ratio = 3.26, 95% CI 1.26-8.43) and mild (odds ratio = 3.08, 95% CI 1.85-5.14) retardation. Other factors that were independently associated with mental retardation in Karachi included histories of perinatal difficulties, neonatal infections, postnatal brain infections, and traumatic brain injury, as well as current malnourishment. Further research is needed to assess the contribution of consanguineous marriage, improvements in child survival, and other factors to the unusually high prevalence of mental retardation in this population.