Neurodevelopmental Outcomes in High Risk Children

The Challenges of Neurodevelopmental Outcomes in

High-Risk Children in Developing Countries

 

Naila Zaman Khan, Professor of Child Neurology and Development at the Bangladesh Institute of Child Health, Dhaka, Bangladesh, began her presentation with a world map  (Figure 2.1) showing that developmental handicaps occur predominately in low income areas of the world. Middle income countries have a lower incidence and the lowest incidence is found in high income countries.

 

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Dr. Khan pointed out that in many South Asian countries there has been a steady and gratifying fall in under-five mortality (
Figure 2.2). However, in those countries, as exemplified by Bangladesh (Figure 2.3), there is a significant prevalence of childhood neurodisability which actually increased from 1998 to 2001

 

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This association between a fall in mortality and a persistence, or increase, in handicapping disorders is not addressed by the Millenium Development Goals, which do not include the goal of reducing disability (
Figure 2.4).

 

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Similarly UNICEF’s End-Decade Multiple Cluster Survey (MICS2) evaluated many issues but child disability was only an optional module in the survey (
Figure 2.5). In six countries that used the optional “10 Question” module, high levels of some disabilities were shown. However, this simple screening technique, validated for cross-cultural use in several countries, requires a second stage of assessment by professionals, which none of the countries applied.(Figure 2.6).

 

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The WHO has classified disability into various categories (Figure 2.7). An adapted version, suitable for application for functional limitations in children, was applied in Bangladesh. The results are shown in Figure 2.8. They reveal that significant disability is prevalent.

 

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It is clear that preterm infants are more likely to experience neurodevelopmental impairments. A Bangladesh study supported this conclusion (Figure 2.9). 60% of the problems were related to cognitive deficits, mostly in the milder categories of severity. Similarly, children recovering from pneumococcal meningitis have a very high incidence of disability (Figure 2.10).

 

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Dr. Khan pointed out the need for a simple, accurate method of determining intellectual delay of children in low income countries. She also pointed out that “Survey without services” is not acceptable and, indeed, is not feasible.

 

The conclusions of her presentation are contained in Figure 2.11.

 

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