Burden of Neurodevelopmental Disorders in Kenyan Children.

This study looked at brain development conditions like autism, ADHD, and intellectual disability in over 11,000 Kenyan children. They found these conditions affect about 9 out of every 100 children, with boys slightly more affected than girls. ADHD was most common, followed by learning difficulties and autism. Risk factors included birth complications, infections with fever, eating dirt, snoring, and poverty.

Many children had more than one condition, and malnutrition was often present alongside these developmental conditions.

This large-scale cross-sectional study examined neurodevelopmental disorders (NDDs) in 11,223 Kenyan children aged 6-9 years using a two-stage screening and diagnostic process. The study found an overall NDD prevalence of 9.1%, with ADHD being most common (5.1%), followed by cognitive impairment (2.7%) and autism spectrum disorder (1.6%). Males showed slightly higher rates than females. Key risk factors included adverse perinatal events, febrile infections, eating soil, snoring, and landlessness.

Common comorbidities were motor neuron dysfunction and malnutrition. Nearly 23% of children had co-occurring NDDs. The findings suggest many risk factors are preventable and highlight the substantial burden of NDDs in sub-Saharan Africa.

Results support implementing NDD screening programs in sub-Saharan Africa and developing preventive strategies targeting perinatal care, infection management, and nutritional support. High co-occurrence rates indicate need for comprehensive assessment protocols. Findings justify increased healthcare resources for NDDs in similar populations.

Cross-sectional design limits causal inference. Risk factors were retrospectively reported, introducing recall bias. Findings may not generalize beyond rural Kenyan populations. Some diagnostic categories may not align with international standards. Attrition between screening stages could affect prevalence estimates.

Neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability contribute to one-tenth of the global burden of mental and neurologic disorders. The burden of NDDs is not well documented in Africa. To assess the prevalence, risk factors, and comorbidities of NDDs in young Kenyan children. This cross-sectional study was conducted among children aged 6 to 9 years residing in the Kilifi Health and Demographic Surveillance System in Kenya.

In stage I of the study, children were screened for NDDs from March 16, 2015, to September 14, 2016; those with a positive screening result and a randomly selected proportion of those with a negative screening result were invited to undergo clinical evaluation to confirm the diagnosis (stage II). Adverse perinatal events, medical and family history, and socioeconomic status. Prevalence of NDDs was estimated, and risk factors and medical comorbidities associated with NDDs were assessed using generalized linear models and link functions. Of the 11 223 children screened in stage I, 5646 (50.3%) were males, and mean (SD) age was 7.6 (0.96) years.

A total of 522 children had an NDD confirmed in stage II, with an overall adjusted prevalence of 9.1% (90.8 [95% CI, 83.4-98.6] cases per 1000 children), which differed by sex (237 of 5577 females [4.2%] vs 285 of 5646 males [5.0%]; P = .045). The NDDs with the highest prevalence were ADHD (50.8 [95% CI, 45.2-57.1] cases per 1000 children) and cognitive impairment (27.1 [95% CI, 22.9-31.9] cases per 1000 children); ASD was also common (15.6 [95% CI, 12.6-19.1] cases per 1000 children). Co-occurrence of NDDs was reported in 118 children (22.6%; 95% CI, 19.2%-26.5%). Key factors associated with occurrence or onset of NDDs included adverse perinatal events (adjusted risk ratio [ARR], 1.64; 95% CI, 1.29-2.09), febrile infections (ARR, 1.28; 95% CI, 1.05-1.56), eating soil (ARR, 1.45; 95% CI, 1.13-1.85), snoring (ARR, 1.50; 95% CI, 1.27-1.76), and being landless (ARR, 1.32; 95% CI, 1.12-1.56).

Head injuries were unique to developmental conditions and febrile infections to neurologic conditions, with many risk factors shared. Common medical comorbidities for NDDs after adjusting for attrition and screening specificity included motor neuron dysfunction (ARR, 2.79; 95% CI, 2.18-3.56) and malnutrition (ARR, 1.80; 95% CI, 1.37-2.39). NDDs were common in school-aged children in this rural area of Kenya, and the findings suggest their occurrence was associated with preventable environmental risk factors. These disorders and associated comorbidities should be identified and addressed in children in Africa.