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

BackgroundNeurodevelopmental 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 findingsWe assessed 3,964 children (with almost equal number of boys and girls distributed in 2–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–ConclusionsThe 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.背景 神经发育障碍（Neurodevelopmental disorders, NDDs）会损害个体、家庭、社区乃至国家层面的发育进程，阻碍其充分发挥社会与经济潜能。尽管此类疾病负担普遍较高，但针对NDDs的相关数据匮乏，导致多数发展中国家的政策制定与项目推进行动受阻。 方法与结果 本研究共纳入3964名儿童，男女比例近乎均等，受试群体按区域分为5组：整体年龄组（2~9岁，N=998，全部为农村人口，16.4%为非印度教徒，25.3%来自在册种姓与在册部落（scheduled caste/tribe, SC-ST），该群体属于需获得扶持的服务不足社区，符合平权行动资格）；北部区域（坎格拉Kangra，N=997，91.6%为农村人口，3.7%为非印度教徒，25.3%为SC-ST群体）；东部区域（德亨卡纳尔Dhenkanal，N=981，89.8%为农村人口，1.2%为非印度教徒，38.0%为SC-ST群体）；南部区域（海得拉巴Hyderabad，N=495，全部为城市人口，25.7%为非印度教徒，27.3%为SC-ST群体）；西部区域（北果阿North Goa，N=493，68.0%为农村人口，11.4%为非印度教徒，18.5%为SC-ST群体）。所有受试儿童均接受了以下病症的评估：视力障碍（vision impairment, VI）、癫痫（epilepsy, Epi）、包括脑瘫在内的神经运动障碍（neuromotor impairments including cerebral palsy, NMI-CP）、听力障碍（hearing impairment, HI）、言语语言障碍、孤独症谱系障碍（autism spectrum disorders, ASDs）以及智力障碍（intellectual disability, ID）。此外，针对6~9岁儿童，本研究还额外评估了注意缺陷多动障碍（attention deficit hyperactivity disorder, ADHD）与学习障碍（learning disorders, LDs）。本研究依据印度2011年人口普查（Census of India 2011）对样本特征进行标准化处理，以得出区域级及所有研究站点合并后的患病率估算值。各站点2~9岁儿童任意一类7种NDDs的患病率[原文此处存在排版截断]。 结论 本研究证实，2~9岁儿童所患的NDDs已成为印度一项严峻的公共卫生负担。听力障碍的患病率高于全球已发表文献数据，而孤独症谱系障碍的患病率则与全球报道水平相当。多数神经发育障碍的危险因素均为可通过公共卫生干预措施进行干预的因素。